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Known To Each Other

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Known To Each Other

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

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

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

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

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

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

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

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

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

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

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

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

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

An arrest has been made.

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

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

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

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

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

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

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

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

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

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

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

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

A Clear Reading Of The Law

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A Clear Reading Of The Law

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

EMS Is A Dumpster Fire

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EMS Is A Dumpster Fire

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

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

Hospitals and providers were overwhelmed with unprecedented new procedures.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Commotio Cordis

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Commotio Cordis

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

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

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

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

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

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

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

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

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

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

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

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

But I digress.

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

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

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

There I said it twice.

Here is a good definition of Commotio Cordis,

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

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

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

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

Again from the previously linked article,

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

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

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

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

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

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

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

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

Which was the point of this entire post.

 

A Decade

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A Decade

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

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

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

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

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

But I digress.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’m a lucky man.

Day of Infamy

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Day of Infamy

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

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

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

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

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

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

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

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

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

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

 

Absent Comrades

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

One of the less enjoyable aspects of getting older is losing friends and acquaintances along the way. It’s one thing to lose a friend who is several years older than I am, but it’s not a pleasant thing.

It’s more disheartening to lose a friend my age or younger. I mourn each passing while at the same time feeling blessed to still be around to see my kids do well and my grandkids aggravate their parents.

Yesterday I received word that a younger acquaintance died suddenly from a Pulmonary Embolism. He was what I would characterize as a friendly acquaintance that I’d see here and there at various conferences. He was however a close friend of a close friend

It seems that every year at about this time another person leaves us and heads for that undiscovered country from which no traveler ever returns.

That’s the nature of life, I guess.

So, to all my friends who have departed, thank you for your friendship, conversations, and assistance on a wide variety of issues over the years.

It’s good to have friends, but it’s always with the knowledge that everything ends sooner or later. Except the memories of times good and bad shared with those who are close.

 

An Interesting Thought

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An Interesting Thought

I had a chance conversation with an EMS official from another state.

Like everywhere else, EMS in his state is having a hard time recruiting and retaining EMS providers. Some areas offer grants to people who want to take EMT or paramedic training, but can’t afford it on their own. They will receive grants to attend school with the proviso that they work in EMS for a period of time after they are certified. The program has had some success, however often people will leave the field after they have fulfilled their obligation.

A lot of people leave the field to go into law enforcement or go to work at a fire department that doesn’t provide transport just first response service. Others leave public safety altogether and thus the field loses an experienced provider.

There are a number of reasons for this including schedules, pay, benefits, and burn out from dealing with ill, injured, and dying patients on a constant basis. Some don’t want to go through the recertification process which requires refresher courses and continuing education classes on top of that course. The process is time consuming and most providers have to pay for classes. Even agencies such as my former service, which provide paid training have the same issue. A lot of the retraining is tedious and repetitive. It’s the nature of the business, but that doesn’t make any difference.

Personally, I think the time of working 24 or longer hour shifts has passed, but there are those who like the extra time off that those schedules provide. Still, it’s a grind to work nights, weekends, and holidays. Plus some services have mandatory overtime and of course the nature of the world is that providers are mandated when they have something planned for their day off.

The person I was talking with said that he thinks it’s possible that EMS is not suited to a long term career. It’s likely, he said, that after five to seven years it’s reasonable for people to leave the field.

This is not the first time that I have heard this. Back in the 1980s we had an administrator that was hired to reorganize my service. He had a lot of in hospital experience as an administrator, but had never worked in an EMS system.

I got to know him pretty well and we had some interesting conversations. One day we were talking about the lack of a career ladder in EMS. There are only so many supervisory and management positions in even larger systems. Unlike the fire and police services, there are not a lot of none care provider jobs in EMS.

The truth is that for most people the career ladder in EMS is more of a career step stool.

Many of the people I worked with had college degrees and eventually went on to other fields. I worked with EMTs and paramedics that went on to be lawyers, doctors, nurses, police officers, fire fighters, and just about every other field that you can think of.

The administrator said that likely was the normal course of an EMS “career” and advised me to start thinking about moving on to some other field. I already had bachelors and masters degrees, but wasn’t interested in moving on to something else. As a result, that was the best advice I ever got that I didn’t follow. In retrospect, it was likely a mistake.

Several years later I went to paramedic school and became certified. I was talking to a friend one day and he suggested that I should think about medical school. I knew myself well enough to know that the 12 year grind of a pre med degree, medical school, and residency was something for which I was not suited. Even if I could afford the decade plus of having essentially no income, I’d be well into my 40s by the time I was able to practice at the attending level.

My friend had the right idea, but in retrospect it was for the wrong profession. What I should have done was go to nursing school. There are a LOT of opportunities in nursing, many of which don’t require clinical experience. Yes, one has to pay their dues working in a clinical setting, but after a relatively few years research, management, and administrative opportunities arise.

Alas, I was too young and foolish to understand all of that and continued on my career path. Although it may sound so, I don’t regret that because I was in one of the best places to be a career EMS provider. Still, I certainly would have had a different, maybe even better path if I had been wise enough to pursue a nursing degree.

In retrospect, both the state official I spoke with this week and that long ago administer were right. For most people there just isn’t a path to a long term career in EMS.

My son always says that starting with the first day on a new job, one should be looking forward to their next job and planning to get there. He’s a smart kid.

My advice to anyone entering the field of EMS is to think of it as an intermediate step on a career path to something better. EMS gives one a great deal of education and experience which can be applied to other fields. EMS requires multi tasking, analyzing a problem, and developing and implementing a plan to fix a problem. That’s a valuable skill in any field.

It’s certainly something to think about and you body will thank you for it years later.

Gone To Texas

EMS Artifact
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Gone To Texas

I’m in central Texas for the next week or so.

I’m at a conference, meeting with a staff from a new client agency, having Thanksgiving with our lovely daughter, and meeting her new beau. Also doing some scouting for potential relocation sites as we’re thinking of leaving the frigid northeast and moving south.

Texas is high on the list as well a couple of other southern states. Not Florida, since neither of us are all that impressed. I at least like the new political atmosphere in the state, but a lot of friends and relatives have moved down there. It’s hard to explain by Mrs. EMS Artifact and I don’t want to move 1,000 plus miles to live near the same people that we live or lived near now.

If that makes sense.

Anyway, we’re going to drive around a couple of days when I’m not busy with work related activities and see what some cities and towns look like.

Hmm. There’s actually movie titled “Gone To Texas.” Now I’ll have to find it on line somewhere and watch.

That’s it for now, I’ll comment on other stuff as time permits.

Things Fall Apart

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Things Fall Apart

1919 was time of great turmoil in the world. The Great War was ending, the Irish Revolution was beginning, the Communists were in charge in Russia, and anarchy seemed loose in the world.

Williams Butler Yeats released a poem titled “The Second Coming” that summed up the mood of the world. I quote only the first part as it’s most relevant to the topic of today’s post.

Turning and turning in the widening gyre   
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere   
The ceremony of innocence is drowned;
The best lack all conviction, while the worst   
Are full of passionate intensity.
Sure seems familiar, at least to me.
Consider the following stories from around America.

NEW ORLEANS — Attacks on medics, pandemic burnout and competition from the private sector contributed to 40% turnover at New Orleans Emergency Medical Services last year, officials told the City Council Friday.

With more than one-fifth of the jobs vacant, the agency is well below an industry standard for responding to the most urgent 911 calls.

EMS leaders said they’re doing their best to juggle an onslaught of calls, and they expressed optimism about a recent pay increase. Still, they said they’re swimming upstream against industry-wide staffing issues.

“More work is needed, and we anticipate persistent staffing challenges over the next few years,” EMS chief Bill Salmeron said at a council budget hearing.

The full story is at the link, it’s an interesting lead. My former agency has a smaller, but significant problem with retention of both BLS and ALS providers. They are always advertising  an in house EMT program as well as posting openings. Part of that is a foolish, but long standing, residency requirement in a city with some of the highest rents and home prices in the country.

Then there is this,

California sheriff’s office stops all daytime patrols due to ‘catastrophic staffing shortage’

A California county sheriff’s office announced that it will stop its daytime police patrol due to a “catastrophic staffing shortage throughout the agency.”

Tehama County, which is located north of Sacramento and has a population of 65,000, will suspend daytime patrol services starting November 20.

Ending the patrols could prove dangerous considering that Red Bluff, the county’s most populated city, has a violent crime rate higher than 97% of other U.S. cities, according to Neighborhood Scout.

Think about that. A law enforcement agency is stopping uniformed patrol during daylight hours because they can’t staff the agency. Further in the article the Sheriff states that he is having difficulty recruiting and retaining officers.

Imagine that. In an atmosphere of “defund the police” over the past 2 1/2 years people don’t want to be police officers.

Speaking of which,

24 Boston police officers to become city firefighters this year in large uptick

Boston Police Patrolmen’s Association President Larry Calderone said the department is “losing officers to the fire department at an alarming rate because, at the end of the day, it’s a great job.”

“Great wages. Great working conditions. No forced overtime. A great quality of life and, arguably, greater respect,” Calderone said in a statement to the Boston Herald. “The officers leaving will tell you they’re sick and tired of being taken for granted and disrespected by the never-ending criticism associated with the ‘defund the police’ movement.”

This summer, the BPPA complained about at least five officers being forced to work 24 hours straight to manage events.

I can’t think of anything to add to that.

Just when I thought that I had nothing to add, this also from Boston.

‘At a Breaking Point’: Boston EMS Seeing Record Low Staffing Levels

Big and small cities, towns, counties are having trouble hiring public safety personnel. It used to be routine in my state to have 15,000 people sign up for the police and fire civil service exams. Getting one of those jobs was highly competitive and they were  highly sought after. Once hired, unless they were fired, firefighters and police officers rarely left before they were eligible to retire.

Not any longer.

Defund the police comes to Burlington, Vermont

Note that the link goes to what is essentially a blog post about an article in the New York Times. Since the article is behind a paywall, I won’t link to is. As a result any quotes are from the blog post, not the original article. That said, on with the quotes.

Consider if you will the city of Burlington, Vermont population 44,781. Burlington is a beautiful place where Bernie Sanders got his start in politics and where even the ice cream is progressive (Ben and Jerry’s). Until very recently, crime was barely an issue in Burlington. Most years there was not a single incident involving gunfire and the mostly white, very progressive populace invested in a park at the center of the city which they dedicated to people they lost during the pandemic. But lately something has changed. All around the city, people’s bicycles started to disappear. Not just a few but hundreds of them missing from porches and backyards.

Bike theft is not exactly the crime of the century. On the other hand, bicycles are NOT cheap these days. Even entry level “Department Store Bikes” are in the $300.00+ range.

This quote is from the comments at the original New York Times article. It was pulled out and quoted in the blog post above. Read it carefully, because it gives a window on a potential future.

An important factor to understand is how police departments are staffed. Originally at roughly 95 in 2018, that was made up of 50 patrol officers and then 45 supervisors, detectives, domestic violence officers, etc. All most all of the police leaving have come from patrol officers. Now at about 60 total, only 15 are patrol officers, so it’s actually a 70% drop from 50 to 15.
This is fairly typical across the country – when you hear of departments being down such and such, the impact is actually far far greater than immediately apparent.

Lots more reactions like these but this reader just says what the Times only insinuates.

Read this article carefully and the take away is the citizens are effectively resorting to vigilantism to solve the bike theft problem. Sure, they are not physically harming anyone now, but it is clear if the police will not or cannot protect lives and property — in this case property — people will take matters into their own hands. If you think this is better than effective law enforcement, think again.

A question that liberals frequently ask about property crimes is, “Are you willing to kill someone over mere property?”

The alternative question, which seems to be asked more and more is, “Are you willing to die in order to steal someone else’s property?”

Then there is this,

I’ve been warning for a while that the breakdown of law and order won’t go as they hope. Ultimately, the police are there to protect criminals from the populace, not the other way around. Get rid of the police, and armed vigilantism is what you’ll get. And what you’ll deserve.

I’ve been warning for a while that the breakdown of law and order won’t go as they hope. Ultimately, the police are there to protect criminals from the populace, not the other way around. Get rid of the police, and armed vigilantism is what you’ll get. And what you’ll deserve.

Vigilantism started in San Francisco in 1851. Citizens fed up with the inability of the small number of law enforcement officers to control crime due to the explosive growth of the city.

WHEREAS it has become apparent to the citizens of San Francisco, that there is no security for life and property, either under the regulations of society as it at present exists, or under the law as now administered; Therefore the citizens, whose names are hereunto attached, do unit themselves into an association for the maintenance of the peace and good order of society, and the preservation of the lives and property of the citizens of San Francisco, and do bind ourselves, each unto the other, to do and perform every lawful act for the maintenance of law and order, and to sustain the laws when faithfully and properly administered; but we are determined that no thief, burglar, incendiary or assassin, shall escape punishment, either by the quibbles of the law, the insecurity of prisons. the carelessness or corruption of the police, or a laxity of those who pretend to administer justice.

In the end, the Vigilance Committee may well have caused more harm than good, but when people see a breakdown in civil society they will react in what they consider the only possible ways.

Add to that the questionable integrity of the 2020 and 2022 elections in states and cities controlled by the Democrat Party and the mood among a good number of Americans is pessimistic to say the least.

Add in that in some large jurisdictions criminals are released without bail almost as soon as they are arrested and elected prosecutors are refusing to prosecute large swarths of “quality of life” crimes and it will be very possible that citizens will take the law into their own hands.

After all, who is going to stop them? The non existent police forces?

We’re entering a dangerous time in our country and things can easily get out of control.

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