mURPHY rULES! (and how to try to stymie him)

Among the blogs I visit more or less regularly, is “Notes From The Bunker”, featuring the adventures of the thoughtful and experienced Commander Zero. Today (As I write this it is 5 Sept 2019), The Commander reviews thoughts on idiot proofing your kit, particularly your first aid kit. (see for yourself: http://www.commanderzero.com/?p=6547#comments , “Mylar After Two Years Of Exposure”) He makes a mighty compelling case for, in effect, double bagging your first aid supplies, and he has, indeed, harshly tested his packaging. He has not found it wanting.

Aesop of Raconteur Report (ANOTHER regular read! Find him here: https://raconteurreport.blogspot.com/ ) commented on the original post, (found here, from March 15 2015: http://www.commanderzero.com/?p=2511), and, as usual, his comments are insightful, practical, and reflect studies in Advanced Placement courses at The College of Hard Knocks. I reprint them here, because I don’t want you all to miss them.

“1) Any FA kit that isn’t waterproof is worthless. If not now, then when you need it, which is worse. As you’ve discovered, and as I did the first time I was working on a movie set on a rainy day. It’s a mistake you only make once.
2. Mylar is nice, but you can’t see what’s inside. Consider heavy-duty Saran wrap or equiv. as something still see-through, but easier to tear open than mylar or two-hand zip-loks.
3. If you’re any kind of handy with a sewing machine, turning mil-spec poncho materials into pack and bag condoms is a quick and elegant way to make your favorite bag far more water resistant. It also gives you options as far as external appearance, whether more camo’ed, or more non-descript than Tactical Timmy camo patterns in urban use around the unprepared muggles. YMMV.
4. Given your penchants anyways, you can get single-use heat seal clear plastic bagging material too, and simply resolve that if you tear something open for use, you’ll re-stock and re-seal it at the first opportunity.
5. As far as opening, putting a guard-protected single-edge razor or retractable box cutter in the top of the kit is never a bad idea. For some of the sterile wrap crap used in the ED, I need bandage scissors, trauma shears, and/or a hemostat (think ER pliers) just to open the goddam packaging, and that’s indoors in air-conditioned comfort, with two hands.

(THIS PART THAT FOLLOWS IS GOLD, RIGHT HERE!)

6. As a general rule, whether for first aid or any other kind of kit, anything that couldn’t be reliably used during a year’s service in the WWI trenches of the Somme probably isn’t proper kit to rely on, and you’ll find that out at the worst possible moment. Field-test your gear and eliminate the flaws now, when mistakes are free.

7. Just random curiosity, but for a bike kit, why not something along the lines of a screw-top or screw-twist together PVC pipe or somesuch thing, clamped/strapped/zip-tied/etc. to the frame? Bombproof, compact, and totally watertight, and you could size the tube diameter to the largest items, and adjust the length so everything fits. Just thinking out loud there.”

With that preamble, may I direct your attention to my own humble work, from mid June of this year? (https://musingsofastretcherape.wordpress.com/2019/06/14/do-it-yourself-emergency-care/ )

With Commander Zero’s (herinafter referred to as “CZ”) insights, and Aesop’s commentary, I have been stimulated to consider shortcomings in my own arrangements.

I have never had my own kit(s) fail as in Czs experience. Mine are presently indoors or in my vehicle trunk. Previously, for years, my kit rode in the back seat of my dual cab pickup truck. When we loaded up, kids, luggage and all, it went into a tote in the back of the truck, inside a camper shell. That has/had worked out alright for me. On the other hand, I have never done a rainy weekend FTX, either. THAT sort of adventure might have elicited Aesop’s perspective.

Since one of the objectives of much of my hobbies/avocations/off duty activities is preparing for unwanted possibilities, the next generation of my deliberations will be considering how I can benefit from the above insights, and integrate them into my own preps.

For example, if I am compelled to hike my happy ass home from work, due to EMP/Carrington Event/One Minute After/civil disorder/Zombie Apocalypse, what is the likelihood that it will be sunny and seventy outside, versus raining cats and dogs at night in a gale? (Select option “B”, if you please!) Or perhaps mid January, with ass deep snow and wind, at a daytime high temp of 1 degree (for our European readers, that approximates minus 17 degrees C)?

The “I don’t want to freeze my butt solid, to the ground” aspects are likely intuitive, to anybody who has lived in The Midwest for any length of time, but protecting your equipment from those conditions may not be so obvious. (To be honest, this particular aspect had not made it’s way to the front of my own consciousness, until today!)

Broadening this thinking to other aspects of, say, a “Get Me Home” bag, suggests that packing said bag in sub-modules might be clever, if said sub modules are water proof (or, at least, repellent). Again, as of present experience, I’ve had no issues with water etcetera damaging my medic bag, or anything in my “possibles trunk”. That’s fine, until my 13 year old vehicle develops a hole allowing water or whatnot into my trunk.

Or, until I have to hop home in the Oobleck Storm. (or whatever). In those settings, I will regret not acting on CZ’s or Aesop’s insights.

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“School Daze, School Daze, Dear Auld Golden Rule Daze!”

My parents had moved from one of the suburbs of Da City, to Some Unnamed Eastern state. Once there, they met the neighbors. One of whom was married to a meteorologist on Da TeeWee.

He (the meteorologist) found himself, from time to time, changing jobs, and this generally involved moving to an altogether new city. Of course, once they had moved, the children would have to be registered in the new school system.

I have, previously, suggested that not every functionary associated with our public schools is, shall we say, the best and/or the brightest. Indeed, from time to time I have wondered if some of these folks are alumni of The Short Bus.

Mrs. Meteorologist told a tale that supported this theory.

It seems that, after one move, she was undergoing the interrogation customarily associated with registering one’s children at the public school. The clerk was presenting questions, and my mother’s friend was answering them.

“Name?” asked the clerk.

My mother’s friend responded with “Name (whatever)”

“Address?”

The response, “(Address)!”

“Telephone number?”

“(Telephone number)!”

“Mother’s occupation?”

“Home maker.”

“Father’s occupation?”

“Meteorologist!”

(Clerk, without missing a beat, steadily typing away:)“What hospital is he on staff at?”

“(Huh?)”

Why?

http://counterjockey.blogspot.com/2019/09/weapons-wednesday-service-smiths.html#comment-form

Why do MEN (and, nowadays, more and frequently, WOMEN) willingly go in harm’s way?

Why do folks bunker up, suit up, gun up, whatever, and run toward the sounds of trouble?

Counter Jockey has gunned up, and sought out the source of those sounds. As have thousands and thousands of others.

Yesterday was The Eleventh of September in the Year of Our lord 2019. Eighteen years ago,  343 members of the FDNY died, doing their duty. 60 police officers lost their lives. 8 EMS personnel died, not employees of the City of New York.

They died attempting to save some of the 2977 people who would wind up dying that day.

“Duty” is the simple answer, and we all are, or ought to be, thankful for our neighbors who see their duty, accept their duty, and pursue their duty.

But what makes someone see such a thing as “My duty”?

What makes someone say, “So help me God.” ? Those who have so sworn, know. Someone has to stare down predators, and say, in effect, “You stop, right here, right now.” Someone has to stand, and hold that line. Otherwise, the dependents behind those stalwarts will lie vulnerable to the heartless. And, those who have selected Duty, will not allow that.

343 members of the FDNY died, that beautiful autumn day, doing their duty. What sort of folks run into a burning building, a building which had already been sized up be one of their own with the prediction, “Some of us are gonna die, today”?

Read the “Never Yet Melted” blog, about Rick Rescorla. Brit born, naturalized US citizen, Director of Security at Dean Witter/Morgan Stanley (https://neveryetmelted.com/2019/09/11/colonel-cyril-richard-rick-rescorla-may-27-1939-september-11-2001-3/) He is credited with saving 2794 of the 3000 employees working that day. He, his deputy, and three other of his security staff were among the exceptions.

So, here’s what I leave you all with. Look for your duty. Do your duty. try not to flinch, try not to step back. Because, you, and I, all of us, are standing in the shadows of Great People. Imagine, if you will, that they are cheering us on, looking over our shoulders, and expecting that we will not falter. Because, they have left us a legacy of honor, of Duty, of doing their jobs, that make it possible for all of us to be here, today, to have the opportunities that we enjoy. Let us not let them down.

Regarding that day an entire generation ago, let us tell of the Heroes who raced into a building, knowing it was to collapse. Let us tell our children of the Heroes, civilians all, who sacrificed their own lives, that others would not die at the hands of the heartless. Let us tell each other of the Heroes who dwell among us, unknown to us, perhaps unknown to themselves, who will rise up to the demands they face, and risk all to save another. Let us measure ourselves against them, and be grateful they dwell among us. Let us hope we can measure up, should our time come. God Bless those who stand in harm’s way, on our behalf.

If You Are Taking Medical Advice From The Voices In Your Head, You Are Doing It Wrong!

So, TINS©, TIWFDASL©, when we caught a run for a “sick person”. My tales of adventure notwithstanding, the overwhelming majority of EMS runs in Da City were what the personnel called “sickies”. This tale is about one such soul.

We arrived, and things progressed in the usual fashion. Six questions, one command.

1. “Who’s sick?” (show of hands).
2. “What kind of sick are you?” (the response generally ran along the lines of “I’m really sick”, or “I’m just sick, that’s all!”) (so much for “History of Present Illness”)
3. “How long have you been sick, Sir/Madam?” (typical response was some variation of “A good little while.”)
4. “Do you want to go to the hospital?” (A surprising number of people did NOT want to go to the hospital. Some wanted to be told that they were alright, others wanted to go to some place in West Bumfuck, way, way, way outside of Da City’s service area, or wanted a ride to the doctor’s appointment that they, surprisingly, had made. We did not take folks to their doctor appointments or to BFE Community Hospital. Fire department rules.)
5. “Can you walk?” (the correct answer is always, “YES!”. Occasionally “No”, but the number of trivially ill/injured folks traveling to ER via EMS was both surprising and disappointing.)
6. “Where are your shoes?” (Again, a surprising number of folks who presumably had lived in Da City all their lives, and had noted snowfall and freezing ass temperatures arrive each and every winter, did not think to have their shoes staged, oh, I don’t know, NEAR THE DAMNED DOOR, once they had determined that they required ambulance transport to the hospital emergency department for their sniffles or whatnot.)
7. (Command) Follow Me!”

So, one such soul, seated in the back of the ambulance with me late one night/early one morning, was being interviewed by me. I asked him his allergies. “No, none, not really.”

I asked him his medications. “Well, no, none, I guess.”

That did not sound right. I asked, again, differently. “Does you doctor think that you are taking any medication regularly?”

“I suppose so.”

“What might that medication be, that you suppose that your doctor thinks you ought to be taking?”

“Oh, some nerve pill.”

“Oh? ‘Some nerve pill?’ Why aren’t you taking your nerve pill?”

“Well, the voices in my head told me I didn’t need them any longer!”

“The voices told you that, did they?”

“Oh, yes! They were very clear about that!”

“I bet that they were!”

“The Price is Right!”

Once I had departed the employ of Da City, I worked as a RN in one of the little ERs dotting Da City. At that point in time, there were perhaps 18, maybe 20 hospitals big or small serving Da City. I worked at one of the middling sized ones, at that time around 300 beds.

Working midnights in ER, well, you commonly find yourself spending time with folks who make poor life choices. Those of you who have worked nights, or do presently, bear with me. Alcohol is a commonly abused drug. Shocker, right? Moreover, those who use alcohol to excess, commonly also do other, similarly, stupid shit. Said stupid shit, typified by the admonition, “Hold my beer, and watch this!”, places the stupid shit performer at significantly higher risk of ER visitation eliciting injury.

In retrospect, that all makes sense. Well, those of our neighbors who fail to contemplate consequences, readily foreseeable consequences at that, PROSPECTIVELY, well, those folks are why my children slept indoors, ate every day, and got suitable shoes regularly. Thanks for the business, my friend!

Later in the night/early in the morning, the flow of sick/injured tends to slack off. When all the stuff that needed doing, had been done, we got to thinking. From those deliberations arose the night shift game of The Ethanol Is Right!

The goal is to appraise a given patient, without any lab work reported as of the time of the prediction, and then write down your vote for the patient’s blood alcohol level. The vote closest to the lab reported value, but not over, “won”.

MAST Trousers

A long, long time ago, in a galaxy not so far away….no, wait. That is not quite right.

So, TINS©, TIWFDASL©, with my partner Doug, and we caught a run for a stabbing. This was a bit out of the ordinary, inasmuch as the preferred mode of interpersonal interaction (based exclusively upon my skewed sample of EMS patients in Da City) was labeled as “a GSW”, or less cryptically, “a shooting”.

In any event, we arrived to find a gentleman who was talking, kinda sweaty, but able to tell us the chain of events that led to our meeting, along with niceties such as his allergies, medications, and previous medical history. Oh, yes: with a solitary stab wound in his chest, just left of center, and around 4-6 cm removed from his sternal margin. (Yep, that means just what you suspect that it means).

We packed him up, after Doug, thinking ahead, had laid out the MAST trousers on the cot.

So, back in the mists of time, shortly after the demise of the horse drawn ambulance (I kid! I kid!), there was this tool, based upon the fighter pilot’s “G Suit”, called the Medical Ant Shock Trousers, or MAST Trousers (Yep, that does, indeed, stand for “Medical Anti Shock Trousers Trousers”. Go figure.) The principle was thought to be that, when you inflated bladders in the legs, and overlying the lower abdomen, you would increase venous resistance, and thereby minimize the amount of blood remaining in the lower extremities, and thereby increase venous blood return to the heart. Since that would increase pre load, and preload is one component of cardiac output, the thinking was that, if we could increase preload, we could increase cardiac output, and that would increase blood pressure. Generally, within certain limits, increased blood pressure in a trauma/shocky patient is held to be A Good Thing.

We were coding merrily along to TTBTCIDC (For those of you keeping score at home, that would be “The Third Best Trauma Center In Da City”). Mr Stabee and I were having a lovely conversation, after a fashion, until he got really quiet. Concerned, I checked his pulse and breathing, finding a considerably weaker, and faster, pulse than previously, along with diminished rate of respirations.

I hollered to Doug that our new friend was circling the drain, and both more alacrity on his part, as well as a heads up to the receiving facility might be really appreciated.

I wrapped him (the patient, not Doug) up in the MAST trousers, and inflated the bladders. Now, we had a protocol of inflating the bladders to pressure “X”, re- assessing the patient, and then either holding there, or adding more pressure. In the spirit of Spinal Tap’s Derek Smalls, I bypassed the intermediate steps, and inflated the bladders, metaphorically, to 11.

To my surprise, out stabbee awakened, and began to converse, asking “What happened?”I obtained a new set of vitals, and wrote them down, as we stopped at TTBTCIDC.

We trotted our friend to the trauma room, and, as I wheeled the cot out of the room, I heard the physician order, “Take those things off of him, now!”

I started to offer our valves and suchlike, in order to wean the pressure off of the bladders, rather than precipitously deflating them, but the sound of ripping velcro was my reply.

Shortly afterward, the code was called, and everybody who had not crowded into the room, now entered.

Before we were done cleaning up the truck and restocking our medic bag, the code had been called. Unsuccessfully.

Things you learn in your early jobs….

Before I was a medic, full of derring do and beating back the scourge of death and disease, I was an orderly at Da City General Hospital. There, I shuffled bedpans, obtained vital signs and generally attempted to do all the routine stuff that did not require the skills nor education of a nurse. I learned a lot, particularly among those things that I learned, was that I did NOT desire to become a floor nurse on a med surg floor.

One day, I was gathering the vitals on our guests, working my way through the wards. One particular gentleman had recovered, sort of, from a stratospherically elevated fever. In most regards, he was on track to recuperation, although the fever had done malign things to his brain. He appeared to have a rudimentary understanding of his surroundings, and did not engage in conversation. We were feeding him each of his meals, although he had (re)mastered chewing and swallowing.

So, bright and early, before my coffee had had the opportunity to effect therapeutic caffeine levels (in my bloodstream, that is), I was bent over at his bedside, both siderails up and secured. For some reason, I was having difficulty establishing his BP, and went through several retries.

On one of them, I had failed to note that he had scooted himself over to the rail, rolled onto his right side, and introduced his penis through the slats of the siderail. That, of course, placed me downrange of the volley of urine he was about to produce.

It is never good to be downrange when that range is hot. I received quite the baptism, and reacted smoothly, suavely, and effectively: I cursed, and attempted to leap, from a standing start, over the bed. Didn’t work, but the other patients in the ward certainly found it amusing.

Later on, on a night shift, I was working on the orthopedic floor, and the nurse requested that I provide a suppository of one sort of medication or another, to one of our male patients. Sure, no prob. She bade me pause, before I left the nurse’s station to administer this to the patient, and asked me, “So, Mr. McFee, how are you going to do this?”

I recited, “I’ll inform the patient that this is the suppository of (whatever it was) that your doctor ordered, and the nurse handed to me, so if you would be so kind as lay on your left side, I will lubricate it, and, with my gloved finger, insert it into your rectum.”

She paused. “You missed a step.”

Huh? “Uh, what step would that be, ma’am?”

“You did not include removing the suppository from it’s foil wrapping.”

Huh? “Uh, OK, ma’am, I’ll be sure to remove the foil from the suppository, before I administer it.”