Fun And Games Off Duty · guns · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene · Protect and Serve

Camping with my family

One Labor Day weekend, TDW-Mk I decided we ought to go camping. I was off, the kids were off, and we could all get out for one more weekend before the grind of school and autumn activities sucked us in.

She had reserved a site in the unimproved area of one of the northern state parks, a “rustic’ site. That meant that we got to carry water from one of several faucets serving the campgrounds, as well as go to the bathroom in one of several pit toilets.

The wimmin folk were not favorably impressed.

We were the only ones in our section of the campground as we pulled in, which was of no concern to us. We set up our pop up camper, cooked dinner, cleaned up, and took a walk.

Once we were back at out site, we were inside the camper, organizing for bed time when another party arrived at a site, 2 or 3 away from our own. They were young-ish, and seemed high spirited. Whatever, live and let live.

So, several hours later, TDW and I were chatting quietly, when the noise from the neighbor site picked up considerably. I peeked from our window, and noted what appeared to be bottles of some sort of alcohol in hand, and our “neighbors” sounded to be involved in some sort of loud, animated, an not altogether amicable discussion.

When we heard the sounds of yelling, and breaking glass, I awakened the kids and had them lay on the floor of the camper. TDW called county dispatch on her cell phone, and I settled in next to the door of the camper, curtain ajar and Colt in hand.

One of the party, it appeared, felt the need to do some sort of work on the mirror of one of the trucks, and this seemed to involve attempting to wrench the mirror off of the door without using any tools. That maneuver elicited yet MORE heated words, and things were escalating, which made it convenient that that was the moment that the park ranger, a couple of sheriff’s vehicles, and a city cop arrived.

One of the officers approached out camper, and I took that opportunity to secure the pistol beneath one of the mattresses, seating TDW thereon.

I told the officer what I had heard, and seen, and he assured me that for this party, their camping weekend was over. “We’ll simply sit here, and watch them pack up and depart. We’ll circulate through several times over the rest of the night, and, if they return, they’ll sleep in the sheriff’s office. In the back.”

Then he added, “If you need us, call us back. Have a nice weekend!”

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact

SPOUSAL ADVICE

A few years ago, I was working a locums gig Up North. TDW-Mark II and I had lived our entire lives in The Un-Named Flyover State, and one recurrent feature of the winter news coverage was the seeming obligatory photograph of the snowy expanse of the northern part of the state. Now, I had grown up in Da City, largest in the state, nestled among the northern tier of states, and figured that I knew me some snow.

Well, it turns out, at least from the photographs of nigh unto 12 foot walls of snow adjacent to the roadways, featured in these photos, I did not know squat. So, when the opportunity arose to work on the shores of Lake Superior, and with this gig an opportunity to see, for reals, these selfsame walls of snow, well, off we went!

When you work 12 hour shifts, you get 4 days off every week. My placement was accommodating, bunching my days into a 3 on/4 off arrangement. That TDW and I plenty of chances to tour the area.

Unfortunately for our intended snow tourism, the winter had been mild, and that snow which had fallen, was paltry. To be honest, we had more snow downstate, than in The Great White North.

Whatever. There was still abundant history and scenery to take in, and we set out to do so. One of our tours took us to the norther edge of the state, to a lakefront town. It was pretty, although, surprisingly, with all the tourists gone, nothing was open.

So, this episode of our curiosity sated, we headed back to our hotel. Cleverly, I suggested that we return along the lakeshore road, which ran along a bluff and overlooked, you guessed it, the lake.

Remember that this was late December, and in Da Nawth, in winter, sunset blasts past you, and night drops upon you like a net. Or, so we experienced.

Simply to make everything nice, it had begun to sleet-mixed-with-snow. Let us review the scene, now: Night? (Check!) Snow/sleet? (Check!) Unplowed Up North roads? (Check!) Slush accumulating on the roads? (Check) And, certainly not least, Anxious Wife overlooking the drop off onto the icy, rocky shore of The Lake?(Why, yes, CHECK!)

So TINS ©, There I Was, Driving Along and Making Time towards our hotel, when I splashed through some accumulation of slush. Our vehicle jogged, just a little, and TDW emitted a shriek.

I suggested that, since it was black outside as a politician’s heart (should such a thing really exist), and I generally had this under control, perhaps declamations of impending doom, absent clear indications of said doom, might distract me from successfully managing to move forward, while maintaining our position on the pavement. Some might consider failure to accomplish this to be A Bad Thing.

She apologized, and I returned to navigating and aviating (so to speak).

A little while later, a county road commission salt truck/plow overtook us (and, yes I WAS driving that slowly!), passed up, and in doing so sent a moderate sized spray of slush and whatnot onto our windshield.

TDW shrieked, again.

I slowed even more, came to a stop on our nearly deserted stretch of icy snowy roadway, and turned to my bride.

“Honey”, I began, “I realize that you have concerns about the wisdom of driving on this road, under these conditions, tonight. However, since we are something like 30 miles from our hotel, and I am unwilling to spend the night sleeping in this car, driving to the hotel is out only reasonable alternative.”

She nodded.

“In addition, you DO recall, that I have driven in snow, for something approaching 50 years, right? And, therefore, know just a little bit about driving in these sorts of conditions, right?”

Again, she nodded.

“While I realize that you want to do your part to help our drive be safe, efficient, and trouble free, I want you to realize that, whatever you may think, it is really not particularly helpful, and nowhere near as helpful as you appear to think it is, when you scream at seemingly random intervals, while I’m driving unfamiliar roads, in pitch black night, in snow and sleet, along a cliff face.

Please, stop!”

Having A Good Partner Is Very Important! · Knives · Pre Planning Your Scene · Protect and Serve · Sometimes You Get to Think That You Have Accomplished Something!

My children, cornered by dogs

Years ago, and far away, we lived Up North. We had three children, one of whom was still an infant. TDW Mark I had decided that we needed pets, and so she brought home two Labrador puppies.

With the wisdom that comes with hindsight, with two working parents, two primary school aged children, and an infant, two Labrador puppies might not have seemed to be a particularly good idea. It seems that, with the distractions present daily in such a household, the dogs do not properly learn the chain of command. In particular, the part of the chain of command that goes, “The little people are NOT to be snarled at, nipped at, or cornered. Under ANY circumstances!”

One afternoon, I was working in the yard, the two oldest kids were playing outside, and somehow the dogs got out. I learned this, when I heard snarling from the dogs, and yelling from my kids.

As an aside, nowadays, I put on my pistol, knives, and spare magazines, before I put on my shoes. I live in a very quiet, nice little town, but, well, between Da City, and the tales I have related here (and am about to relate here), I have grown to loathe when I do not have the tools I need RIGHT FUCKING NOW!

I reached this epiphany, as I rounded the corner of the house and observed the two dogs backing my children into a corner, snarling. Each dog was, at this point, around 60 pounds, and outweighed my children.

I pushed my way between my kids and the dogs, and pushed the kids behind me, as I faced down the dogs. I waved my arms, snarled, my own self, and began to harangue the dogs, slowly advancing on them.

“Motherfuckers! You DARE to threaten my kids! I will cut your miserable throats, I’ll crush you like insects, I will break your necks, and toss your cadavers to the buzzards! Don’t you FUCKING DARE snarl at my children! I will field dress your sorry asses, and toss the gut pile into the fucking road! Try me, motherfuckers! TRY ME, you sackless pieces of shit! YOU-DO-NOT-DARE-TO-THREATEN-MY-CHILDREN! I will OWN your sorry asses, and put such a hurt on you that dogs, everywhere, will whimper and cross the road, lest they step upon my children’s shadows! I fucking DARE you, to cross me!”

Well, all the excitement likely had penetrated the house, and TDW Mark I came a’running, big kitchen knife in hand, to sweep up the children, and arm me. Once they noted two adults, and, likely, from the yelling and screaming I was emitting, figured that Bad Things were pending, they ran off at a lope.

You may wonder what my plan was? Well, besides the fact that I decided promptly that I was NOT about to watch dogs attack my children I really had no plan at all. It had occurred to me that I was right handed, and, in extremis, should I jam my left forearm to the back of the lead dog’s mouth, and wrap my right arm around his neck, if I could push away with my left arm as hard as I could, and pull back as hard as I could with my right, I just might snap the dog’s neck.

But, after reflecting, 15 rounds of XTP hollow point in 9 mm might be just a bit more effective.

Fun And Games · Having A Good Partner Is Very Important! · Pre Planning Your Scene · Protect and Serve · Sometimes You Get to Think That You Have Accomplished Something!

Transfer To Florida

A long, long time ago, in a county very far away, I was a nursing supervisor. I had migrated into supervision after several years as an ER nurse.

One afternoon I arrived at work, and the offgoing supervisor reported that a gentleman had been brought in and admitted for his heart attack. Now, in these far away days, there were no angioplasties, no stents. There was no TPA, no other thrombolytics (“clot busters”). Indeed, the state of the art, outside of referral hospitals, was oxygen, hydration, rest, aspirin, and pain control. We had THAT, in abundance!

So, a couple of days later, one of the CCU nurses took me aside, and informed me that this guy was, to employ her own professional and finely tuned appraisal, “acting kinda squirrely”.

It developed that the attending physician determined that this soul was both having/recovering from a MI (heart attack), but, in addition, was a florid alcoholic, and was entering into DTs. Like, classic, textbook, tachycardic, hallucinating, writhing, pre-seizure tremulous, DTs.

Simply to make everything just nice, the internal med doc that the cardiologist consulted did not believe in using benzodiazepines for alcohol withdrawal. (that would be medications like Valium or Librium, useful both for the sedating effects, as well as their efficacy in protecting the patient from convulsions that might be lethal.) No, he insisted in using antipsychotics, which weren’t altogether effective in addressing his twitching nor his restlessness. Shit.

Well, he survived all this excitement, and, eventually (like, 4-6 weeks worth of eventually) was ready to go home.

Our discharge planner discovered that our new friend was a resident of Florida which we, in The Unamed Flyover State, were not anywhere near. He had wrecked his vehicle in the initial confusion, and therefore had no vehicle to get him home. In any event, what with his MI, and his lengthy stay in Thorazine Land, was in no sort of shape to (a) drive home to Florida, nor (b) master the intellectual challenges inherent in navigating the interstate home, even if he was strong enough to physically do so, Which he was not.

Her investigations revealed that none of his family was in any sort of position to happily drive up here and retrieve him (which of course begs the question of what was he doing here, with his pleasantly confused self, something like 1200 miles from home? And alone?)

So, once the dust settled, he was still our problem, and The Suits determined that springing for a flight home would end the financial drain that he represented, since no insurance company in the Western World would pay for him to reside at the Grand Hotel De Our Little Hospital, once his medical need had resolved. I did mention that he was squirrely, right? Well, our discharge planner hypothesized that his heart attack, and DTs, had trampled his previously marginally sufficient coping mechanisms, and he was, now, fully senile. Therefore, putting him up, unsupervised, in a hotel, would not work out at all well.

So the plan was laid. Our discharge planner purchased a plane ticket. He had specifically purchased a ticket on a nonstop flight, determining that there would be fewer opportunities for him to wander off, and get lost Ghawd Alone knew where. Then, she dumped it in my lap. I called A Competing Ambulance Service, and spoke to a supervisor.

“I have this guy, and we are going to fly him home. He is not altogether there, and so he needs both supervision, and a chain of custody. The flight is at 5 pm, so I want him at the gate at 4 pm sharp. I want your crew to physically deliver him to the boarding gate, physically observe him belted into his seat, and obtain a signature as a receipt from the flight attendant who seats him. Can you do all that?”

“Sure. You just have to set it up with the airline. OK?”

“Outstanding! I’ll set it up, and call you back.”

So, I called the airline. I spoke with a supervisor, and laid out my problem, and my view of the solution. “Sure, no problem. We can do that. Anything else?”

“Yep. Can you get a receipt for my guy, from the folks who pick him up, and then call me with the fact of safe arrival, please? Then, mailing us the receipt would be wonderful!”

“Sure, can do. Gimme your name and mailing address!”

I called the Competing Ambulance Service back, and brought the supervisor up to speed. “Oh”, I added, “One more thing. We’ll hand the plane ticket to your medic, and also hand him or her the chart. That HAS to go with him, and is part of the chain of custody business. OK?”

“OK!”, was the response.

So, on the appointed day, I was at the nurses station awaiting The Competing Ambulance Service crew. Once they arrived, I reviewed all the foregoing. Both medics nodded, and one opined, “Yeah, that’s all according the the briefing we got from the supervisor. Where’s the chart, and the ticket?”

The charge nurse handed both items over. The medic made a show of placing the ticked into the inside pocket of his jacket, turning so both his partner as well as the nurse and I could see it settled deeply into it. His partner tucked the chart beneath the pillow, and they were off!

Around 1630, I got paged to pick up a phone call. “Mcfee!” was my greeting.

“Mr. Mcfee, this is Bob from The Competing Ambulance Service. My crew just radioed me to let me know that your patient is on the flight, seatbelt secured, and they have a signature form one of the flight attendants. So far, so good. That attendant has you phone number, and will phone you once he has been handed over to family at the other end.”

And, as promised, around 1930, the crew from The Competing Ambulance Service arrived, hunted me down, and handed me a copy of their trip sheet, prominently featuring the name, signature, and employee ID number of the flight attendant accepting Mr. Man for his flight.

To frost my cake of WIN!, the next day the night shift supervisor relayed via days, that our patient had successfully, and uneventfully, been handed off to his family at his destination.

Hallelujah!

Fun And Games · Fun With Suits! · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact

“Little Mary Sunshine is NOT a Force Multiplier!”

Once upon a time, long ago and far away, I was nursing in an ER in a medium sized city. For some reason, I was unable to evade being placed in charge.

Lord Knows that I tried! While I have established that I can be reasonably effective in a supervisory role, I really do not like it. For one thing, it places me in overly close proximity to Suits. I do not enjoy proximity to suits. Hell, my Suit Aversion Disorder led me to work midnights, in the first place! (well, that and shift differential, as well as seven-on-and-seven-off scheduling, to be honest.)

For another, I get subjected to all the bullshit from other departments, which, invariably, appears to consist of interacting with slothlike souls who manifest only one burning desire: skate through their shifts, while expending as little effort as is needed to maintain their receipt of a paycheck. Notice, I did not attribute to these chuckleheads the desire to actually do something resembling their jobs. That wuld be different.

Finally, when in charge, I get to cope with all the malignant and ill considered decisions regarding staffing the aforementioned cursed suits have enacted.

So at this point I was working in a relatively urbanized area, with a sixteen bed ED, in a town with three total Eds of various sizes. We had been short staffed for an extended time. This, of course, made me oh, so very happy. Or, not. I had been bitching, complaining, protesting and generally making known that not only was this sort of staffing insufficient, but, into the bargain, was considerably short of their own goddamned published staffing parameters, written by the goddamned suits themselves, and for which I would be written up should I let someone go home leading to staffing short of these parameters.

Well, as it developed, one of the Junior Suits (our assistant director) was compelled to show her smiling face up to work some of the short midnight shifts. She was, let us say, “entertaining”, to work with. She would “help out” by triaging. Well, when you triage someone, it is helpful if you (1) obtain and record vitals, (2) ascertain, and document allergies, medications, medical history, as well as (3) history of present illness, typically elicited by asking something along the lines of, “So, Mr./Ms/Xr X, what motivated you to come out in the dark of night to join our happy little party?”. You did notice how much fun I seemed to think it was, to, ya know, DOCUMENT, the aforementioned items, right? Sort of like that was, oh, I dunno, a GOOD THING, or something?

So, it develops that Little Mary Sunshine did not document (or even obtain; it was difficult to sort that one out) vials, allergy/med/history, or present complaint information, at least, not consistently. In addition, it seems that an ED physician with, say, a dozen patients, really, really gets petulant if these items are not there in the chart to be found. Slows him/her down, considerably.

Then, there is the part about both bedding the patient, as well as noting such fact on the greaseboard, as well as reporting off to the the nurse who would, oh, I don’t know, maybe BE CARING FOR THAT PATIENT.

Finally, it was established practice to start the needful IVs, collect the blood, and send it to the lab, along with a requisition for the bloodwork the physician was going to be desiring to see. None of which had penetrated Little Mary Sunshine’s cranial vault.

She was no more helpful as a “floor” nurse, Which is to say, she would half ass do things, not tell anybody at what point she had grown disinterested and wandered of Ghawd alone knew where, let alone document anything that she, by some miracle of random happenstance, completed.

As my partner, Andy, opined, “Ya know, she is not really a very effective force multiplier!”

Much more nicely phrased than the tsunami of profanity that was boiling away, waiting for me to spew forth as my OWN opinion of her “efforts”!

So, visiting as she was from the warm climate of Daytime “Suitworld”, Little Mary Sunshine was chilly most of the time. (she might have been warmer, had she been moving about as briskly as the rest of us, but, then….) Andy, once again demonstrating the situational awareness that made him a fine nurse and great partner, noted this fact, and brought it to my attention one long, long night during a missing Mary moment.

He implemented a plan based upon this observation, and turned the department thermostat down to around 60, from the typically balmy 70 where it normally rested.

Well, time passed, Mary Sunshine wandered around, fucking things up, and soon the HVAC system equibrillated at the new set point. Mary zipped up her sweatshirt, and began to complain that it was cold.

Nice of her to notice.

Shortly thereafter, she loudly opined that “You guys seem to have things under control. I’m gonna go back into my office and do some paperwork. Call me if you need me!”

Once she was safely away down the hall towards her (independently heated) office, we returned the thermostat to the baseline setting.

The rest of the night passed as the typical clusterfuck of shortstaffed jackassery, fortunately not exacerbated by halfwit half assed managerial fumble fingering.

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact

Child Rearing Tales

So, TINS, TIWFDASL….well, OK, really, this is another child rearing tale. Our oldest son, Adam, was approaching middle teen years, and, in The Unnamed Flyover State (TUFS), that meant anticipating driver’s education, preparatory to acquiring a driver’s license. At that time, the child in question had to be around 15 years of age, so, shortly after Adam’s fourteenth birthday, I sat him down for a little chat.

“So, Adam, you starting to get excited about taking driver’s ed?”

“Yep! I really can hardly wait!”

“Outstanding! Now, you do realize that, here in TUFS, you aren’t required to get my signature in order to take driver’s ed, or to get your license, right?”

He responded with a blank look. “Huh? All the kids in my class say that your parents have to sign for you to take driver’s ed, or to drive!”

“Well, they are mistaken. You do not require my signature in order to drive, or in order to take driver’s ed!”

He reflected upon this for a moment, and his face brightened. “Oh, yeah, right! I’ll just get Mom to sign!”

I sat back. “Say, I have an idea! How about you go talk to your mother, and ask her about that idea! Let’s say, for some reason, that I refuse to sign for driver’s ed, or for you to drive, ask her what her next move might be! Come on right back, and let me know what she says, OK?”

He scampered off. From another part of th house, I overheard low pitched murmurs, as of distant conversation. The murmurs ceased, and Adam made his reappearance.

“So, tell me about that ‘no signature’ thing, please, Dad.”

That told me how his conversation with his mother had gone. He had said something along the lines of “Mom, if Dad won’t sign for me to take driver’s ed or to drive, will you?” Her response had likely gone along the lines of “Have you lost your fucking mind? What makes you think your dad and I would not be on the same page regarding something like that?”

So, I answered him. “Well, Adam, in the Great and Sovereign State of TUFS, you do not require a parent’s signature in order to take driver’s ed, nor in order to drive!”

“Dad, that can’t be right! All the kids in my grade tell me that you need a signature!”

“Well, they are all wrong. Indeed, here in TUFS, you can get your driver’s license, you can take driver’s ed, without my signature, or you mother’s. Why, once you are eighteen, it is all very simple! You simply sign for yourself!”

He looked thoughtful for a moment. “But, Dad, why would I want to wait until I was eighteen to drive?”

Now, I looked thoughtful, for a second. “Adam, that is an excellent question! I am confident that your behavior between now and then will demonstrate the answer you came up with!”

So, fast forward several years. I had had this same conversation with Betty, Number Two child. She had taken, and passed driver’s ed, and acquired her license. She was driving whenever she could wheedle the loan of a car from her mother or me. She was also, as an adolescent girl, not entirely meeting behavioral standards.

Her mother TDW-Mark 1, and I, considered her transgressions, and intervened when needful. When behavior did not improve, we physically took her license, and secured it. After the “license grounding” had elapsed, she, again, could drive. More misbehavior, more license grounding.

Finally, she had demonstrated sufficient lack of grasp of acceptable behavioral standards, that we were done grounding her from driving. TDW-Mark 1 and I held a conference, featuring Betty. I reviewed past interventions.

“Betty, you did (whatever), and had been told not to. We took your license for a week, and told you that another violation would result in us taking your license for two weeks. You violated (whatever the rule in question was), again, and so we took your license for two weeks, and told you that the next time would be a month. Again, you violated (rule), and we took your license, and told you that the next time, we would simply yank your license and stop screwing around with this stuff. Well, last night you did, again, violate (rule), and so, now, your mother, and I, and you, are going to the motor vehicle office, and you are going to lose your license.”

She responded, “Well, I will just go there tomorrow, and get it back!”

I smiled at the sixteen year old. “I do not think that it works that way, Honey!”

She looked at me, and brought me up to speed (or, so she thought). “All the kids at school tell me that I can, and I just will!”

I produced her license from my pocket. “See this name here, at the bottom? Where it says Director of Department of Motor Vehicles? Read that name, please, Honey. The print is a little small for my old eyes!”

She read, “’Alyssa, M. Snodgrass’ Why do I care about that?”

“So, sweetie, which one of your classes is she in with you?”

“Huh? Nobody in any of my classes has a name like that!”

I looked at TDW Mark 1, and she looked at me. We then turned our gaze to our darling daughter. The TDW Mark 1 carried the ball. “Well, Betty, that is indeed a surprise! Since Ms. Snodgrass is the director of the department of motor vehicles, and is charged with writing, and enforcing, the rules for who gets, and who loses, a license to drive, perhaps she knows just a teensy, weensy, little bit more about how all that stuff works, than your illiterate, self absorbed, ignorant, prideful, and arrogant classmates. Doncha think?”

Betty gaped at her. Her mother smiled, serenely. “So, honey? Get your shoes, and let’s go. Now, Honey, now!”

With that, our little gaggle promenaded into the DMV office. Once our number had been called, we strolled up to the desk, and the civil servant asked, “What can I do for you?”

I smiled, my best won the jackpot smile, and proclaimed, “We are here to have this child,” and my sweeping wave indicated the glowering Betty beside me, “officially credentialed by the Great and Sovereign State of TUFS, as a pedestrian!”

The poor woman, only trying to get through her workday, looked at me blankly. After a second, she asked, “What?”

TDW Mark 1 clarified it for her. “We are here to yank this child’s license.”

“Oh, right. Please may I have the child’s license?”

I produce it. “And, your ID, please?”

We produced it.

Tap, tap, tap went the keyboard. Our new friend, the DMV Lady, then snipped off one of the corners of Betty’s license, and, looking up, asked, “Do you want this back?”

I looked at TDW Mark 1, and Betty. TDW Mark 1 looked back at me, and smiled at the DMV Lady. “Oh, yes, indeed, we want it back!” she exclaimed. “We’re gonna frame that bad boy, and hang it in the hallway, where all of us can admire it every day!”

Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

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.