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

Neighbors

One fine day, TDW-Mark II and I were at home, doing some sort of chore or another. Our doorbell rang, and I answered it, to find the neighbor girl, a seven year old classmate of Grand Daughter Number Two, standing there with her three year old younger sister, hands clutched one in the other.

“What can I do for you?” I asked.

“My grandpa fell, and he hurt himself, he’s not moving. Can you help us?”

I hollered, “Honey! Emergency at the neighbors!”, and headed out the door, TDW-Mark II watching me turn the corner into their yard.

The girls led me into their home, where I saw an elderly gentleman (now, THAT would be the pot calling the kettle over-the-hill!) prone on the floor, at the foot of the stairs, with a pool of blood about his head. The girls stood by, anxious appearing, until TDW-Mark II appeared, and led them into the kitchen, and attempted to distract them from the front of the house drama.

I asked the gentleman if he was OK, and his answer did not inspire confidence. Looking over the scene, multiple bad scenarios played out in my imagination, all leading to the conclusion that I did not want to manage this scene alone, and I really, reeally wanted EMS here, pronto.

I dialed up dispatch, and abruptly realized that I did not know the house number.

Fortunately, all those years of Street! Medic! Experience! started to pay off, as I realized that the house would have the number displayed prominently on the front. I walked out front to familiarize myself with that little detail. Oh, yes. AND the name of the street one block East of my residence.

You don’t have to say it, I already know. Bad Stretcher Ape! Situational awareness fail!

So, anyhow, I shared my new-found wisdom with dispatch, and summarized what I knew. She assured me that our little town EMS would be on the way, and then proceeded to start into pre arrival care instructions. I played along, until she paused, and I observed, “So, I’m an ER nurse. he is breathing, he is speaking, sort of, and I am reluctant to move him in any way, because it appears that he fell down the stairs.”

“Oh. Right. Well, if things change, call us right back!”

“Yes, ma’am, will do.”

The medics arrive shortly thereafter, and I reported the little that I knew. The one medic was surprised. “You don’t know any of his history?”

“Nope. We’re the neighbors. The little girl came over and got us, when he fell.”

At about that time, the mother returned home, and TDW-Mark II filled her in on what we knew. We turned the kids over to her, said our goodbyes, and departed.

Housekeeping · Pre Planning Your Scene

Staging your CAT Tourniquet

I found this, here: https://elmtreeforge.blogspot.com/2021/07/some-good-information-on-setting-up-cat.html Known as “Irons In The Fire blog.

As is likely no surprise, I consider myself a sort of “Surprise, BAD!” guy. Since I might not always have my medic bag right in my hand, well, enter the concept of “everyday carry”.

I have a CAT tourniquet on my belt, well, pretty much all the time that I am wearing pants. Similarly, I have a SWATT tourniquet in my off hand pants cargo pocket, again, pretty much all the time that I am wearing pants.

To date, I have never required a tourniquet, either in a scramble, nor RFN. Still, as Bat Masterton is reputed to have said, “When you need a gun, you really, really need a gun!”, which, given today’s discussion, might be paraphrased as, “When you need a tourniquet, you likely will really, really need a tourniquet. And damned quickly, at that!”

Having stumbled over this video, I felt compelled to pull out my own front line tourniquets, and have a look see.

It develops that my McFee Tourniquet Stowage Plan-Mark I, was one of the featured fails in this video.

Oops!

I guess that makes July, “Medic Bag And First Aid Kit Review, Repack and Revise Month”!

Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

First noc I wore fire boots at work: freeway run, on a snowy night.

TINS©, TIWFDASL©, and going to paramedic school in my off time (this was many, many years ago). In the course of this schooling, I spent some time in clinicals, variously in the local ED in a wretched hive of scum and villainy not so very far from Da City, or with one of the advanced life support crews running calls in the self same wretched hive.

It’s generally educational to spend time with other medics, as their organization’s culture, and lore, is likely to be kind of at a tangent to your home outfit. The education may run both ways. In any event, There I was, (studying) Fighting Disease, and Saving Lives in The Wretched Hive, and one of the host medics came on duty, ferrying his “load out” into the ambulance. I noticed that he tucked a pair of fire boots behind his seat, and asked him about them.

It being winter in The Northern Un-Named State, well, we were susceptible to receiving considerable amounts of snow from time to time. I believe the professional meteorological term is “ass loads”. My host noted that this could result in snowy shoes, and therefore wet feet, and that there were few things so miserable as cold, wet feet, in Da Nawth, in winter. Waterproof boots, that reached nigh up to one’s crotch, served admirably to avert this sort of undesirable outcome. I took notes.

Soon, I acquired my very own pair of “Storm King” (old standard) NFPA complaint boots. So, it happened that I wore them to work one snowy evening, and, early in the shift, Doug and I caught a run for “one down” on the expressway.

We pulled up behind the state police cruiser, and saw a figure prone in the snow and slush. The trooper told us that the patient had been struck by an overtaking vehicle, when the overtaking vehicle did not notice that our patient was bent over the lip of the trunk of his STOPPED vehicle, ON THE SHOULDER OF THE DAMNED EXPRESSWAY!

Our patient did not fare well in this exchange. I pulled up my bunker style boots, so that they reached nearly to my crotch, and knelt in the slush. Doug logrolled the man, and I slid the backboard beneath him, and logrolled him my way, so Doug and I could then center him on our spine splint. We buckled him in, collared him, schlepped him into our rig, and beat feet to TSBTCIDC, which happened to be one exit and a coupla turns away.

I remained dry and warm. If I had never worn those boots another day, that night, in that slush, they paid for themselves!

Duty · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

You Call Me “Packrat”, I Call Me “Well Prepared”

So, TINS©, TIWFDASL© in the little, rural ER at Erewhon Memorial Hospital (slogan: “Both Nowhere, and Backwards!”). Remember (because, after all, y’all have read, studied, and committed to memory Every Single One of my blog posts, of course!) that long ago, and far away, I had been an orderly on the gen med floor of TBTCIDC. In that capacity, I had been presented with two keys, one of which would unlock a Posey brand locking vest restraint, the other of which would unlock a Posey brand limb restraint. The key to this latter resembled a handcuff key, only on a considerably larger scale.

One evening, in Erewhon’s ER, a local State Police trooper entered, seeking some assistance. It seemed that out towards the periphery of our county, some child had found Grandpa’s antique handcuffs, and has secured himself to a radiator or some such immovable object. This child had done so, PRIOR to identifying the key required to unlock the handcuffs, and, of course, said key was nowhere to be found. The officer was on the verge of inviting the local fire department to demonstrate their extrication skills, featuring property damage, destruction, and loud noises, but wondered if we might have something less dramatic, to release the child. The officer noted that the key required resembled a handcuff key such as the key he, himself had, only considerably larger in size.

Fancy that.

I observed that I was in possession of something resembling that which he sought, and he could give it a try. I rummaged around in my Bag Of Tricks, retrieved my Posey key, and presented it to the officer. His eyes lit up, as he noted that this appeared to be just what he was looking for.

He returned, a couple of hours later, reporting that indeed, my key had unlocked the offending handcuffs, the child had been released, no property damage had occurred, and everything ended happily.

Contributing to my legend, of “If McFee doesn’t have it, You do not need it!”

Duty · Fun And Games Off Duty · Gratitude · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

PROFESSIONALISM

While my divorce was unwinding, I was working midnights in the ED of Mid Sized Hospital in the Adjacent Relatively Big City. I had a seven on/seven off schedule, which worked out pretty well for the week on/week off custody schedule for the youngest two kids.

So, TINS©, TIWFDASL© (well, to be precise, I was standing in my kitchen, looking around to see what I had forgotten to pack for the night to come), when my phone rang. My darling daughter was on the line. “Hey, Dad! How would you like to come over and take a look at your grand daughter?”

“I’m always up to visit my grand daughter, as well as her mother! What’s the occasion?”

“Well, Carmen is having some difficulty breathing, and I’d like you to look at her and tell me what to do.”

“Be right over. Unlock your door!”

A couple of minutes later, I was knocking on her door, stethoscope around my neck. Brenda opened the door, and I heard Carmen wheezing from across the room. “Call the ambulance, right now!”

Brenda was unconvinced. “Dad, if we call the ambulance, they will simply take her to Local Small Town Hospital. They will simply wind up transferring her to Next Town Big Hospital. Why don’t we just drive her to Big Hospital, ourselves?”

Good time for me to collect data. “Honey, do either you or baby daddy know CPR?”

“Um, no.”

“Y’all have oxygen in your car?”

“No!”

“You guys have any way to alert Big Hospital ED that you are coming in hot with a critically ill child?”

“You know we don’t!”

“So, let’s call EMS, who do indeed know all those things, and have all those things, so that they can treat Carmen properly, hmm?”

“We’ll just drive her over to Small Town Hospital, ourselves.”

“NOW, sweetheart. Right now!”

“I just have to…”

“No, you don’t. Get your ass on the way, right freaking now, and no more delay. Now!”

As they cleared the door, I phoned Local Hospital ED, where I had been an ED nurse, and provided a heads up. “Hey, my daughter is on the way with my grand daughter, who is in respiratory distress. Under a year of age.”

“When will they be here?”

“Open your door, now!”

I locked up, and made my way to Local ED. Once there, I saw the staff meeting that was a pediatric critical child. The ED physician was in the room, my daughter and baby daddy, two ED nurses, a respiratory therapist, the lab, and a couple of other folks that I could not make out in the crowd. I spoke to my daughter, and told her that I was off to work, and I’d stop by in the morning to see how things were going.

I called my daughter the next morning, on my way out of work, and met her at the Big Hospital Peds ICU. She told me that, unsurprisingly (to me), Local Hospital had tested, x rayed, oxygen-ed, and IV-d Carmen, and then transferred her to Big Hospital, via Peds Mobile ICU ambulance. Carmen was considerably improved over last night. I could not hear any wheezing, and she appeared to breathing easily within her oxygen tent. I said my hello to Carmen, ascertained if my daughter needed anything from me, and said my goodbyes to return home, and to bed.

Carmen was discharged the following day, and Brenda had a ream of instructions, as well as the opportunity to administer breathing treatments, as well as oral medications, to an infant several times daily. As a civilian, not a nurse.

A couple of weeks later, I was again preparing for work, and, again, received a phone call from my daughter, again inviting me to visit Carmen. “Always delighted to visit. What’s the occasion, this time?”

“She’s struggling to breathe, and the breathing treatment did not seem to help today.”

I instructed Brenda to immediately go directly to Local Hospital ED. “But, they will simply send her to Big Hospital again!”

“Yep, that is entirely likely. As is the fact that they will send her in a peds MICU, with a physician, respiratory therapist, and a couple of paramedics. All of which I highly approve of. Now, get going, right now!”

I, again, met Brenda at our local ED, again Carmen was the center of a veritable staff roll call in the treatment room, and, again, that evening she was whisked as described, approvingly, above, back to peds ICU at Big Hospital.

I stopped by the next morning. Brenda greeted me. “Dad, just like you said, they transferred her by ambulance back here. When we arrived, all the ICU nurses remembered Carmen, and were crying as they brought in the vent, the crash cart, and the intubation cart. Mom was here, and, gotta tell you, I was trying as hard as I could to keep it together for Carmen. The nurses’ crying was *NOT* helping! If mom had not been here, I would have lost my mind!”

I replied, “Honey, your mom is a pretty good nurse, and she keeps her head really well in a crisis. I’m really glad that she was here for you!”

And, at that point, I did the smartest thing I had done in a while. Right then, I shut up!

Duty · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

Health Care Stagecraft

So, I see children from time to time. Commonly, they are dubious about the entire “Going to the doctor” thing (yeah, I DO realize that I am not a physician, I am a midlevel. May I observe you explain that distinction, to an anxious child?) With that as a starting point, you can imagine that my approaching said anxious child with a stethoscope, and then with an otoscope (“the ear looking thingy”) might not end well. Yeah, me too.

One of the lessons I learned on Da Street (besides knock from the side of the door, and always have a second way out of any room I enter, and always have a knife, and…well, the important lesson is…..) is misdirection. On the street this manifested itself as changing the topic of conversation, as, on a hostile scene, announcing, “WE have to go and get the stretcher!”, and then both of us doing so, and motoring merrily away from the threatened free fire zone. Returning, if at all, with police.

In a more sedate clinical setting, this manifests itself with my (now) stock spiel for kids.

“This here (hold stethoscope up) is my body tickling thingy. Now, this is really, really tickley, but I only have one, right? That’s not enough to share. So, if you laugh, everybody will know how much fun it is, and they will be sad. ‘Boo-Hoo! (insert child’s name here) got tickled, and I didn’t! That is so unfair! I am so sad!’ Now, we don’t want them to be sad, do we?” (generally, toddler-sober negative head wag) “So, try very hard not to laugh, so that they are not sad! Okay?”

(generally, “ok”)

Once heart and lungs are auscultated, I continue with my misdirection. “You did so very, very well in not laughing, now we move up to the ear tickley thingey! Same rules, try not to laugh so that they do not know how much fun it is, and they are not sad that I cannot share, okay?”

Generally, again, “Okay.” While the child is trying to identify what the heck is so darned tickley about otoscopy, I finish.

One bonus point, is, even if the child screams and kicks and writhes, I can congratulate them. “Wow! You did so very well! I don’t think that they even suspect how much fun that was! You can stop pretending, now! You have successfully finished! Well done!”

Sometimes it is healthcare stagecraft, that lets you complete your job.

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

Self Defense Cost Benefit Analysis

TINS, TIWFDASL, I had caught the detail, and the happy go lucky soul with whom I was working that particular night on Da City’s EMS, decided it was time to ask me about my ballistic vest. Now, it was not any sort of secret among members of the department that I wore a kevlar vest. After all, in Those Days, Da City was known as “The Murder City”, and not without some justification. We chatted about the threat profile we confronted (although, the chat went along the lines of “What? Do you expect to be shot?” My response was “Nope. I wear this for those scenes on which I do NOT anticipate being shot. On those on which I anticipate being shot, I will simply refuse the run until the police have secured the scene!”)

This guy, no doubt thinking himself clever, pronounced, “Well, if the scene goes to shit, I’ll run out, and you follow me! That way, your vest will protect both of us!”

My rejoinder was, “In that case, you had best be certain that you do not slow down, lest you have my bootprints all up your back, as I run you over!”

Later, my partner and I discussed the vest and EMS. He asked, non-snarkily, how I had come to the conclusion that the vest was the way to go.

I noted that the vest cost me about as much as a Colt Government Model in .45 acp.

It was not a felony to wear the vest concealed, in contrast to the Colt.

It was not a black letter violation of department regulations, in contrast to the Colt (or any other firearm).

The vest would not inadvertently discharge, in contrast to the Colt, where that was a potential problem.

The vest was not going to drop out of my pocket, on the floor of the ED, in front of Ghawd and Everybody, in contrast to a handgun which another of our peers had won the opportunity to explain.

I would not in any circumstance hesitate to use the vest, in contrast to the Colt.

Finally, I was interested in meeting the soul who could relieve me of the vest, and hurt me with it, again, in contrast to the Colt.

So, I wore a vest. Others, or so I was told, elected to wear a firearm.

Pre Planning Your Scene

Reading Recommendation

https://eatonrapidsjoe.blogspot.com/2020/10/home-field-advantage-egress.html?showComment=1602787988156#c8439774302017330220

I don’t think that this guy needs *my* paltry recommendation, but, he has successfully drawn me in, and engaged me. His series-s are very, very thought provoking, in a Aesop’s “Tomorrow” sort of way. Lots of food for thought both at a “micro-economics” as well as at a “macro-economics” level.

Is your larder prepared for the presentation of spice? Metaphorically speaking, of course.

Fun And Games · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Random Thoughts, Part IV

You may have heard of the ChicomFlu. It has been all over the news, and, evidently it is all Mr. Trump’s fault. Interestingly, the same folks voicing concerns about Mr. Trump being a fascist dictator, who is planning on a putsch in order to become President For Life, also are criticizing him for failing to seize control of the economy, and not dictating the minutiae of our lives in order to Halt! This! Scourge!. Apparently, that entire Federalism thing, and Tenth Amendment thing, bypassed these commentators in Government class.

Or else, our government schools failed them. Again.

So, in clinical medicine, in 2020, we now have drive in care. Care, that is, of a sort. So, folks drive up (remember that point), announce themselves (no clown’s mouth, thankfully!), and our registrar trots out and registers them. Our MA does preliminary interview, and obtains most of the vital signs (except BP). I then suit up in an impermeable gown, goggles, N-95 mask, with another lesser mask over top of it to prolong it’s service life, and gloves, and stroll out. I interview them through the vehicle window, examine ears, throat, auscultate heart sounds and breath sounds (and, by the way, I can tell you things about your engine and transmission). With this information, I form a diagnosis, formulate a plan of care, and instruct the patient in that plan.

I nearly always ask if my patient smokes. If the answer is affirmative, my response if “Stop doing that!” Occasionally, when the answer is “No”, I have indisputable olfactory evidence that this is an untruth. If I can smell your marijuana fumes through two masks, you are doing it wrong.

*History Lessons*

If you live in Bagwanistan, or Cuomo Valley
 New York, or, really anywhere, KNOW 
YOUR DAMNED MEDS!

It's commonly considered to be A GOOD
 THING if I avoid prescribing a medication
 that, in concert with whatever crap you
 take daily, will turn you into a flaming 
zombie, or cause your ears to drop off. So
 write that shit down someplace where 
you can find it. This appears to be a novel 
insight to a significant fraction of the
 population.
 

And, while you're at it, ask your pharmacist 
what you're allergic to, and WRITE THAT 
DOWN, as well. 

And, for those of you who are thinking
 that “All that is in my record!”, uh, well,
 if your records are in, say FREAKING
 FLORIDA, it might be a bit difficult for
 me to access. Particularly on 
weekends, or after 1800 hours their time.
 By the way, this also applies to folks
 whose records are in Milwaukee, and are
 visiting Flambeau Hospital, since that is
 the nearest healthcare to Copper State
 Park in BFE, Wisconsin.  Big City Hospital
 in Milwaukee may not see us as an 
entertainment subsidiary of their 
megalithic hospital system, and your info
may well be securely hidden away, 
from us. 

Jes' sayin. 
Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Clem, Cletus, and Why Heavy Equipment Operators Require Functional Partners, Too

Many, many years after I had left the employ of Da City, I came to live in Small Rural Town. Our little slice of Heaven featured, among other things, a municipal water system. The town had been built out shortly after the Second World War, and the infrastructure was contemporaneous with that construction.

Apparently, the engineering lesson of corrosion occurring at the junction of dissimilar metals, had not percolated to the individuals who built the house in which we lived. This epiphany developed after I noticed one Friday morning that there was water pooling in our front yard, between the door and the street.

Side note. NEVER! call the water department with that sort of observation on a Friday. They will shut off the water. It turns out, the service line from your home to the main is YOUR problem. You will NOT get that problem resolved late on a Friday. Or on a Saturday. Or on a Sunday. Not having running water makes for a long weekend of work.

Monday, I was again working, but TDW-Mark I had successfully contacted the Knob City Excavating Company to respond and repair our service line.

This involved excavating my front yard, and, having accessed the service line, replacing it.

It appears that professional excavating practice involves having one individual operating a back hoe, with another standing by, inspecting the back hoe’s progress, apparently in an attempt to avoid engaging the service line with the back hoe’s bucket, reefing thereon, and using that service line as a leader to abruptly extricate all the plumbing from your home.

So, about that. Clem was the back hoe operator, and Cletus, evidently, was tasked with leaning upon his shovel so that neither he, nor the shovel, fell over. In that, he appeared to be successful. Clem DID notice the entanglement of his back hoe bucket with my plumbing, but only after he had begun to extract my plumbing from my house. Fortunately he had only JUST begun to do so, before he determined that Things Were Not Right, and stopped. That was about the point at which I returned home from a day of fighting disease and saving lives.

Things were at a standstill as I entered the house. TDW-Mark I was standing there, gazing into the hole adjacent to our foundation, looking decidedly unamused. Clem was there as well, while Cletus was a’holding that shovel, determined that it was NOT going to fall!

TDW pointed into the depths of the hole, calling my attention to the copper stretched out from the foundation to it’s junction with the iron pipe that, evidently, had been our service line. Another vehicle pulled up, disgorging a worthy who was, is seemed, Bob The Knob, owner and operator of Knob City Excavating. TDW beckoned me inside, where she showed me where the service shut off on our domestic water feed, formerly near our ceiling, was now located at the floor. I suggested to Bob The Knob that he might want to get somebody with plumbing expertise in to review the situation, and effect such repairs as seemed needful. On his dime. And, RFN. (Right Fucking Now)

He did not appear to think that this was particularly unreasonable, particularly if he were to consider the alternative, which would involve court, attorneys, attorney fees on both sides, and much bad Ju-Ju.

The next day, I returned home from work, and TDW-Mark I informed me that Some Dude had arrived, crawled around in our attic, and had pronounced everything shoreward of our shut off to be intact. This worthy had then replaced our shut off, and the associated piping, and Knob City Excavating had replaced our service line with copper, had installed a bimetallic junction (TDW-Mark I had asked/insisted) at the main, backfilled everything once the city building inspector had signed off, and we Now! Had! Water! (cue the rejoicing)

It turns out that Bob The Knob was satisfied with my check in the original, estimated, amount as payment in full. We did not have any leaks subsequent to this adventure, and we all lived happily, ever after.