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!

Protect and Serve

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.

Fun And Games · Having A Good Partner Is Very Important! · Pre Planning Your Scene · Protect and Serve

The Leviathian Comes Alive!

So, one time we got dispatched to an unconscious person run on the east side. We arrived to see a number of police officers from DBCPD standing around. One of them pointed out a large slumped soul, leaning up on the steps on a rear stairway of some house.

He was not entirely flaccid, and he WAS breathing on his own, both desirable attributes from my point of view. Even so, leaving him to metabolize towards mobility appeared to be a bad plan, so Porthos and I attempted a hold-him-under-his-arms walking assist. It worked, sort of. Well, it appeared to be working well enough that we could maneuver him to the truck, and thence to TBTCIDC, where he could indeed metabolize to freedom, under the loving and watchful eyes of the TBTCIDC Emergency Department nursing staff. For bonus points, he would then not be our problem.

Porthos and I were making progress, of a sort, toward the ambulance, and the police were doing their police type stuff, when I got the bright idea that perhaps a whiff of an ammonia capsule might energize our guest.

Now, with the wisdom that comes with hindsight, THAT might have a good idea to, ya know, DISCUSS with my partner. That discussion might have elicited several beneficial outcomes, like problem solving IN ADVANCE, and anticipation of ways in which this brainstorm of mine might have turned horribly wrong, for example.

As might have become evident, I did NOT discuss this little plan of mine with my partner, and simply retrieved an ammonia cap from my pocket, snapped it, and allowed Mr. Leviathan to breathe deeply of the healing aroma.

He abruptly, and I mean RIGHT FUCKING NOW! Became considerably less stumbling, and way, way more energetic, shaking loose of my grasp on his arm, and turning on my partner.

This might be a good point in my tale to note that our guest was tall, and big, and outweighed me, as well as Porthos, by a considerable margin. If he should commence to some wrasslin’, well, whichever one of us was the object of his affections, would not enjoy being so objectified.

Porthos had noticed our guest’s reanimation, although he was a fraction of a second slower than I in so noticing, and so King King, our newly energized patient, was advancing upon my partner, hands outstretched, and backing Porthos rapidly into a corner.

I realize that things happen quickly, and it appears that time stands still, nevertheless those officers sure appeared to be statues, while this shambling wreck of a man-mountain was advancing, cornering my partner, presenting a clear and present danger of laying hands on him.

I found my Mag Light in my hand, and advanced, on my toes, behind him. My flash plan was, once he had indeed grabbed Porthos, well, I was going to go for that line drive, featuring his head as the baseball.

So, Ninja like, I was advancing upon Leviathan, Leviathan was advancing on Porthos, the cops were unmoving, and I, catlike, managed to step on his foot.

Good news: he forgot about Porthos.

Bad news: he figured that I was oh, so very much more deserving of his attention than my partner. He began to turn on me, so as to show me some love. Of some sort.

Good news: whatever was the source of his previous lethargy, it slowed his synapses, and so the insight that he would rather be thumping on me, rather than Porthos, took him a not inconsequential amount of time to process, and then to act upon.

Good news: Porthos took that opportunity to zig to Mr. Leviathan’s zag, and begin to beat feet to the truck.

Good news: I accelerated to warp speed promptly, and so managed to arrive at the ambulance about the same time as Porthos.

Good news: our officer friends were, themselves, in motion, and they converged on Mr Leviathan, and dissuaded him from pursuing any further laying-on-of-hands ceremonies.

Indeed, they were so persuasive, that they elected to transport our new friend to TBTCIDC, themselves.

Porthos and I had, well, I suppose you might consider it “a teaching moment” once we were back in service. My ears stopped burning after a couple of hours.

Fun And Games · Overdoses · Protect and Serve

Commercial Quantities of Meds

Thanks to Aesop (https://raconteurreport.blogspot.com/) for the inspiration for this post. See his series of posts, July 10 2019 to July 12, 2019. I write this on 12 July 2019. He may have more: it appears that he is just warming up!

So, TINS©, TIWFDASL© as a midlevel in a county lock up. Our sheriff had a policy of no drugs (I.e, no euphoriants narcotics or sleepers) for inmates. I was told that the rationale was that he did not want inmates to “sleep their sentences away”. Cool story, there were very few occasions wherein I would consider prescribing scheduled meds (euphoriants, narcotics) anyhow.

I was working part time. One morning I came in, and an offecer invited me to step into his office. He showed me a dispenser pack of what looked to be 140 or more tablets, labeled “Methadone 10 mg”. The administration instructions read “take 9 tablets daily”. Holy cow! That’s 90 mg of methadone, equal in pain killing (or sedating) effect to around 1 000 mg of morphine every day. ONE THOUSAND MILLIGRAMS of morphine equivalent, every day! The medical history form related that this had been prescribed for debilitating arthritis.

The officer noted the department’s “No Narcotics” policy, and asked me, the medical authority (Hah!) present, for an opinion. I thought that placing this gentleman in the “detox”/observation cell, and obtaining and recording vitals every hour for the first 24 hours sounded prudent. I also provided a checklist of concerning symptoms to watch or. I provided my cell phone number, and directed that, if certain parameters of vitals or observation were exceeded, send him to ED by ambulance immediately. If any grey area, phone me at ny time of day or night.

So, the officers recorded vitals and made “nurse’s notes” on their guest. I came in early the next day, read the noted, and re assessed the gentleman myself. All nominal, no alarming findings. We repeated this process, now every 4 hours, and, again, the next day, I arrived early and re-re-assessed the inmate. Same nominal vitals, same unremarkable exam. This did not seem to all fit together as it had been presented.

Another day, another 24 hours of vitals and “nurse’s notes”, another benign exam.

After several days of this, the jail command suggested that , with nearly a week of normal vitals and normal exams, perhaps our guest could be moved into general population? It seemed alright to do do, and I seconded their initiative.

So, after nearly a week of no methadone, nearly a week of no abstinence symptoms, my attention wandered to other topics. One morning I arrived, and an officer beckoned me into his office. “Hey, I thought you’d want to see this!”, was his opening conversational gambit.

It turns out that there are surveillance camera throughout the jail. (Who knew?). One had captured the methadone-for-debilitating-arthritis fellow getting into an altercation with another inmate, and whupping same. That’s correct: the “debilitating arthritis” inmate, delivered a whupping onto the person of another inmate.

The officer turned to me, and observed, “I am beginning to think that that prescription is rather more of a commercial opportunity, instead of a medical intervention!”

Pre Planning Your Scene · Protect and Serve

Do It Yourself Emergency Care

First disclaimer: LOONNGGG post warning!

Second disclaimer: for the terminally thick, NO, I AM NOT ADVOCATING THAT YOU AVOID PROFESSIONAL MEDICAL CARE. WHEN IT IS AVAILABLE!

Third disclaimer: I apologize for my computer fumble fingery, but the hyperlinks do not show as hyperlinks for most of this post. Feel free to copy and paste the links into your browser.

So, the preceding obligatory disclaimer having been presented, why might you want to be able to provide your own medical care?

Well, if professional medical care is not available, you might have a zero-sum choice to make. Kind of like Graham’s Kill House Rules. (http://grahamcombat.com/the-killhouse-rules/ )

NOBODY IS COMING TO SAVE YOU.
EVERYTHING IS YOUR RESPONSIBILITY.
SAVE WHO NEEDS TO BE SAVED.
KILL WHO NEEDS TO BE KILLED.
ALWAYS BE WORKING.

If, indeed, nobody is coming to save you, in any clinically relevant time frame, then, indeed, EVERYTHING IS YOUR RESPONSIBILITY! Therefore, you can seek out and achieve training at whatever level you are comfortable with, or not. Good luck with extemporizing on your particular slice of Armageddon. (And, just like with defensive firearm use, exactly at what point are you really “good enough”? And are you willing to bet your life, or your family’s lives on that “good enough” level of expertise?) Because, if help will not arrive, or not arrive “in time” (whatever that is in your emergency scene) then either you are ready to act, or you are not.

Even if you do not anticipate a Zombie Apocalypse, because “that will never happen”, how about coming upon a collision, and Tag! You’re IT! As first on the scene? (BTDT) Or, maybe, you, or your dad, or your kid was chopping wood, or clearing brush, or cleaning up after a windstorm, and the axe, or hatchet, or chainsaw slipped and added a laceration to the wonderful day everybody is having? Or, you (or your wife) (or your neighbor) fell from a ladder?

Have you ever had to extemporize an emergency response kit out of your household stuff? I have (Once. A LONG, Long time ago! Never Again!), and, as you may surmise, I did not enjoy it.

Being an old medic, and an old ED RN, I LOATHE surprises. While The Universe cares not a whit about my preferences in that regard, if I anticipate trouble, and put in place preparations and training and action plans, well, surprise is not quite so disturbing.

First of all, read my blog (shameless plug!)

Secondly, read this guy’s blog in general, and this post in particular. He relates that he’s been a nurse for a considerable time, and everything upon which he opines, for which subject I feel a right to have an opinion, he’s right. (his series on first aid/emergency care, Sept 24 2017, to May 13 2018 is PURE GOLD!. Hit his site, find the “first aid” tag, search, read, learn, find your life enriched.)

https://raconteurreport.blogspot.com/2019/06/aom-how-to-build-first-aid-kit.html

Now, full of resolve to improve your life (and the lives of everyone around you, amirite?), go ye and set up your own emergency response kit. Make It Yours! My list, Aesop’s list, FEMA’s list, your old squaddie’s list, don’t mean nuthin’ if you do not know how to use the items you have at hand, and if you do not have the correct items at hand.

About that last thing: let me tell you a little story. TINS©, TIWFDASL© (well, I wasn’t REALLY Fighting Disease And Saving Lives, but, verily, This Is NO Shit!), as my then girlfriend and I were motoring Up North to visit her family. Fat, dumb and happy, I was motoring along, chatting companionably with my girlfriend, when we observed several vehicles pulled over, on the median of the divided highway that led us on our way. Closer examination led to the insight that likely these folks had pulled over due to the minivan on it’s roof, in that selfsame median.

To paraphrase the Noted Medical Ethicist and Moral Philosopher, Han Solo in the trash compactor, “I had a bad feeling about this!” Once I alighted, medic bag in hand, I noted (Thanks be to Crom!) that the nominal patient appeared trivially hurt, with a small amount of bleeding from her head. This was particularly wonderful because I COULD NOT FIND ANY DAMNED GLOVES! I have no excuse (other than being stupid, I suppose…). It is not like I have spent, mmm, oh, let’s see, carry the ‘nought, seven goes into 11…uh, yeah. FORTY FREAKING YEARS, at that point, in the sick people business or anything. So, yeah, having the basics is kind of important.

So, lists. Make the list that you select, YOUR LIST!. Work that bad boy. Repack your kit on every seventh full moon, if that’s how you roll. Solstices and equinoxes work for me. Or, try your birthday, and anniversary, and two national holidays of your choice. But, repack that kit! You thereby get the opportunity to be sure stuff has not expired, that vermin have not spoiled it, that the elements have not f*cked with it. (And automobile trunks, in Michigan, reach not less than 142 degrees F in the summer. I know. I checked. I logged it, somewhere. In winter, well, MFC [mighty fenomenally cold] just about describes things!) For the record, hot and very cold are not good for shelf life (or trunk life, for that matter!)

As an introduction, and starting point for conversation, here’s my
(annotated) list. First, the list and prices

Green Bag
LAPG Bail Out Bag 26
CPR mask 9.2
BVM 10.94
CAT TQ 29
SWAT-T TQ 12
6” IBD 7.55
4” IBD 6.95
gauze 4×4 4.00/100
ABD 5×9 6.32
celox 28.75
Bandage Shears 2.95
tongue blades
Stethoscope
BP cuff
adhesive tape 2 in 2.6
roller gauze 4 in x 3 1
vaseline gauze
elastic bandage 4 in
elastic bandage 2 in
Elastic Bandage 3 in 1.25
Total 159

Now, with commentary and links:

You may notice that I have selected a LA Police Gear Bail Out Bag for my case.( https://lapolicegear.com/tabaoutbag.html $26 bucks) It really doesn’t matter what sort of container you employ for your emergency supplies, so long as it meets your particular needs for security, identification, accessibility, protection and convenience. My choice (in Fire Department Red) is not water resistant, is not neatly compartmentalized, and does not have an IR glint Star of Life embroidered upon it. On the other hand, I know how my stuff inside is organized, it is convenient to sling over my shoulder when the scene requires that I do so. It will fit beneath a van seat, or in a tub in my trunk, and I can work out of it when I have it slung.

Some fire departments use plastic “totes” to organize supplies required for specific types of calls. For example, haz-mat supplies are packed inside specific totes, and the top secured with a cable tie or some such device. An inventory is attached to the top (sealed in plastic) to identify what is inside, as well as out dates of time sensitive components. When properly closed, such bins are drip and dust resistant, resist crushing or jumbling of the contents, and can be convenient to carry when not overfilled. On the other hand, they will not conveniently fit beneath a vehicle seat, may be unwieldy to retrieve and place into action, and may get buried beneath other stuff in a trunk or truck box.

Others of my acquaintance use ammo cans, or plastic fishing tackle boxes. These are generally more convenient to shlep about (unless your tastes run along the lines of a 20 mm ammo can) and are more drip/dust/duh! resistant than the tubs mentioned above. On the other hand, they may overturn with disappointing ease, spilling your supplies into whatever noxious fluid is abundant on your particular scene.

IN THE TOP, OR IN AN OUTSIDE POCKET

Items that I am likely to require promptly are either in the outside pocket or immediately inside the top flap of the bag. These are things that I do not want to be fumbling for as I approach a scene. I will not list what might be considered “everyday carry” items like pocket knife, flashlight(s), CS spray, sidearm, and a cell phone. While these tools help keep the rescuer from becoming a victim of an ambush laid for a “Good Samaritan”, particularly when employed in concert with a Condition Orange mindset. (I did mention I started out in Da City, didn’t I?), these items do not seem to me to be rescue/first aid/emergency medical tools.

First up is several pairs of gloves. (well, now, anyhow!) I am allergic to latex, so I have nitrile gloves. Current practice is to wear gloves anytime you might reasonably anticipate exposure to blood or other bodily fluids: tears, urine, stool, saliva, gastric contents, or any other moist, body-origin material you might imagine (and perhaps a few you might not!). I have so thoroughly incorporated this into my life that I get uneasy caring for my own children (or, at my advanced age, grandchildren!) without gloving first. These are in a zip-lock bag, safety pinned (now!) just inside the top flap of my green bag.

The upside to all this is that scrupulous gloving and thorough hand washing have so far proven highly effective at preventing the spread of the most common blood-borne infections. Diseases spread via airborne droplets (for example, Legionnaires disease), of course, require additional precautions. Others are spread by organisms coming to rest upon environmental surfaces and then accessing a vulnerable host (just like you and I are vulnerable hosts to “the common cold”) by means of unconsciously touching our faces after touching a contaminated surface. For myself, after 40 plus years of patient contact the worst I have brought home has been an occasional upper respiratory infection due to my conscientiously applying the glove/hand wash/hands away from my face regimen. (https://www.harborfreight.com/7-mil-nitrile-powder-free-gloves-50-pc-medium-68504.html $10/box of 50)

The next item I’ll feel a burning need to have in my hands is a bag-valve-mask (BVM). This is a manually operated ventilation tool. It is employed by sealing the mask over the unbreathing patient’s face, squeezing the self inflating bag, and thereby forcing air into your patient’s lungs. Repeat at a rate of approximately 12-20 times a minute. Advantage: no kissing strangers, required for mouth-to-mouth resuscitation. You are able to maintain situational awareness of such things as evolving environmental hazards (like leaking gasoline), or indicators of your patient’s improving condition (…he said, thinking positively!). On the downside, using a BVM is difficult in untutored hands. It is easier (compared to mouth-to-mouth) to force air into the patient’s stomach (which is a bad thing), which will elicit vomiting (which is WHY that is a bad thing!). Aside from the aesthetic issues this presents, vomiting in a profoundly unconscious patient (such as one so unconscious as to have stopped breathing) presents the opportunity for aspiration into the lungs of that which has been vomited, which may be deadly.

Training in use of a BVM will be part of an EMT class which can (OUGHT TO!) be part of the training that I mentioned earlier. I’ll wait here while you go find out when your local community college or rescue squad will be having their next class. Plan on being a part of that class. You will be making your community, and thereby your family, safer.

You can buy your own disposable model (https://www.liveactionsafety.com/lsp-disposable-manual-resuscitator-adult/ ) for around $14. In the hospital, we use these once and discard them. Your local rescue squad or ambulance may shop locally, and you might want to do likewise. Ya know, if you were to volunteer with your local rescue squad, you might be able to obtain things like this at your agency’s cost. All this on top of the good karma from helping to provide a necessary community service. And, besides, becoming known to the locals (police included) as one of “the good guys” can only be a good thing for many reasons. Your phone book likely will provide the contact information you require. I’ll still be here when you get back.

One of the adjuncts to using a BVM is called an oral airway. Oral airways come in sizes, which may be selected according to the size of the patient. Their purpose is to hold the flaccid tongue of a profoundly unconscious patient forward, so that it does not sag against the rear of the throat and thereby block the passage of air into and out of the lungs. The problem it may trigger is, should your patient be other than profoundly unconscious, he or she will vomit. Among other disasters this may cause, the enzymes from the stomach, designed to digest proteins, will (unsurprisingly) begin to digest the proteins found in the delicate tissues of the air sacs (alveoli) of the lungs, with effects you are likely to be able to imagine on your own. Very Bad Thing.

Another way to fail when employing an oral airway is to bunch up the patient’s tongue in the rear of the throat. This blocks air flow, strangling your patient. This device must be restricted to only profoundly unconscious patients, and only if you are schooled in its use. You can buy them individually, or in sets. Before shipping, they go for around $5.00/set. You might elect to buy them one at a time, but at $5 a pop, they aren’t a particularly major investment. (https://www.buyemp.com/product/curaplex-berman-oral-airway-kit )

When I’m confronted by an actively bleeding patient, I reach for an Israeli Battle Dressing. (https://www.bestglide.com/the-emergency-bandage-4inch-military.html $7 each in the 4 inch size, https://www.bestglide.com/the-emergency-bandage-6inch-military.html $7.55 in 6 inch) It consists of a sterile dressing incorporating an elastic bandage to secure the dressing to the wound.

On a side note, should you shop gun shows or surplus stores for your equipment, be wary of old dressings. They present potential issues of failed sterility as well as mustiness or mildew occasioned by improper storage or imperfect packaging.

Another wound care product is QuikClot. (https://www.liveactionsafety.com/quikclot-combat-gauze-z-fold-expire-2023/ $40 each) This is a mineral product, bound to a dressing, which enhances clotting, and thereby slows and limits blood loss in the bleeding patient (common in trauma, surprisingly enough!) One 2008 article (QuikClot Use in Trauma for Hemorrhage Control: Case Series of 103 Documented Uses. Journal of Trauma-Injury Infection & Critical Care. 64(4):1093-1099, April 2008.) reflected the occurrence of burns in several patients, but the manufacturer’s web site reports that changes in packaging and delivery system have addressed this issue.

An alternative you might consider is Celox.
(https://www.emergencysafetysupply.com/celox-blood-clot-gauze-roll/ $29 each, 3 inch x 5 feet) It appears perhaps to be a reasonable alternative to QuikClot. It is derived from shrimp shells, although it seems to not produce allergic reactions in folks otherwise allergic to seafood. I have no personal experience with either product, but the reports are interesting. This goes on my “further research” list!

SECOND TIER SUPPLIES

The preceding items are to be found in the outside pockets or very top of my jump kit. I don’t want to be searching for them when I feel the need for them Right Freaking Now. Beneath the don’t-wanna-wait-for-them items, I have supplies of somewhat lesser immediacy. These allow me to assess the situation in greater detail, or address issues that may come to light that are of less time sensitivity.

Triangular Bandages are useful for slings of injured arms, or may be folded into narrow strips and then used as a means to secure splints or dressings (as “cravat bandages”). If we were to consider them as a backpacker might, they may be used as expedient dust masks, bandannas, head coverings, or washcloths. I buy muslin by the yard at Wal-Mart, and cut it from one corner to the other, forming (surprise!) 2 triangles approximately a yard on a side. I keep 6 to 8 in my kit.

Bandage shears are the most obvious of the prehospital medic’s tools. You can go with Lister style bandage scissors, often found as “nurse’s scissors”, or the plastic and steel “super shears”. Prices range from $4.00 and up (shop around). Frequently employed to trim dressings to the proper size, cut away clothing from wounds, and to cut bandages.

Did you ever notice that a tongue blade/tongue depressor is almost exactly the width of a finger? And just a bit longer than your Mark 1, Mod 0 finger? Exactly like it were designed to be a finger splint, isn’t it? In addition, should you tape three of them together one on top of the other, you have a dandy tool for tightening that “Spanish windlass” you are going to learn about, when your (probably, in 2019, “Wilderness”…) EMT class teaches you how to apply and improvise a traction splint for a fractured femur (thighbone). Finally, if you are unhappy at the thought of wiggling somebody’s fractured femur (broken thighbone) so you may place ties (cravats: remember them?) for a splint, tongue blades are thin, stiff, and very helpful at limiting the wiggling as you place ties beneath the broken bone of your choice. I keep a handful handy.

You can pay a couple of bucks for them at the corner pharmacy, or you might be able to talk your way into several for free, like when you are volunteering at some public service event with your local volunteer fire department, emergency medical service, or amateur radio club.

Stethoscope/Blood Pressure Cuff. A stethoscope allows you to hear the sounds made as air moves into and out of the lungs, and note changes from normal. These changes might occur because your patient has a collapsed lung, or has pneumonia, or heart failure. When you get that far into your EMT class (hint, hint), you will learn how to evaluate these changes, and what sort of treatment decisions you ought to consider when you notice them. In addition, you will learn how to measure, and interpret, your patient’s blood pressure.

I am certain you will know somebody who will go out and get the cardiology deluxe stethoscope, with Wi-Fi, mag wheels, and gold trim. Do not join them in this folly. Spend $10-80 at the same place the local student nurses get their stethoscopes, and spend the difference on your spouse, whose enthusiastic support you will require, anyhow. If you can show your spouse how your expenditure of family money and time on supplies, education, and volunteering promote values that you both agree upon, the both of you will thereby make your family more crisis resistant. If your family is more crisis resistant, then you are not only NOT a drag on community emergency services during an emergency, you all might even be an affirmative community asset during bad times. That cannot fail to be a Good Thing when you get to explain yourself to The Jewish Carpenter. Me, I’m going to require all the help I can get. I’m volunteering!

Adhesive tape (1 inch, 2 inch) secures dressings, holds loose ends of bandages, and provides a single use notepad (tear off a length, tape it to your thigh, and jot notes. You will not lay it down somewhere to be forgotten). If you listen to some friendly and knowledgeable athletic trainer, you can learn how to use it to support sprained ankles or knees if the preferred treatment (rest, ice, elevation) is not possible. Before you employ these tricks, bear in mind that physicians frequently cannot differentiate a sprain from a fracture, even after an x-ray. In my view, except under the most dire possible circumstances, walking on a fractured (or sprained) extremity is a Very Bad Thing. Two rolls each are at hand when I open my green bag. (https://www.galls.com/dynarex-cloth-surgical-tape-6-pack-?PMSRCH=tape $16/box of 6)

I keep 12 to 15 Gauze pad, sterile, 4×4 in my kit. I employ them as eye pads, padding beneath splints, or as (oddly enough) dressing for wounds. Occasionally I encounter a wound bleeding so enthusiastically that a couple of gauze pads will be overwhelmed. Fortunately, I haven’t come across such a wound off duty, but in the hospital we use a “boat” of sterile gauze. This is a plastic tray of ten sponges in one pack. The tray also may be used as a clean basin for wound irrigation/cleansing solution. In the hospital we use sterile saline, you may elect to use the water from your retort pouch, or fresh from the bottle as you purchased it for storage. I would certainly give it some thought. Gauze, 2 per pack, 10 packs per box: https://www.firstaidsuppliesonline.com/first-aid-products/tapes-wraps-dressing/gauze/sterile-gauze-pads-4-x-4-10-box-2/ $4

If you happen to be the purchasing agent for your entire survival community, ambulance service, or the entire Boy Scout Council, you might find the case price from Vitality Medical to be useful. (https://www.vitalitymedical.com/kendall-dermacea-gauze-sponge.html $50) 1200 sterile 4×4 pads for $50 works out to around 4.2 cents each.

Triple padding/ABD padding, sterile, 5×9 inch. (https://www.vitalitymedical.com/invacare-abd-pad.html $0.12 each) These multiple layer absorbent dressings are designed for wounds producing a lot of drainage of either blood or other fluid. They are my first choice for a bulky dressing or splint padding. I keep 6 in my kit. The frugally minded may note that “sanitary napkins” are designed to absorb drainage, are “medically aseptic”, and are available nearly everywhere.

Roller Gauze, 4 inch https://www.galls.com/dynarex-comforming-stretch-gauze-4-inch?PMWTNO=000000000002328&PMSRCH= $4/box of 12) is typically used to secure a dressing (see Gauze Sponge, above) to the wound. I pack 6 in my kit, and they have “found careers” as bandages to secure dressings, securing splints when I run out of triangular bandages, and upon occasion as packing/dressings for vigorously bleeding wounds. In fact, when one is employed as the dressing, and another as the bandage, I can not only dress the wound, but also (since the bulky roll provides a pressure point) apply direct pressure to the bleeding site. This provides an alternative to the Israeli Dressing, cited above.

Vaseline Gauze (sterile, 3×9 inch) (https://www.buyemp.com/product/kendall-vaseline-gauze-pads $9.50/10) is intended to seal wounds penetrating the chest, in order to prevent collapse of your patient’s lung(s). When you seal the defect in the chest wall, your patient will not draw in air through the wound when s/he inhales, and thereby not fill the space between the lung and the chest wall (the pleural space) with air. When you can avoid this, inhaling draws in air through the mouth, trachea and bronchi, and that inflates your lungs, and we think that is a good thing. Myself, I pitch the gauze and tape three sides of the foil package, sterile side towards the wound, forming a flutter valve sort of effect. In this way I allow excess pressure in the pleural space to vent to atmosphere (stopping further lung collapse, I hope), and seal the hole when the pressure inside the chest is less than atmospheric pressure (like when the patient inhales). The only way left to equalize that pressure is by inflating the lungs, already described with approval above.

The other use for Vaseline gauze is when my lips or hands are dry, in which case I use the Vaseline to remedy that little problem.

We all can think of uses for the common elastic bandage, 3 inch and 2 inch (https://www.amazon.com/ProAdvantage-P156003-Latex-Free-Bandages-Self-Closure/dp/B06XT743T3/ref=sr_1_3?keywords=elastic+bandage&qid=1559746937&s=hpc&sr=1-3 3 inch, 10 pack $5.25, and 2 inch https://www.blowoutmedical.com/elastic-bandage-2-inch-x-4-5-yard-3662.html $0.42 each. Two inch is useful for sprains of your wrist or thumb, and the 3 inch is used for an ankle twist/sprain. In addition, I can use them to secure a splint (there is that rule of threes, seen in posts on other blogs), or as the “swathe” part of a sling-and-swathe to immobilize an injured shoulder, or as part of a pressure bandage over a dressed wound that does not want to stop bleeding.

Large Bulb Syringe (for which you can substitute a turkey baster) functions as an expedient means of removing fluids from the airway of someone who is not managing to do so effectively on their own. It will not work nearly as well as a battery powered or pump action suction, such as you might find on your local rescue squad rig, but it won’t cost you $30 (for the manually pumped version seen on Amazon today for that price. Comparison shop.) either. Second best is superior to nothing.

Mylar “Space blankets” protect you or your patient from the hypothermia-inducing effects of the wind, slowing heat loss. Generally colored bright orange on one side and silver on the other, there are signaling opportunities as well. In a pinch, you can improvise shelter from one or two. Amazon sells the generic copy for $10 for a pack of ten (https://www.amazon.com/Primacare-HB-10-Emergency-Thermal-Blanket/dp/B00DZ1NFSK/ref=sxin_0_ac_d_rm?keywords=space+blanket&pd_rd_i=B00DZ1NFSK&pd_rd_r=2123eee5-db98-41a8-867d-fb632b7e1ffa&pd_rd_w=TNeM6&pd_rd_wg=86xXL&pf_rd_p=91b604bb-c371-4573-970f-bed68a552852&pf_rd_r=SJ8DY55TS6GG0J9T2NQR&qid=1559768962&s=gateway&smid=ATVPDKIKX0DER ). Equip your jump kits, and each member of your family with one or two.

Any accident so severe as to convince suspicious old me (alumnus of Da City’s EMS) to stop and offer assistance will not be fixed with a couple of Adhesive Bandages (aka “Band Aids”). I have six in my jump kit, two entire boxes at home (and parceled out among my camper, car, and household kits).

I keep a couple of Ice Packs around, as assorted adventures may bring on modest orthopedic injuries. Ice is helpful for strains, sprains, or overuse of an over aged joint (…not that I would know anything, firsthand, about that…). Choices include “instant cold packs”, or that old picnicker’s standby, a zip lock bag full of ice from the cooler.

Either option has drawbacks. I do not generally drive about with a cooler of ice at hand, although when camping I am likely to do so. Instant cold packs are kind of fragile, and you might find, when you go to place one in service, that you have a leaking mess on your hands. On the other hand, they are more likely to be there when you want one.

The foregoing lists the contents of my “jump kit”. I keep one kit in each vehicle, and another at home. In addition, there are Subordinate Kits, kept in camper, car and home, for lesser sorts of occasions. I have customized each by adding more dressings, triangular bandages, roller gauze, and gloves. In addition, I improved over the baseline “Wally World” $15 first aid kit, by adding zip lock bags of various household medications. I labeled each bag with the name of the med, the out date of that particular bottle, directions for use, and date of packing. I made my selections by inspecting my own medicine cabinet, and pondering which meds I had wished I had kept handy the last time I was out camping, for example. Most everything commonly needed is therefore in the Camper Kit, Car Kit, or House Kit.

The jump kits are reserved for “Holy Fertilizer!” sorts of events. They are not mere “boo-boo boxes”: THAT is why I have subordinate boxes in each vehicle, the camper, and the house. Reserved in this way, I will not find myself hunting (and swearing) in crisis, as I need this or that widget, which some child (or adult) has used, and not restocked.

IFAK OR “BLOW OUT KIT”

The jump kit is kind of bulky, the subordinate (“Band Aid kits) sort of inadequate, in the event of BFD injuries. I have created “Blow Out Kits”, also referred to as IFAK (Immediate First Aid Kits) for the possibility of arterial bleed, GSW, or similar potentially exsanguinating injury. Hey, I shoot recreationally, and , as “TexasUberAlles” noted (https://disqus.com/by/TexasUberAlles/),
“Always wear safety gear-poor judgment is a team sport, and other people get to decide whether you’re on their team without asking you first”. In short I may hold the Cooper Distinguished Professorship In Safe Firearms Handling, but, Cletus in the next bay who does the macarena when the first round of his 32 round magazine gets lodged in his tank top, might inadvertently put a couple of rounds in my chest. Or somebody else’s. Therefore, I have a handy, smaller, trauma and bleeding focused have-it-on-my-belt kit.

Contents first, discussion after.

IFAK
pouch 14.95
4 “ IBD 6.95
Quick Clot 40
4×4 x 12 1
abd x 2 1
roller gauze 4 in x 3 1
TQ 29
triangle bdg x 2
gloves x 6
Tape 2 in 2.6
shears
Total 96.5

Again, I need a pouch or case for the IFAK. Some of the other blogs addressing this issue, including Raconteur Report, have suggested “SAW” ammo pouches, others have suggested M-16 ammo pouches. My take? Well,folks who are alumni of the military, and have in fact been in combat, likely have opinions that you, and I, ought to listen to. Having said that, I have patched up (temporarily) a few bleeding folks in my day, and here’s what I use:

(https://www.opticsplanet.com/red-rock-outdoor-gear-mavrik-small-medic-pouch.html $6.) (Yeah, my spreadsheet excerpt shows a cost of nearly $15. See? It pays to shop around!). Feel free to employ the case that suits you.

Israeli Battle Dressing (see above, $7 or $8)

You may notice that I specified QuikClot in my IFAK, in contrast to Celox in the jump kit. If you have a reason to prefer one over the other (eg, Quikclot), then go for it.

A dozen sterile 4 x 4 gauze dressings. This for fast, initial care. I anticipate buying enough time to go get (or delegate one of My Minions to go get) my jump kit from my vehicle.

I specify 2 ABDs, 5 x 9, for the same reason.

4 inch roller gauze, similarly. When I require additional roller gauze, well, that is why I have a large handful in my jump kit.

CAT Tourniquet, around $30 on sale at Rescue Essentials (https://www.rescue-essentials.com/tourniquets-holders/ ) Alternatively, you can get a SWATT tourniquet, which is a heavy duty elastic band, with imprinting upon it so you can assess how tightly you have wound it, for around $12, but I cannot know how more (or less) effective it is than the CAT. Get your training, get some experience, and form your own opinions. Myself? I have both a CAT on my belt, and a SWATT in my pocket, every day.

For a discussion of triangular bandages, and tape, and shears, well, see the previously presented material.

One comment on the hemostatic agents (that’s the Celox and the Quikclot), among other contents: read the packaging. Some of this stuff has an out date, and my practice is to rotate outdated material (like outdated TQ, IBD, hemostatics, etc) to the “training bin”. While it MIGHT not be a big deal to use outdated IBDs, or TQs, I betcha outdated hemostatics might be litigation bait. In addition, it is simply good practice to check and rotate your stock at regular intervals.

Finally, remember that training comes first. Years and years ago, I heard a story that, in the early days of the Israeli state, the emergency response planners had the budget required to train their personnel to stabilize and transport spine injured patients, or buy the splints (called backboards), but not both. The story relates that the planners elected to train their personnel, and subsequently noted a spine injured kibbutznik transported to the hospital by his comrades, secured effectively to an entire barn door. You! Over there! Yeah, YOU! Go get trained! Pass that training on to your shooting buddies, camp mates, hiking buddies, family, friends, fellow cube dwellers. You will make them safer, you will make yourself safer, and, in the event of another mass casualty incident, you, yeah, YOU!, might be the reason folks survive, or do not lose limbs.

Seize that opportunity.

Thank you all for reading along this far.

Protect and Serve

What is this “Memorial Day”?

This is Memorial Day 2019.  This the day set aside, to contemplate, to remember, those who have stood in harm’s way, have said to Evil, “you shall not pass!”, and have died so doing.

Today we recall those immortalized in Francis Scott Keyes’ fourth stanza, opening,

“Oh! thus be it ever, when freemen shall stand
Between their loved home and the war’s desolation!”

I want to repeat a story.  I first encountered it on the “Never Yet Melted” blog (https://neveryetmelted.com/). I’ve re read it multiple times, yet it still moves me to tears. Here’s the source: https://www.businessinsider.com/john-kellys-speech-about-marines-in-ramadi-2013-6

 

Scroll to the end, for the picture. 

 

Then, read the story. Lifted directly from Business Insider. This–THIS–is how MEN face DUTY. I pray that, should the need arise, I can be worthy to stand in their presence.  Corporal Jonathan Yale, Lance Corporal Jordan Haerter. This is what we remember, on Memorial Day. 

via Marines Magazine

Five years ago, two Marines from two different walks of life who had literally just met were told to stand guard in front of their outpost’s entry control point.

Minutes later, they were staring down a big blue truck packedwith explosives. With this particular shred of hell bearing down on them, they stood their ground.

Heck, they even leaned in.

I had heard the story many times, personally. But until today I had never heard Marine Lt. Gen. John Kelly’s telling of it to a packed house in 2010. Just four days following the death of his own son in combat, Kelly eulogized two other sons in an unforgettable manner.

From Kelly’s speech:

Two years ago when I was the Commander of all U.S. and Iraqi forces, in fact, the 22nd of April 2008, two Marine infantry battalions, 1/9 “The Walking Dead,” and 2/8 were switching out in Ramadi. One battalion in the closing days of their deployment going home very soon, the other just starting its seven-month combat tour.

Two Marines, Corporal Jonathan Yale and Lance Corporal Jordan Haerter, 22 and 20 years old respectively, one from each battalion, were assuming the watch together at the entrance gate of an outpost that contained a makeshift barracks housing 50 Marines.

The same broken down ramshackle building was also home to 100 Iraqi police, also my men and our allies in the fight against the terrorists in Ramadi, a city until recently the most dangerous city on earth and owned by Al Qaeda. Yale was a dirt poor mixed-race kid from Virginia with a wife and daughter, and a mother and sister who lived with him and he supported as well. He did this on a yearly salary of less than $23,000. Haerter, on the other hand, was a middle class white kid from Long Island.

They were from two completely different worlds. Had they not joined the Marines they would never have met each other, or understood that multiple America’s exist simultaneously depending on one’s race, education level, economic status, and where you might have been born. But they were Marines, combat Marines, forged in the same crucible of Marine training, and because of this bond they were brothers as close, or closer, than if they were born of the same woman.

The mission orders they received from the sergeant squad leader I am sure went something like: “Okay you two clowns, stand this post and let no unauthorized personnel or vehicles pass.” “You clear?” I am also sure Yale and Haerter then rolled their eyes and said in unison something like: “Yes Sergeant,” with just enough attitude that made the point without saying the words, “No kidding sweetheart, we know what we’re doing.” They then relieved two other Marines on watch and took up their post at the entry control point of Joint Security Station Nasser, in the Sophia section of Ramadi, al Anbar, Iraq.

A few minutes later a large blue truck turned down the alley way—perhaps 60-70 yards in length—and sped its way through the serpentine of concrete jersey walls. The truck stopped just short of where the two were posted and detonated, killing them both catastrophically. Twenty-four brick masonry houses were damaged or destroyed. A mosque 100 yards away collapsed. The truck’s engine came to rest two hundred yards away knocking most of a house down before it stopped.

Our explosive experts reckoned the blast was made of 2,000 pounds of explosives. Two died, and because these two young infantrymen didn’t have it in their DNA to run from danger, they saved 150 of their Iraqi and American brothers-in-arms.

When I read the situation report about the incident a few hours after it happened I called the regimental commander for details as something about this struck me as different. Marines dying or being seriously wounded is commonplace in combat. We expect Marines regardless of rank or MOS to stand their ground and do their duty, and even die in the process, if that is what the mission takes. But this just seemed different.

The regimental commander had just returned from the site and he agreed, but reported that there were no American witnesses to the event—just Iraqi police. I figured if there was any chance of finding out what actually happened and then to decorate the two Marines to acknowledge their bravery, I’d have to do it as a combat award that requires two eye-witnesses and we figured the bureaucrats back in Washington would never buy Iraqi statements. If it had any chance at all, it had to come under the signature of a general officer.

I traveled to Ramadi the next day and spoke individually to a half-dozen Iraqi police all of whom told the same story. The blue truck turned down into the alley and immediately sped up as it made its way through the serpentine. They all said, “We knew immediately what was going on as soon as the two Marines began firing.” The Iraqi police then related that some of them also fired, and then to a man, ran for safety just prior to the explosion.

All survived. Many were injured … some seriously. One of the Iraqis elaborated and with tears welling up said, “They’d run like any normal man would to save his life.”

What he didn’t know until then, he said, and what he learned that very instant, was that Marines are not normal. Choking past the emotion he said, “Sir, in the name of God no sane man would have stood there and done what they did.”

“No sane man.”

“They saved us all.”

What we didn’t know at the time, and only learned a couple of days later after I wrote a summary and submitted both Yale and Haerter for posthumous Navy Crosses, was that one of our security cameras, damaged initially in the blast, recorded some of the suicide attack. It happened exactly as the Iraqis had described it. It took exactly six seconds from when the truck entered the alley until it detonated.

You can watch the last six seconds of their young lives. Putting myself in their heads I supposed it took about a second for the two Marines to separately come to the same conclusion about what was going on once the truck came into their view at the far end of the alley. Exactly no time to talk it over, or call the sergeant to ask what they should do. Only enough time to take half an instant and think about what the sergeant told them to do only a few minutes before: ” … let no unauthorized personnel or vehicles pass.”

The two Marines had about five seconds left to live. It took maybe another two seconds for them to present their weapons, take aim, and open up. By this time the truck was half-way through the barriers and gaining speed the whole time. Here, the recording shows a number of Iraqi police, some of whom had fired their AKs, now scattering like the normal and rational men they were—some running right past the Marines. They had three seconds left to live.

For about two seconds more, the recording shows the Marines’ weapons firing non-stop…the truck’s windshield exploding into shards of glass as their rounds take it apart and tore in to the body of the son-of-a-bitch who is trying to get past them to kill their brothers—American and Iraqi—bedded down in the barracks totally unaware of the fact that their lives at that moment depended entirely on two Marines standing their ground. If they had been aware, they would have know they were safe … because two Marines stood between them and a crazed suicide bomber.

The recording shows the truck careening to a stop immediately in front of the two Marines. In all of the instantaneous violence Yale and Haerter never hesitated. By all reports and by the recording, they never stepped back. They never even started to step aside. They never even shifted their weight. With their feet spread shoulder width apart, they leaned into the danger, firing as fast as they could work their weapons. They had only one second left to live.

The truck explodes. The camera goes blank. Two young men go to their God.

Six seconds.

Not enough time to think about their families, their country, their flag, or about their lives or their deaths, but more than enough time for two very brave young men to do their duty … into eternity. That is the kind of people who are on watch all over the world tonight—for you.

 

 

 

Here’s what it looks like when MEN face duty, in the last seconds of their lives
Fun And Games Off Duty · Protect and Serve

Christmas Eve MVA

Christmas Eve MVA

This one time, at Band camp….no, wait: that doesn’t seem quite right….

Oh, yeah: TINS©, TIWFDASL©…(no, not altogether correct, either…). Well, I was NOT FDASL, rather I was visiting The Momette, in The Un-Named Maternal State, and, it being Christmas Season, I was shopping for Christmas presents for the family. Indeed, it was Christmas Eve (for am I not well prepared, and forward thinking? Well, no, not so much) when my brother, The Attorney, and I were attempting to find an open store for the Christmas Shopping, that I had not yet accomplished.

So, there I was, motoring down the highway, and my brother, a veritable fountain of trivia (as is his brother, come to think of it), observed, “They call this stretch of highway the Death Mile, because it narrows from 4 lanes to two, just ahead here, and there are a bunch of collisions right along here.”

How interesting. Just about that moment, I noted beacons in my rear view mirror, and moved to the right to allow a Maternal State Police Trooper to zoom past us at flank speed, siren wailing and beacons flashing. The Attorney commented, “He sure seems like he is in a hurry! Wonder why?”

A few seconds later, ANOTHER Maternal State Police Trooper zipped past us, at about Warp 8, similarly beaconing and sirening, and sped around the upcoming corner and off into the distance.

As we, ourselves, rounded the curve, I noted chaos, as one would normally find at the scene of a high speed collision. Indeed, it certainly appeared that there had been such a collision, with three cars scattered across several lanes, and the shoulders, of the roadway. I parked on the shoulder, clear of the debris, and alighted. Approaching one of the troopers, I introduced myself. “I’m an off duty medic from Da City, Can I help?”

The trooper looked over my shoulder, and pointed. “Yep. Talk to those guys, right there.”

I turned to see an ambulance stopping. I approached one of the medics, and repeated my spiel. He nodded toward one of the vehicles. “You take that car, my partner and I will take the other two.”

I whistled to get my brother’s attention, and directed him, “Get the medic bag in the back of my truck. It’s got that Medical Star on it. I’ll be over here.”

I approached the car, my brother running over and handing me my jump bag. I noted an adult male seated in the passenger seat, another adult male laid over, sideways from the driver’s seat, his head in the passenger seat occupant’s lap. He, the laid out guy, was not speaking. I saw the head sized divot in the windshield over the steering wheel, and supposed that might have something to do with that.

The guy seated in the passenger seat stated, “I don’t think he’s breathing!” I invited the passenger seat guy to move out of the vehicle, and assessed things myself. Yep, he was not breathing. Didn’t have a carotid pulse, either. I asked the recently moved passenger seat guy, “Do you know CPR?”

Yep”

Good. Get on his chest, I’ll ventilate him.”

My new friend set to chest compressing, and I dug my BVM (manual resuscitator) out of my bag, and began to ventilate our patient.

We resuscitated along for a good little while, until the arrival of a second ambulance heralded our relief. We continued CPR until the medics had cut off our patient’s coat (feathers everywhere!), initiated an IV, and began cardiac monitoring (VF, about as I had expected). Once all the technology was in place, we all four of us moved the patient onto their cot, and they took over from there.

I walked back to the truck, set my medic bag in the back, and approached one of the officers.

Officer, do you need my contact information?”

He squinted at me. “Who are you?”

I’m the medic from Da City, who worked that guy over there.”

He turned fully to me, and shook my hand. “Mister, gotta tell you, I’m really sorry I couldn’t talk to you before you left, because I really, really, want to tell you thank you for getting involved here, several states away from your home. Drive carefully, try to have a Merry Christmas!”

I was surprised, but said, “You’re welcome!”, and returned to my truck. I told my brother about my surprising conversation with the trooper. He looked at me, and finally asked, “You just don’t get it, do you?”

I had to admit that I didn’t.

He just did you a tremendous favor. You just gotta know that, with a likely dead person in this collision, there is gonna be a huge trial, right?”

Uh-huh.

And, you are a witness, right?”

Again, I “uh-huh’d” him.

So, being a witness, you would be subpoenaed to testify, and would be required to comply with such an order of the court. Which means you would have to travel your happy ass across the country, and find accommodations, and then miss work while you were here, to testify. At no small expense, both directly as well as in lost income. Said subpoena cannot be served on ‘Sumdood, Da City, usedtabeamedic’, right?”

Might be tough to serve.”

Yep. That cop just thanked you, in certain and unmistakable terms, for your service to his community.”

He paused, and then looked at me as if he had never seen me before. “I watched you out there. You really, really looked like you knew what you were doing. I would have been totally lost, but you just stepped right up, and started working away. Pretty impressive!”

I shrugged, just a little embarrassed. “Not like I haven’t done the same thing like, I dunno, a couple of thousand times before, right?”