Blogmedic

2007-04-01T22:59:00.001-04:00

March 26, 2004

Welcome to my org....

Obviously, the latest thing is the new blog. Much thanks to Eric for managing that for me. Many readers have asked for functionality that just wasn't possible through blogspot. Still, many thanks to the people at Blogger for what they provide. Hopefully, transferring to moveable type will make this blog a little more interesting. I haven't worked out all of the ins and outs yet, but it should be interesting.

As to activation, the 1 April date was put on hold, although things continue to move forward in anticipation of a June activation. This is so army!! Looks like we'll be going in about the same time the 3rd Infantry heads back. Hate it for those guys.

By the way, I can still be contacted at blogmedic@yahoo.com. This is really a trial run to see how easy MT is to use. I can now build an email notification list, so if you would like to know when the blog has been updated let me know.

2007-04-01T22:59:00.000-04:00

April 12, 2004

Does anybody know what's going on?

When I last posted, I told you that the 1 April date was on hold. I had originally planned to take the last two shifts off at work to have a little time to work on my house and maybe do a little early spring fishing. I called the unit on the 1st to tell them that I would be late arriving on the morning of the 2nd which was my next regular drill weekend, as I was at work and would not get off until 7:00 the next morning. Lo and behold, there was an email instructing the units to bring their leadership on active duty starting on the 5th.

So when were they planning to tell all of us?

So on the 2nd I showed up for my regular drill weekend, and they handed me orders putting me on active duty on the 2nd!!

I get the impression that either no one really knows what's going on, or someone just doesn't think it's a priority to pass information down the line. There really is no excuse for either one.

So here I am on active duty with the army again after 14 years. The big wait now is for the official mobilization order to come out which will dictate exactly who is going and in what capacity.

You will of course notice that some things have changed around on the blog, and all credit is due to my BIL. Thanks Eric. I really want to build this email notification list, so email the yahoo account.

2007-04-01T22:58:00.002-04:00

April 26, 2004

"Vegas dealin' "

The logistic requirements of moving an ACR are staggering. I knew it was going to be bad, but I had no idea. Actually, my personal part is not altogether unbearable. The biggest problem has been a personnel issue well above my pay grade. At the center of the storm is what is known as the ODD (Overseas Deployment Draft)(or document-nobody is really sure).

Basically, we were instructed to form what is known as a Direct Support Field Artillery Battalion. Our tasking will be to coordinate indirect fire support and other logistical needs for the other maneuver elements, as well as maintain two mechanized companies. There are quite a few field artillery qualified soldiers in the Regiment, but it seems like very few are actually in 1st Squadron. This means that there has to be a tremendous amount of "cross-leveling;" that is, moving men and equipment to new homes so that we meet the configuration demands. It really is a big swap meet.

Or if you think of it in Vegas terms....

Imagine a cool handed, sharp eye dealer, with a wreath of smoke circling over his head....long, manicured fingers skillfully manipulate a deck of cards, shuffling, cutting, reassembling. High rollers with thousand dollar suits gather to watch the master while hushed whispers fill the room with a palpable tension. All the while he stares down his opponent with steel in his eyes and ice in his veins, knowing that every card will move to the position that he has ordered.

.....now forget all that and picture a two year old in a dirty diaper, who just broke into the closet and is busy throwing your Monopoly money around, eating your Backgammon pieces and has no less than seven old decks of Bicycle brand crammed in every conceivable crack of the floor, covered with Cheerios and smashed banana with a Mad Magazine look on his face that screams, "What? Me Worry?" 'Cause that is really much more what it's like.

And to top it all off, I can't seem to find anyone other than me, that thinks it's a big concern that I haven't received any of the medical supplies that I ordered.

What? Me Worry?

2007-04-01T22:58:00.001-04:00

May 22, 2004

The Valley of the Shadow

"Yea, though I walk through the Valley of the Shadow of Death, I will fear no evil, for thou art with me." (Ps. 23:4)

The days are quickly passing by.
We will deploy in just over a month. But our climate has changed. We will not be going in theater with the same country that invaded Iraq. Since the fall of Saddam, this has become a much less popular war.

I am still convinced that we were right.

We know that he had WMD.
We know that he did not comply with UN directives to account for what he had.
We know he was willing to use them.
We know he had billions of dollars, and at least a passing relationship with various terrorist organizations.

To say that we should have allowed the UN to continue to try and negotiate compliance is the pinnacle of naivety in light of their failure to force compliance with 19 separate resolutions.

Given the events of September 11, 2001, we had no choice but to view Saddam as a threat. I contend that if the United States government had said prior to 9/11 that we were going into Afghanistan to take down the Taliban and Osama Bin Laden, there would have been public outrage at the unprovoked, pre-emptive nature of the action.

The fact is we failed to act on what we did know, and 3,000 of our citizens went to their graves.

So don't tell me that Saddam wasn't a threat.

The political pundits who trumpet the righteousness of the UN are blinded by their own intelligence. The UN has proven itself to be an ineffective, straw man existing for the sole purpose of giving mental comfort to people of weak constitution with the idea that "something will be done".

There is a feeling of discontent with the events in Iraq.

The weapons have not been found, allowing those who hate the current administration to rail against the president unchecked.

Meanwhile, soldiers have continued to fight and die in a country where a growing number of their countrymen don't think we should be in in the first place.

And as if this weren't enough, the spectacle of the Abu Ghraib prison has come to light. This has to be the single most disheartening blow to morale since this whole thing started.

My emotions are mixed. I personally am willing to tolerate a lot more in terms of gathering intelligence if:

A) they are known terrorists
AND
B) there is good reason to believe they have knowledge of impending attacks on Americans.

I will not say how far I would be willing to go, but I will say this- I will not weep for the guilty.

The problem is that there were innocent Iraqis that were swept up into prison and that is to be expected. To keep them confined, to strip search them, to remove them from the luxuries of life, to keep them isolated- that is all justifiable. Remember, Iraq is a war zone, not your home town.

The things that were done beyond that are absolutely despicable and the soldiers involved deserve what's coming to them. And I mean all the soldiers.

1) The junior enlisted knew that what they were doing was wrong.
2) If they were given orders, they knew they had not just a right, but a responsibility to refuse those orders.
3) If there was confusion as to who was in charge, then they are guilty of negligence in determining the chain of command.
4) Their NCOs are guilty for their own participation.
5) The NCOs are guilty of not providing leadership, support, and moral guidance.
6) The platoon leaders and company commanders (officers) are guilty of dereliction of duty for not being in control of their soldiers.
7) The officers and NCOs are guilty of failing to enforce standards when the soldiers were in Reserve Component status, thereby fostering the climate that allowed soldiers to live without discipline.
8) The Commanding General is guilty of failing as an officer at so many levels that I can't bear to speak of it.

....and so on and so forth.

It is true that the chain of command is liable for the actions of its soldiers. What is less clear is how far up the chain you go.

Regardless, for those unfamiliar with the Uniform Code of Military Justice, let me assure you that is is fair, it is harsh, it is applied swiftly, and I am quite confident that several soldiers will go to prison for their actions. I am also confident that it will not be limited to the junior enlisted.

On top of this, I still hear people use the phrase "..during the war". What does that mean? No, there is no huge movement of troops and machines going into Baghdad. But the war is still going on. In fact, the fight has in a sense become harder, as the enemy has us where he wants us. Our soldiers are surrounded, and they are being forced to fight his kind of war. If you must refer to the specific period of time during the push to Baghdad, please the use the phrase "..during the invasion". To say "during the war" only lessens what the servicemembers with boots on the ground are doing.

So what does this all mean to me?

I am leaving my family, my home, my job to go fight in a war that is supported less and less everyday. My commander-in-chief is attacked every day by the media, the congress, Hollywood, most of whom have never given anything in the service of their country. I have been ashamed of the behavior of fellow soldiers, and there is evidence that the actions of the chain-of-command are little better. My enemy is using tactics that are nearly impossible to predict.

I feel that I have already entered the Valley of the Shadow of Death, for there is a cloud hanging over this nation. The only good thing about a valley is that in order for one to exist, there must be hills and mountains.

"I will lift up mine eyes unto the hills- from where does my help come from?
My help comes from the Lord, the Maker of heaven and earth. ( Ps. 121: 1-2)"

This has been my state of mind over the last weeks, so I was looking forward to the EMS awards banquet this past Wednesday night. It was a chance to put the business of the Army behind me for awhile and see my coworkers again. It was quite the enjoyable evening with good food, good friends, good fellowship, and free babysitting. I chose to wear my Class A (suit and tie equivalent) uniform. I wanted to do that as a show of respect for those soldiers who weren't enjoying a night on the town. After the banquet my wife and I were not ready for the evening to be over, so we went to a local pub to enjoy a beer and some time alone. As we sat there, me with the uniform and symbols of 14 years of service to my country, I couldn't help noticing the crowd and wondering what impact the war, the lives lost, and the sacrifice made by our men and women in uniform had had on them. Did they care? Did they realize what millions of men and women had given up? What would they be willing to sacrifice? As I sat there I started to sink lower and lower, convinced that these people would continue their lives, blissfully unaware, and unconcerned. The Shadow that had been pushed back, if only for brief time, had returned on me full force. Our waitress came to check on us.

"Can I get you anything else?"
"No thank you. We'll just take the check please."
"Actually," she replied, " Your tab has been picked up by someone, and I'm not allowed to tell you who."

Have you ever noticed how a tiny candle can push back the darkness?

2007-04-01T22:58:00.000-04:00

June 05, 2004

Windows to the World

I'm sorry about the notification list. According to my BIL that particular function of MT requires a bit of software that can't be installed on his server, so I will build an email list based on the Yahoo address.

We are still scheduled to deploy on the 25th of this month.

The odd thing is that working for the Army full time has not been as humorous as working EMS. In fact, it is quite dull. I blame this fact for the lack of blogging.

Two rather funny things that did occur:
I was making the point to one of my medics that we needed signs that could be posted around the aid station designating where triaged patients could be located(ie: critical, delayed, etc)

He said he knew where he could get hold of some road signs that we could take with us. I replied that that would be fine, but we would have to add to them in order to make them functional as in:

STOP
(here for the aid station)

YIELD
(to the seriously injured)

RIGHT LANE MUST EXIT
(to leave the area)

you get the idea.

Then Friday we finally received a briefing giving a specific location in Iraq. As we waited for the computer to power up, the discussion centered on the harshness of life in a combat zone, the threat in the area, recent combat action and the like. As the computer and projector booted up the Windows XP desktop known as "Bliss" came into view. For those not familiar, it is a very pastoral scene of a sunlit, rolling green meadow.

Someone interjected
"Well, that doesn't look so bad!"

Would that it were so.

2007-04-01T22:57:00.002-04:00

July 06, 2004

Hello Mother, Hello Father. Greetings from Camp Shelby

In 1992 I came off of active service with the army and began my association with the National Guard. We did our first Annual Training(AT) at Camp Shelby. Now I realize that they probably have not had the same money that is currently being infused by the active component, but what have they done with their annual budget since 1992? They certainly haven't invested in the facilities.

We left out on the morning of the 25th and it was appropriately rainy and dreary. It was heartwarming to see the number of people that came out to say good bye and stand in what was often a down pour.

My family and friends were gathered around the Brown's Ferry Road exit. I didn't get a real good last look at them though. Even at 45 mph convoy speed, it's next to impossible to focus on all those faces. Still, I know they were there and that means the world.

As we came through Trenton, my driver and I noticed a man driving his pickup slowly along the shoulder, with his arm out the window waving his UT cap at us. We didn't think much of it; we just attributed it to the natural desire of Tennessee fans to relate whatever is going on to the world of football. All things are blessed in Tennessee if we can incorporate Phil Fulmer and the colors of orange and white.

We passed this guy and not too much later he was pulling along beside us and hollering "Take my hat with you!" I was relucatant since I knew it would clash with all of the outfits I had brought with me.

After a "Dukes of Hazard" transfer of the hat, I took a closer look. It is autographed by one of the Tennessee players and has the owner's name and information on it. So now my plan is to carry it all the way to Iraq and try to photo journal its travels. I will of course return the hat.

Camp Shelby is a dismal place and it has rained everyday to some extent since we got here. I have not blogged sooner as it took me this much time to get regular access.

There have been efforts to brighten our little world, most notable of which has been Apache Battery's landscaping attempts. I commented on it to their commander this morning as a group of us were shaving. Someone else asked him to what I was referring. He commenced to describe in detail the work that had been done with the "black marble gravel" red mulch and various plantings.
To which I added "Yeah, it's a regular Queer Eye for the Cav Guy over at A Battery."
Too good an opportunity to miss.

Training is beginning, despite a rough and confusing start. Things will move along and get better. I found myself in a unique position the other day.
We are now running the Battalion Aid Station and one of the soldiers that came in had to be taken up to the Troop Medical Clinic for something that we could not completely evaluate. They asked me if I could take him up there in my Hummer.

As I walked out the door with the soldier it dawned on me:

I'm back running ambulance calls.

2007-04-01T22:57:00.001-04:00

July 18, 2004

Then again....not that much has changed....

Despite my new surroundings, I still find myself at work.
Our mission as a medical platoon has changed every day since our arrival. To begin with, we were not supposed to be providing any internal medical support. Sickcall was to be handled by the Troop Medical Clinic (TMC) all of the ranges and training events were to be supported by Shelby people, and I had asked all of these questions well in advance of our arrival.

It began with the CO wanting our PAs to see people casually to help get them back to duty quicker and has now grown to us operating a Battalion Aid Station for twelve hour days. We have been seeing and treating between 30 and 40 soldiers a day.

The funny thing is that we see the same things that are often seen in the civilian world. You would think that being a soldier, one would tend to avoid the appearance of being trivial about their health. On the other hand, avoiding duty by using sick call is a time honored soldier tradition. Besides which, most of these soldiers have never had the ready access to a health care provider that the army provides. It does mean now that I am functioning much more like I am supposed to.

The biggest event lately was Thursday on the firing range. The S3 had asked for one of the PAs to go to the ranges so that the next level of care was readily available. We were anticipating a lot of the soldiers having to struggle with the heat. Given that we are in a time sensitive training schedule, the hope was that we could get soldiers back to the firing lines so that they could qualify, rather than having to send them all back to the rear.

The day started off typically. I have covered a lot of ranges over the years and this was no different. Early formation, sorry breakfast when you get there, range is not set up and working correctly; which all resulted in tired, hungry soldiers that didn't get to start firing until mid-morning. The heat index was steadily on the rise and would hit 108 before the day was through. I had brought my personal aid bag and some extra stuff, but didn't really think it would be too dramatic.

At about noon, things started to happen. Soldiers started dropping like flies. Not enough water, rest, or adequate food caught up with them. In addition we were all in full body armor and Kevlar helmet, which makes you feel similar to a potato wrapped in tinfoil and shoved in an oven.

As they started going down in more than one place, I made the mistake of trying to get myself and the medics from one point to the next. Finally I woke up and decided to have other soldiers bring the patients to me and the PA and the rest of the medics. I commandeered a tent that had been set up for shade and essentially established a Casualty Collection Point. Once that happend things began to move easier and we were able to control and treat a lot better. From noon until 6 that evening, we evaluated and treated upwards of thirty soldiers for varying degrees heat injury. I personally started about 12 IVs and all of my guys each got several more. Good training for us, not much fun for them. Mainly I was able to focus on directing the movement of people and supplies and getting tasks done.

Ultimately I hope that I was able to solidify my position as the man to go to when things like this need to be done. It is difficult for a 2nd Lieutenant to establish a position of authority against senior officers no matter what the experience level. Hopefully this little mass casualty event built a little confidence in them that I do know something about handling these situations.

Meanwhile, I am tired and need a day off.

Sorry, not much humor here today.

2007-04-01T22:57:00.000-04:00

August 07, 2004

Next month we're done!

What a beautiful phrase! Up until now we kept saying "....month after next..." which is not anywhere near as comforting. Unfortunately, we still have the NTC ahead of us, not to mention a year in theatre. But to leave Camp Shelby, aaahhh what bliss! You can imagine the the taste I have in my mouth if I am actually looking forward to going in theater. Besides, it will mean we've taken one more step towards home.

We are still seeing 20-30 patients a day in the aid station, and my personal workload is focused on keeping that operation functioning. To date, we have not received anything in terms of medications that I have ordered. I am as frustrated as I can possibly be with the army medical supply system. What's sad is that it is not so much the fault of the system as it is the people that are supposed to be operating it. I cannot abide laziness. I knew we would be in this situation. Everyone kept shouting down my inquiries about our stock and now we are edging closer and closer to a crisis. If I can't get through to the right people in a very short amount of time, we will not be prepared to do what we need to do.

Other than that, things aren't too bad.

I just received the second in a series of six shots of the Anthrax vaccine. Yes, this is the vaccine that such a fuss was made over when a soldier refused to take it.

I will tell you that it is a very devious vaccine. There is very little if any pain after the initial injection. After about thirty seconds on the first one, your arm begins to feel like someone hit it with a baseball bat. I was anticipating much the same sensation on this one, but this time it felt like someone had injected a glowing ember in my arm. I can definitely see why someone would be reluctant to get it.

In other news:

A tractor trailer from the Mayfield Dairy Ice Cream plant showed up, crammed to the gills with ice cream in various forms. What no one seems to have thought of is the fact that none of the enlisted guys have freezers available to them. This presents a problem in Mississippi in August. A valiant effort was made by all to consume the products within the first thirty minutes. Many thanks to Scottie Mayfield and associates.

I am currently reading my way through the Patrick O'Brian series on which the movie "Master and Commander" was based. Pretty good for historical fiction. It presents a unique challenge since much of the dialogue involves archaic naval terms with spelling that is meant to communicate a thick British accent. Much of the time I must content myself that when a "broadside" strikes the ship tearing away the "foc' sle" or the "main top 'sle or "mizzen" or "jib", this spells impending disaster.

Still it makes for good early morning reading on my "poop deck".

2007-04-01T22:56:00.001-04:00

August, 2004

Progress is a dish best served slowly.

What news can I give you?
It's still hot and I'm still here.
Although air conditioning is going in building by building. The training schedule continues to move on, which is a good thing since everystep behind us brings us closer to home. There is still a tremendous problem getting Class VIII in, that's medical supplies to you non-army types.
We had to get our aid station equipment validated, which was to consist of a layout inspection to make sure we had all the stuff we need. Never mind that we had received a whole new issue in December of last year(which, by the way, was my first clue that we were going to be going over). Anyway, we load all this stuff up, drive it to a large covered area, pull it all out, the guy looks through two cases, satisfies himself that I can count band-aids and says he's done.

!!!!!!!

Why didn't you just believe me in the first place when I said I knew what I was missing? It would have saved me a lot of labor.

I had my first day off in three weeks on Sunday. I pretty much only left my bed for bodily functions and spent the rest of the time inspecting the inside of my eyelids.

Amazing that I took a day off and the world didn't end. I must try to do that more often.

Camp Shelby has quite the skunk population.
Seeing one or two would not be so unusual, but these things are everywhere. And they love MREs.

I'm going to end this blog, since all I can seem to write about is the wildlife.
Someone get me out of here.

2007-04-01T22:56:00.000-04:00

August 17, 2004

Uninspired

So many people tell me "You need to update your blog...", but it's hard to turn out work of this quality with such a lack of inspiration. I do want to note several things for the record:

Within the Regiment we now have 12 new Lieutenants that had orders to report to active units and have now been sent to fill vacancies with us. That is huge. I guess it's been done before, but I've never seen it. It makes me laugh when I think of how many times I've heard soldiers/other people say, "The army can't do that!" Oh, yes they very much can. They can do whatever they want.

On the heartwarming side, I had occasion to go by an oral surgeon's office that we have been using to do a lot of corrective dental work. They have huge flags hanging down the front of the building representing Tennessee, Mississippi, Texas and New Jersey (yes, we have a unit from New Jersey going with us, and my, don't they stand out in the crowd).

Also, apparently word got around in Chattanooga that we were trying to procure an EKG to go with us since the army, in its infinite wisdom, doesn't think that's important enough to issue us one. A private citizen heard about the need, went on E-bay, and bought one for us. Funny thing is, it's one the army had purchased at some point and never used. It's an older model HP, but it's in brand new condition, will give us five leads, and is more than we had yesterday. It won't defibrillate, but I'm going to see if I can find the add on module for it.

To the concerned citizen:
You're a great American, and I don't say that glibly. You have the heartfelt thanks of me, my platoon, and the entire 1/278th.

So maybe I'm a little inspired.

2007-04-01T22:55:00.002-04:00

September 06, 2004

"Turn the glass and set the watch."

I feel compelled to make an entry if for no other reason than to mark the passage of time. My free moments have been much occupied with continuing on in the Patrick O'Brian series, hence the obscure title as it is a fitting tribute to my current situation as well as this fine series of novels. I can clearly identify with O'Brian's characters as they enter periods of the regular routine of sealife, often wistfully staring out to sea, longing for the cry of "Sail Ho!" and the promise of a raucous engagement with the enemy. O'Brian's masterful writing pulls the reader in whether the ship is fully engaged or drifting along in a listless sea for weeks on end. He is able to carve out each particular character as jovial, sinister or sarcastic in spite of the setting in a fairly conservative time period and using often archaic english.

When I have time, I intend to blog certain classic examples of what I am referring to.

Our life here is much the same with only the new pleasure of beginning to pack for both the NTC and for theatre. I am convinced that once the regiment is in Iraq, morale will greatly improve. The continued languishing at Camp Shelby has done nothing but degrade the soldiers in my humble opinion. The time has allowed us to correct several situations, but that is small comfort as though things would not have been issues in the first place had people simply been doing their jobs.

I continue to profit from working closely with our PAs as they are able to educate me on the management of long term problems that I am not too familiar with due to the nature of my work. The experience of being a leader in this situation is also adding to my frame of reference as it brings its own unique challenges. I hope to add to my as yet unpublished blog discussing methods for utilizing some of the army principles of leadership in EMS.

My entire family came to visit my two weekends ago, and my wife came down for a three day visit and left this morning. These brief visits are bittersweet. As much as I enjoy my family, the parting is just reopening of old wounds for all of us. I sometimes think that to simply be gone will be so much better.

It is, of course, September, which marks the beginning of my six month of active duty and brings us that much closer to the actual deployment overseas. The 155th out of Mississippi is now here, and as they will be here when we are gone, there is a definite joy that the glass has been turned, the new watch is set, and we are gaining speed in a fair wind.

What lies beyond our horizon? All the charts are marked with an ominous warning:
"Here there be monsters."

2007-04-01T22:55:00.001-04:00

September 23, 2004

West of Omaha, NE

Well, the army, in its infinite wisdom, decided to change my flight time from sometime Friday morning to 19:00 this evening. Not such a big deal, except that they did it at 9:00 last night.
So I will be boarding a plane bound for California later this evening.
I have never travelled further west than Omaha unless El Paso, TX happens to be geographically further than that.

The problem with the army is that my experience has allowed me to travel, but I always am in a training status and don't really get to capture much of the local flavor.

The army recruiting line should be:
"Join the army. Learn an exciting job, travel to foreign places, meet no one, see nothing interesting, and eat really crappy food while you're there."

Think it will work?

So far the whole NTC thing doesn't sound too promising. I don't know how they expect to gain anything from going out there when all of our equipment is loaded up and headed to Kuwait. The usual complement of NTC equipment isn't avialable either as they are currently downscaling that operation to support the Iraq theater. No one seems to have a good plan for the movement of the Regiment from the holding area out to the training area. Somebody really should start planning some of this.

I did get sent to the Combat Casualty Care Course (C4) at Ft. Sam Houston, TX, which amounted to repeating much of the same training that we have done here, but with the added benefit of trying to show a bunch of doctors and nurses how to move tactically and take care of patients. Very funny as you can imagine. They were completely reliant on those similar to me to show them how to get things done. Fortunately, most of them will never be in that kind of tactical environment and if they are, something has gone very, very wrong.

Well, not much else to relate from here. And it's doubtful that I will be able to blog from NTC. But then, what else is new?

2007-04-01T22:55:00.000-04:00

October 16, 2004

Seriously, it never rains in California

....except for a brief shower one evening that didn't even dampen the ground.

Yes, I know...this desert is not representative of the rest of California, but this is ridiculous. It has been a trying three weeks and I am ready for this to be over.

It did serve to act as a training tool, which is good. My platoon was well received by the OCs (evaluators) and they really didn't mess with us too much. The secret is that I have a group of guys that are very willing to work so that all I have to do is stand and answer questions and pretty well keep them befuddled. I may not be the smartest guy in the world, but I know how to move ambulances around.

I think our battalion had a very good rotation. We had many very positive comments on our whole operation. There were things that could have gone better, but I think we proved that we can do what we need to.

There has been time for some fun.
My platoon sergeant tried to tell a joke about a monkey and a bar that was served "grapes and acorns". He meant to say peanuts or popcorn or anything else other than "grapes and acorns" but once that was out, we were all in hysterics wondering what kind of screwed up bar this was that he couldn't finish his joke.

We also had a sand sledding contest down the side of one of the 8-10 ft berms that the bulldozer had pushed up. Wasn't a whole lot of sledding, but there was a lot of falling and sand getting into very strange places.

And tonight we had an impromtu baseball game with bandages wrapped up in duct tape and part of a cot frame as a bat.

I still miss my job though. Much as I hate to say it since most of my blogging to this point seems to be griping about the worst aspects of work.

I have been extremely impressed with my guys and their skill level. Most of them have very little if any real world EMS experience, but by and large they seem quite capable.

By way of introduction:

Mike: 40 years old, our PA, lots of experience, has a hard time taking the army seriously. Has been good to have him around.

"Smoke": 56, my platoon sergeant, always has a smile, works as a raft guide. already did some time in Vietnam

Kenny:38, very reliable, very high strung, easy to mess with.

Shawn:? works for Monroe county EMS, reliable, easygoing, has his boat Captains license so a lot of common ground about fishing

Ed: 31, our only black member. also easygoing and reliable. am really beginning to build a friendship with him.

Erin: 30 went to OCS with me and didn't take his commission despite my advice. now wishes he had listened to me.

Albert: 58. not a mean bone in his body. struggles with EMT skills but is very willing to help out. also did time in Vietnam.

"Big": 40 lays block for a living. not very motivated but doesn't mind hard labor.

Mike G: ? cop. knows what to do, but you have to tell him to do it.

Tobey: ? former marine. new to the unit but fits right in. very willing, very capable.

Adam: 25. good kid. knows what to do, does it, never complains.

Caleb: 22. also a good kid. emphasis on kid. willing, good knowledge, lacks maturity and experience.

Jamie: 22 good kid. has his head in the clouds, but is gee whiz at a computer.

...and then there's the Col. another PA in the section. considered now as my nemesis. civility prevents further comment.

These are the men I will lead in Iraq. May God protect us all.

2007-04-01T22:54:00.000-04:00

October 25, 2004

I spoke too soon.....

....because it opened up and poured on us. I don't know how much rain we got in one day, but it was enough to force us to dig a trench past the shelter we were using to rout water away. In the best tradition of the American soldier we ran the trench right past the door and created a river with obstacles and class 4 rapids on which to race Fruit Loops, which by the by, proved two undeniable facts: 1) soldiers will wager on anything 2) Fruit Loops are really only good for about one trip down river.
The competition was fierce and all colors seemed equally buoyant save blue, which was ridiculed and cursed with extreme ferocity. (Note to self: check displacement value of Blue #5 as a food additive).

We finished NTC in grand style, even if we were a little soaked, and returned to Shelby to do....absolutely nothing. Went through the paperwork process again which involves a lot of people, sitting at a lot of tables making a lot of mistakes. To top it off, the next to last table, after a three hour process, is someone checking to see that everyone did their job, followed by someone checking to see if somebody checked! And I am still not confident everything was done right.

In the process of getting my ID card updated to reflect my promotion (yay...), my PA was sitting at the next computer doing the same thing. The one clerk stated that his computer would finish uploading the data to Mike's file before mine was finished.

Mike: Dollar?
Me: Done!

(see the paragraph regarding Fruit Loops)

So back home for a short time of leave and then on to the big show.

I got a buck that says something gets screwed up between here and there...any takers?

2007-04-01T22:53:00.001-04:00

November, 2004

kuwait

Having arrived in theatre yesterday, I am struck by the fact that this place looks remarkably like the NTC.
The temperature is a mild 80+ which is a relief.
I had a brief moment of nostalgia in Germany reflecting on my assignment there. That was of course during Desert Storm. Now, 14 years later, I can't believe I am sitting in Kuwait. Not much improvement it would seem.

There is not as much here as I would have guessed and this internet connection is intolerably slow.

Sorry about all the spam comments, I am working to clean that up.

More later.

2007-04-01T22:53:00.000-04:00

December 15, 2004

So this is Iraq.....

Well, well, well.....here we are.....the big Sandbox....the former domain of the Bush family nemesis....

To characterize it simply...is there any country on earth that doesn't have flies?

After years and years of hearing it, of reading about it, of seeing it portrayed on the big screen, the fear, the boredom, the humor, the irony of life in a war zone have come home to roost.

Fear is riding down a narrow road pockmarked with holes from ambush sites.
Boredom is realizing that you have no bootleg movies to watch.
Humor is watching a bootleg movie and seeing someone's head pass in front of the projection camera.
Fear is getting caught watching bootleg movies....
....which, by the way, is kind of ironic.
Irony is also having an international calling card from ATT, having the automatic operator tell you that you have 300 minutes and would you like to contribute some of those minutes to troops overseas.
Humor is telling the operator no, you would not like to donate because you are a troop serving overseas (fear) and then being told that you now have only 30 minutes on the same card because you are now trying to place a call back home from overseas in an attempt to fight boredom. More irony.
Humor is two convoys of hundreds of vehicles trying to turn in the same intersection while dodging the local Iraqi road crew.
Fear is that which drives a herd of 40 camels into the same intersection in an attempt to graze the last bites of grass before the Americans and/or the road crew destroy them.
Irony is that the grass over here looks awful.
Fear is that I won't get my camera out in time to photograph this circus.
Irony is a soldier from your camp, days from returning home, who is wounded by an IED. And he hardly had left the base in a year.
Fear is that the next time it will be me.
Fear is that boredom will overtake you and you will become complacent.
Humor is getting to the end of a convoy and being able to hug your fellow soldiers and find things to laugh about....and in that there is certainly no irony.

2007-04-01T22:52:00.000-04:00

December 25, 2004

A Soldier's Christmas

At home they have a large evergreen, decorated with tinsel and balls, and lights. But not for the soldiers.
At home they have boxes and bags wrapped in the colors of Christmas. But not for the soldiers.
At home they have a turkey, done to perfection, with all of the trimmings. But not for the soldiers.
At home they are laughing and spending time with their loved ones. But not the soldiers.
Where is Christmas when you are so far from home? How do you fill that void and remove an ache?
Christmas is an evening worship service held in a makeshift chapel, singing with other soldiers with more enthusiasm than talent.
Christmas is a sharing a pot of coffee in the morning with your guys coming off patrol.
Christmas is breaking into the canned food stockpile for a feast of salami, ham, crackers, and smoked mussels.
Christmas is a wry grin and a "Merry Christmas" from a soldier as he walks in the rain to his vehicle with a .50 caliber machine gun on his shoulder.
Christmas is cornbread baked in an auto-clave because you don't have an oven.
Christmas is a heartfelt handshake from your platoon.
Christmas is reassuring one another that "....next year we'll be home for Christmas."
But mostly Christmas is a month in country and we are all alive and well.

From the 278th: Merry Christmas to all the ones we love.

Posted by andygienapp at 11:11 AM

2007-04-01T22:50:00.000-04:00

January....05

I don't want to write for the sake of keeping this thing updated. It seems pointless. Especially given the fact that the blog is supposed to documenting the fast paced world of EMS...not the day to day of life in a war zone.
Things are becoming routine here. My guys spend their days on patrols or convoys, and I fill in as needed. Mostly I focus on keeping the administrative side of things in order. It's hard to believe that I have spent so much time trying to get to this point, where I manage schedules, vehicles, and people. Less and less patient care seems to be the order of the day for me. I do still love to get my hands dirty.
Things have been calm but are steadily heating up as the election day approaches. We are finding more IEDs more weapons caches and more bad guys. It is hard to know how to feel about the Iraqi people. I think most of them just want to survive. But then we get reports of them infiltrating the police or the Iraqi army. They all seem to know, but are hesitant to take action. The Iraqi police, at least in this part of the world, are worthless. Unwilling to take risk, undisciplined, and ineffective.
Life on the FOB could certainly be worse. It could also be much better. But we have it so much better than others that I don't want to gripe. Some of our guys have nothing.
We at least have hot showers.
The worst part is facing the idea that my career and family are on hold while I am here. That wouldn't be so bad if you could clearly see progress or could tell that the Iraqi people are grasping hold of the concept of democracy. Granted, democracy is a slippery baby to get hold of but take a stab at it will ya'?
I am beginning to relate to the soldiers that have done this before and left a war with a sense of frustration at their government. In my most rational mind it can't be denied that a stable country in the middle east is a benefit to the entire world. It's just very hard to keep that in mind when this is January and we won't be leaving until December. Blech!
But that's pure selfishness showing through aggravated by the same stupid crap that frustrated me with the active army anyway. And that's where I will stop with that line of thought.
One of our convoys was hit by an IED two days ago. Thankfully, there were no serious injuries.
So we're still here and the best thing about tomorrow is that its tomorrow.

2007-04-01T22:49:00.001-04:00

January 28, 2005

The Birth of a Democracy

If you get the sense that there is very little detail in my postings you will understand that I must censor myself. While I am absolutely a defender of our First Ammendment rights, there are greater things at stake.

The significance of the next few days is not lost on me and I hope that it is not lost on you, dear reader. We have the opportunity in our lifetime to observe the development of a nation that has been given the chance to rewrite its entire future. I truly believe that the next two days will set the tone for the people of Iraq for a long time to come.

On a practical front, I have been very busy trying to make sure all of my players are in place and prepared to support this process. Again, I am not at liberty to discuss this, but am quite certain that the media has been able to convey a general impression of what is going on all over Iraq. Those of you in the emergency management fields could probably form a fairly accurate hypothesis of what our setup will be and look like.

We have had several good contacts with the Iraqi people on the medical side. Their own health care system is so tied up with red tape and fraud that it is largely ineffective. So anything they can get is much appreciated. This is just one of the many issues that any new government will have to address rather quickly if Iraq is to stabilize and provide for their own people.

We spend our time looking for ways to entertain, and recently have begun to build up to a large chess tournament. Which is probably more productive than poker, but doesn't lend as easily to......things that naturally come with poker.

We have had quite a bit of rain and the FOB has turned into a large mudhole. We also are not getting any mail right now.

But, as I have pointed out on several occasions, there is a war on you know.

What movie was that....?
"It's a s----y little war, but it's the only one we've got."
Too true.

2007-04-01T22:49:00.000-04:00

February 15, 2005

Disclaimer

Posted by andygienapp at 01:49 AM

Let me apologize to all of my readers about the spam comments. I in no way advocate most of what they are advertising. And even if I would support their products (there are some legitimate prescription drugs that are spamming me) I do not support their right to utilize my blog as a forum. This is simply an outrage that these companies and individuals feel that it is ok to take advantage of all bloggers in this manner. I am afraid I will have to disallow comments and just go back to allowing you to email me. I am truly sorry if anyone has been offended by what they have seen connected with this blog.
And this has nothing to do with free speech - what they are doing is tantamount to spray painting graffiti on my house.

In terms of Iraq, things are grinding away. Missions go on, and we continue to manage as best we can. It has become evident that the entire infrastructure is inadequate. The Iraqi government does not have the resources available to even begin making headway on most of its problems. Obviously, security is the first concern, but in healthcare alone they face a daunting task. Many of the local children that we make contact with have genetic disorders that could only be attributed to years of little or no prenatal care and probably exposure to a laundry list of pollutants. While this is the state of affairs in most underdeveloped nations, it seems especially harsh here with the United States spending the amount of money that we are trying to get them back on their feet. It will take years to fix this place and require a robust and growing Iraqi economy, with dedicated Iraqi leadership at every level.

Hard to see how that will happen when a murderer can drive a car bomb into a crowded market and obliterate anyone near him. Face it America, we are going to be in Iraq for a long, long time.

2007-04-01T22:48:00.000-04:00

February 18, 2005

Rest and Relaxation

Posted by andygienapp at 04:48 AM

The following is a review that one of my guys did after his pass for rest and relaxation. Keep in mind this is supposed to be a period of relief for soldiers. This particular soldier, since we have been here, has had the element he was with engaged twice with small arms fire and had an IED hit his vehicle.

Comments that appear {-AG} are added by me for clarification.

Transient Housing Quarters{LSA Anaonda-AG}: February 3rd, 2005 to February 6th, 2005
The housing quarters provided was a plywood building with no waterproof roof. The night of the 3rd it started to rain at approximately 0400 hours, soaking the entirety of the barracks. At approximately 0700 hours, the barracks occupants were moved. The barracks was provided with metal railing beds with a foam mattress of approximately 2 inches in thickness. Showers were provided at approximately one kilometer away. There was no gravel at all to and from the showers. On the date of the 5th, the leave date from LSA Anaconda, The R and R group was moved to a temporary housing tent near the flight line at approximately 1100 hours. The flight time was changed three times, the last being at 0300 hours. The tents had inadequate heating, the thermostat reaching at a maximum temperature of approximately 18º Celsius. At approximately 1100 hours, the R and R group was released at Camp Doha, Qatar.

Camp Doha: February 6th, 2005 to February 12th, 2005
The housing quarters for males E-7 and below were communal living tents in a warehouse. The tent at which our R and R group stayed in was occupied with two other groups during our stay. The maximum of occupants were approximately 100 people. With groups being moved and groups coming in, the lights out hours were interrupted between the hours of 2400 and 0800 hours every night after the 8th. The post recreational activities available are as follows:
1) 1 24 hour PX
2) Two vendors licensed by AFEES selling cultural souvenirs and Persian Rugs.
3) Chilis Restaurant with 4 main courses offered
4) Burger King Restaurant
5) Green Beans Coffee Shop
6) Pizza Inn
7) 1 TV room with a big screen TV.
8) 1 gym
9) 1 massage parlor
10) 2 internet cafes
11) 2 phone centers
12) 1 swimming pool
13) 2 bars serving alcohol, 3 drink limit
The souvenirs at the local souvenir shop range in Pakistan Marble tea sets $35, Indian Jewelry Boxes $100, African ostrigue eggs $80, Persian Rugs $1600 (3 X 5, hand-woven silk) to $4500 (8 X 12, hand-woven silk), Persian Rugs $300 (8 X 12, machine-woven silk). The Chilis restaurant menu had one choice of steak (ribeye), steak or chicken quesadillas, chicken strips, burgers, and salads. The internet cafes, phone centers, and gym had no wait time. 1 bar was housed in a warehouse. The other bar was set up like a night club, featuring a dance floor and live dj. The 3 drink limit was enforced by a computer database populated with social security numbers. The beer served was Budweiser, Hobarg, Heineken, and OrangeJamm at a price of $3 each. The liquor served was 1 well-brand shot at $4 or 1 mid-shelf at $5.
The off-post recreational activities offered are as follows:
1) 2 malls
2) desert off-roading with picnic
3) 1 kilometer cruise
4) Cultural tour
5) Fishing Trip
Two Trips are offered consecutively with a three day break. The trips can host approximately 20-40 people, depending on the trip. At the time I was there, there were approximately 300-400 people at maximum wanting to go off post. The trips last approximately 3-4 hours each.
On the fourth day of R and R, there was a formation of 0400 hours. After setting in a hanger with very inadequate heating until approximately 1800 hours, we were informed the flight was cancelled. Our luggage was palletized for flight, including sleeping bags.{This meant that they had nothing to sleep in - AG} The following two days followed the same pattern. On the day of the 12th, at approximately 1600 hours, our group flew out.
LSA Anaconda: February 12, 2005 to February 16, 2005
The quarters were similar as before, with the addition of a waterproof roof. The walls were not waterproof. Each day, we carried our luggage approximately 1 kilometer from the last housing unit to the first housing unit to board transportation to the flight line. On the 12th, we were transported to the flight line at 1100 informed at 1300 hours the flight was cancelled. On the 13th, we were transported to the flight line at approximately 1200 hours and informed the flight was cancelled and returned at approximately 1800 hours. On the 14th, we were informed at arrival to the flight line that the flight was cancelled. On the 15th, we were transported to the flight line at approximately 1700 hours and informed the flight was cancelled at approximately 2100 hours. On the 16th, I was informed by SSG ------ and CPL ------ that they had convoyed down and they could take me back. I decided not to go to the flight line and gave up my seat amongst the 10 chosen to go to the flight line that night. At approximately 1700 hours on the 16th, the 278 liason had informed us that ---Squadron had convoyed down to return us, and that I was not on the “list” to go back with SSG ----- and CPL ----. I decided to convoy back in the open-back 5 ton of -------Squadron. The liason had no way of contacting or finding the address of the convoys that come down from FOB --------. They also had no way of contacting FOB -------- that I know of.

Sound like any vacation you want to go on?
We are passing this up the chain.

2007-04-01T22:47:00.000-04:00

March 26, 2005

Mandalay Needs Help

Posted by andygienapp at 05:11 AM

Since we entered Iraq we have been working with some of the local physicians and clinics trying to get them equipped and working to build confidence in the local populace that their own physicians are capable of treating them. The physicians have been quite receptive and by and large appear to be very competent. They simply don't have the tools that they need. The town of Mandalay will be opening a new emergency and day treatment clinic in a very short while. Most of the construction has been paid for by the Iraqi government as well as some funding through charitable organizations. They will need everything from pens and paper to an x-ray machine in order to function.
This is an appeal to those of you in medicine that would like to do something to support a brand new democracy. If you would like to help, please contact me at my Yahoo address.

We would like to see them receive:
12 Lead EKG and defibrillator
Incubator for newborn
X-ray machine with developer
General and emergency surgical equipment

Those are just the high dollar items. They will need band-aids, gauze, alcohol, basins, bandages, clip-boards, drugs, stethoscopes, otoscopes.....all the things that you folks use on a daily basis.

There are fellow physicians and a whole population that need your help. The doctor in town told me within the last week that he lost two patients to sudden cardiac arrest because he couldn't defibrillate. This shouldn't happen.

Please help me help them.

2007-04-01T22:46:00.001-04:00

December, 2005

Christmas this year has been quite different from the last (I refer you to my entry of a year ago). Despite all of the hubbub and merriment of my own holiday, I still think of those servicemembers all over the world that cannot be with their families this year. I hope you continue to pray for them.
The holiday has served to push me, mentally, back into the EMS mindset, and I certainly feel that I have delayed my return long enough. It has been good to not have to jump back into the grind, but I'm ready for the return of a little tension.
One would think that spending the holiday with copius numbers of family would add enough tension. And they did. Overall though, the enjoyment of being with the family outweighs the negatives. The holidays have served in helping to delay my return normalcy, and I find that a little uncomfortable. We are creatures of routine, and my routine has been disrupted for nearly 2 years now. I will return to work on the 3rd of January.
Hopefully, it will be blogworthy.

2007-04-01T22:46:00.000-04:00

April 15, 2006

I'm back at it. I started back to work on the 3rd of January. I spent most of the day with the paramedic who has been supervising in my absence. The idea here was for us to be able to focus on administrative stuff so I could get back up to speed.Well, we did plenty of admin stuff.....We were in one of the supervisor vehicles headed out to get started. I was driving and came to a stop at the top of the entrance ramp from 153 Southbound to Hixson Pike south. I was leaned forward and looking over my left shoulder for a break in oncoming traffic when WHAM!, we got rearended. I came forward in the seatbelt enough to slam my left eye on the steering wheel. After we got our wits together I called it in and R. checked on the people in the other vehicle.Fortunately, we were all ok. But statistically speaking, I was safer in Iraq.
To paraphrase the movie "Dodgeball"....
Its a shame they don't make a "I just got rearended by 1 ton of irony" tshirt.

2007-04-01T22:45:00.001-04:00

Due to the unfortunate collapse of blogmedic.org, I have reverted to the original url. It will take me a while to get it back into shape, but then, what else do I have to do?
You should start seeing more regular posts from me.

2007-04-01T22:45:00.000-04:00

For those of you who haven't seen it, this picture is of the first contact with my kids after a year in Iraq, one of the most beautiful moments in my life.

2004-03-17T07:04:00.000-05:00

"Wait a minute....."
About three days after my last post the unit called. The 1 April date is on hold.

Apparently someone forgot to sign a check or something.

The frustrating part is that now I'm right back where I started. While the April date was early, at least it gave me some sort of time frame to work with.

I do not want to do this for the next few months. When the original deployment for Operation Desert Shield started, this is what I went through with "We're going" "We're not going". That kind of thing is very hard on a soldier and their family. Ultimately, I believe we will go.

Meanwhile, I can't tell you how glad this makes me.

First of all, this is our election, not the French.

Secondly, the biggest attraction for the French seems to be that Kerry is more genteel than Bush.

You know, I've been to France, and for the life of me, I can't think of a reason to go back.

Unless we're going to exhume our boys and bring them home.

2004-03-10T10:11:00.000-05:00

"I used to wear my faded jeans, now I'm wearin' army green."

Well, my life just changed dramatically.

As many faithful readers know, I am an officer with the Tennessee National Guard, assigned to HHT 1/278th ACR. We received an alert for deployment to Iraq about a week ago, and I have been ordered to active duty starting the 1st of April. I don't want to go into more detail than that on the WWW, but there are some of you that are privy to some more specifics.

Consequently, any blogging that I do will now shift focus. I hope that you, dear reader, are as interested in army EMS as civilian EMS 'cause that' s what's on my mind.

At staff meeting yesterday, the Chief made the announcement that I had been activated, and that they would begin the hiring process for a temporary Lieutenant.

This made me sick to my stomach.

I know it has to be done, but these are my guys and gal (singular) and I am very possessive of them. I want whomever steps in to do the right thing by all of them.

Also, there is of course the chance that the temp will be better liked than me. While this hardly seems possible, it is more than a little disconcerting. Unfortunately, the one who stands to lose the most out of this deal is C.

Her possible scenarios are:
1) The new lieutenant asks her to stay on M9 and they work well together.
2) The new lieutenant asks her to stay on M9 and they hate each other.
3) The new lieutenant asks someone else to be their partner, forcing C. to move to another station with either:
A) someone she gets along with or
B) someone she doesn't get along with
4) She is the new Lieutenant.

What you have to understand is that C. came to work with me on her own accord. I could have made her, but I wouldn't have done that. So she is now in this position because of her willingness.

Whatever the scenario, the good news is I'll be in Iraq where she can't strangle, suffocate, gouge out, or generally mutilate any part of me.

Also, the new HCEMS website is up and running. It looks ok, but needs some work. You can check it out here

Also, this is the link for the 278th Cav if your interested.

More will be blogged, and I hope to maintain this when we get in country.

Meanwhile,

"Gary Owen"

2004-02-11T21:00:00.000-05:00

The Perils of Middle Management

I realized the other day that I have successfully navigated the ship of my career through the treacherous waters of "rookie", past the craggy islands and dangerous breakwaters of "seasoned", through the narrow passage of "promotion", and into the quiet and blase harbor of "middle management". Although the argument could be made that it wasn't as much of a harboring in port as it was smashing into the docks and just deciding to make the best of the circumstances.

How do I know I have arrived?

I attend meetings.

We have a monthly QA/staff meeting on the second Tuesday of every month. The Quality Assurance (QA) is necessary, and indeed required by law. We used to call it Quality Improvement, but in keeping with the best traditions of the politically correct, we changed the name from "improvement" over concern that people might feel threatened by the whole process and do something drastic like take up drinking, or commit Hari Kari with a spatula. My experience has been that a little threatening can go a long way toward getting better performance out of people. Besides, the biggest issues that come up are instances where we want people to improve. The process is supposed to identify weak points, not assure ourselves that we're really as good as we think we are! Maybe we need to think of it as "Please assure the committee that you'll never do this again." Or "If you do this again, I can assure you there will be hell to pay." Or "It's assure thing you're getting time off for this boneheaded move!" Or even "Assure hope you've learned your lesson."

Anyway, it went pretty well. We have a good group of people on all the shifts, generally speaking.

The problem with meetings is that they are unavoidable, and few people know how to conduct them in an expeditious manner. I have made a solemn vow to myself that when I am in position of conducting the meeting, I will put a kitchen timer, set to forty-five minutes, in the middle of the table, and when the bell goes off, we're done. Really, I understand that some things call for long debate, but meetings should not be stream of consciousness. There are some of my peers who think that staff meetings can be done away with all together. "I don't subscribe to that point of view" to quote Sting, Dream of the Blue Turtle circa 1980'sish.

The other aggravating part of this last staff day was (and usually is) the training. This is not as bad if your shift is the one that's on that day, but if you have to come in on your day off, this can really get annoying. Staff meeting wrapped up about noon, break for lunch, return by 13:30 for training which is....(drumroll)...a HIPPA brief from the Erlanger people so we can go on their trauma rounds, which none of us are really excited about anyway, and never mind we already had this from our own people, and why can't we just watch the video tape of the presentation that everybody else is going to watch at monthly training, and we came back for this when I could have gone home at noon?

Safe, but blase I tell you, blase.

2004-01-16T17:42:00.000-05:00

Paved With Good Intentions

Miller Park is located in the heart of Chattanooga, and reflects the best intentions of the city to beautify the downtown area. Unfortunately, the park attracts all of the local ne'er-do-wells. The design is partly to blame. The park is built in a circular design with high ground and a brick retaining wall surrounding it. I guess this is done to isolate the park from the city traffic. It also creates a natural windbreak for those that would like to pass out on the park benches.

Our call was to a fifty something male having a seizure in the park. Given the time of day, location, and nature of the call, we were pretty sure we were responding to Terry. Plus, I had seen the report from the previous shift when Medic 10 had transported him. Terry likes to wait until he has a good crowd of bystanders around that he knows will call 911. Then he fakes a seizure in the hope that we will transport him to the hospital where he can get a meal, and maybe, just maybe, if the gods are kind, he'll get to spend the night inside. Unfortunately for Terry, I was working.

Terry had piled himself under one of the benches, and had managed to work up a good bit of foam out of the side of his mouth. I'm not quite sure how he does this, but it's quite frightening, and I can see how the untrained eye would think he had one foot in the grave. At least he hadn't yet urinated on himself.

Of course the innocents were there with concerned looks on their faces. Mind you, they weren't so concerned that they bothered to drag him out from under the bench, but who's keeping score?

We also had a resident from Erlanger riding with us as part of her ER rotation. These residents, by and large, do not want to be in the ER, let alone be dragging Terry out from under a bench.

My first treatment was to grab Terry by his jacket and drag him out where I could really wake him up. I started calling his name and pinching his chest to make him respond to me. This is about when we noticed he smelled quite strongly of mouthwash. If you're unfamiliar, these homeless alcoholics will buy mouthwash or cough syrup when they can't afford liquor or beer. At least they smell better. Terry was putting on quite a show for the crowd. He woke up when I told him that he had either better wake up and start walking or he was going to jail. He finally managed to get to his feet and was adamant in not wanting to go to jail. I told him to start moving and that I didn't want to get called back on him.

As we began to walk back toward the ambulance, this idiot standing there watching the show hollered out that Terry was "...in no shape to be walking." C. suggested that he take Terry home with him.

That pretty much ended the discussion.

2004-01-10T21:38:00.000-05:00

Thursday I returned to work. In the discussions with my captain, regarding the bone marrow donation, I told him that I thought I would be fine and could even work on the truck if need be. Still, he made an effort to assure that I had a floater so that the physical labor required on my part would be minimal. Unfortunately, someone called in sick, which neccessitated that I crew an ambulance.

I still didn't anticipate any major problems, since I was three days post-op and feeling pretty good. Granted, my strength and back had not as yet been truly tested, but I weren't skeered o' nuthin'.

The morning was spent fairly routine. I wasn't really able to climb in and out of the truck that easily, but at that point I had not taken anything for pain other than some Tylenol and I was quite certain that I would rise to meet any crisis and perform with my usual level of aplomb and skill.

We were able to enjoy a pleasant breakfast and headed off shortly thereafter to take care of the day's administrative concerns. At about 8:00 we turned off of Amnicola highway towards Medic 14's quarters. M14 had been sent only a few minutes ago to the Burger King, which is right next door to their station. As we made the turn, I could see the crew through the window conducting business as usual. C. inquired as to whether I wanted to go and help them, but I operate on the philosophy that these guys are all competant and don't need or want me hanging over their shoulder at every turn. We went on to their station to pick up their paperwork and proceeded over to supply to engage in my favorite sport of "Find Some Inane Topic to Discuss or Argue About Ad Infinitum With the Supply Officer". I don't know that I have discussed our supply officer much, but we each consider the other a verbal scratching post on which we sharpen our already razor-like whit. I had just gotten comfortable and was preparing to launch into a protracted discourse on the first random thought I had, when M14 called for help on the radio. Mind you, I only knew it was a call for help because of the inflection of voice. Their diction was terrible. C. and I headed for the door while I tried to get a clarification on what the problem was. Again, what was said over the radio was basically unintelligble, but what was clear was that one of my crews needed the unique help that only I could provide.

When I opened the back of their ambulance, both crew members and the observer they had with them were holding down a violent, confused, post-seizure male, and the patient was winning.

" CRY HAVOC!!! And let slip the dogs of war!!"

That's Shakespeare by the way, but I can't hear that quote without thinking of Christopher Plummer as a Klingon. ( Yes Captain Kirk, the hills are alive with the sounds of Mugthwopfark!)

Back to our story....

In the ensuing struggle I found myself sitting astride said patient and trying to coordinate our efforts to restrain him. C. who of course knew all about the bone marrow donation, warned me to stay out of it. I know she was merely concerned with my own well being, but

A) She's a woman

and

B) I'm a man

and

C) Someone's holding a fight and I'm not invited?

My point exactly.

C. concentrated on getting the left arm restrained and some IV access on the guy and I tried to free up S. the paramedic on that truck because he was the only one with access to the drugs we would need to assist us. Meanwhile, our supply officer showed up to assist bringing with him his assistant, whom we affectionately refer to as " The Slave".

So now there's

3 from Medic 14
2 from Medic 9
2 from Supply for a grand total of
7 people on this guy and he's still kicking the crap out of us.

I told S. to give the guy 2mg of Ativan, which he did, and which basically had no effect. So I called for 5mg of Haldol, which again had no effect.

By this time I had been kicked several times in my three day post-op butt, and this guy didn't show any signs of slowing down.

I freed myself from any immediate restraint duties, and got over to the radio so I could request permission from our medical director to RSI this guy. Generally, I like my autonomy and am willing to stretch the boundaries, but paralyzing and intubating a patient with no other cause than combativeness is a little too much John Wayne, even for me.

By the time I got our director on the air, we had headed for the hospital, with me, the observer, S., and the Slave in the back. When I requested orders to RSI this guy, I could tell the MD was hesitant. He directed us to give 4mg of Versed and call him back.

I had just been making the point that morning that I had received 2mg of Versed with the bone marrow harvest, and all it did for me was give me a buzz. I was not really confident that Versed would touch this guy, but he is the MD. We gave the 4mg and I directed another 2mg when the first had no effect. I called the MD back and told him it wasn't helping, and he agreed to RSI the patient.

100mg of Sux later, no problem.

But in the short time that it took to get the patient into the ER, he began to bite on the tube. So I nailed him with 10mg of Norcuron.

ER Doc: " So what all have you given him?"
Me: " 2 of Ativan, 5 of Haldol, 6 of Versed, 100 of Sux, and 10 of Norcuron."
ER Doc: Raises eyebrows quizzically as if to say Whaaaa?
Me: " I wouldn't bulls--- ya' doc"

And it wasn't even 10:00 am yet.

2004-01-06T22:42:00.000-05:00

My Aching Back

I have had a lot on my mind recently and it has detracted from my blogging. But let me tell you about my most recent experience.

Several years ago, a fellow paramedic's father was involved in a very serious car accident. The request was made for donations of blood and naturally our EMS community responded. At the time, and just on a whim, I had Blood Assurance add me to the National Bone Marrow registry. I never thought anything about it until about six weeks ago.

I was contacted by the local National Bone Marrow Donor Program (NBMDP) rep, and told that I might be a match for a recipient. My understanding is that it can be as much as a 1 in 10-20,000 shot to come up as an initial match. So I went through the next phase of testing where they string the genetic code out further to test compatibility. Again, I beat the odds and came up as an almost perfect match. Who woulda' thunk?

So throughout this entire process I moved, fully expecting to be disqualified at some point. But I wasn't.

On the 5th of January, I donated almost a liter of bone marrow to a 14 year old girl with Aplastic Anemia. That's all I know.
This is a pretty gruesome process(harvesting bone marrow that is). I did mine under spinal anesthesia. The surgeon questioned me as to why I didn't want general anesthesia.
I explained to him that I give paralytics in the field, and while I know that there is really very limited risk, the whole idea just kind of freaked me out. Besides, I'm not comfortable with blank spaces in my life. I already have one blank episode due to an altercation with a bottle of rum in which the rum emerged as the victor. So why volunteer for more?
The surgeon was very pleasant at every contact, and it was good to meet a physician that treated me as a healthcare provider given the local climate lately. When explaining the procedure, he even made the association with the intraosseous needles we use in the field. Although, I think his perspective is a little skewed. He showed me the needle they used when the procedure was over, and it was as bout as big around as a car antenna!... and about ten inches long.
For those unfamiliar with the procedure:

Step 1: Give patient Versed to make them agreeable to anything. (WHooohooo) (Makes sense 'cause that needle looks painful)

Step 2: Administer anesthesia (to the patient that is)

Step 3: Make small incision over the posterior pelvic area. ( In my case, 4 separate incisions)

Step 4: Take large car antenna spike, and ram it into patients pelvis.

Step 5: Withdraw whatever is handy.

Step 6: Since step 5 only yields 3-5ccs of marrow and nearly 1000ccs are needed, repeat Step 5 somewhere around 199 times.

Step 7: Continue to answer questions throughout procedure from idiotic paramedic that insisted on having only spinal anesthesia.

Step 8: Apply pressure bandage to incisions.

Step 9: Show the idiotic paramedic the needle you were jamming in his back, to pay him back for his drug induced conversation.

Really, I would do it again in a second.

Please, register with the National Bone Marrow donor program wherever you donate blood.

Comments are welcome and all info and links will be added to the blog.

2003-12-22T09:39:00.000-05:00

I'm calmer now

I've cooled off a bit since the last post. However, what I said I stand by.

I need to mention that I do have many friends in these same hospitals, that are doing a good job and are overworked and underpaid.

Go to Spanky's Place and read his response to the last.

Merry Christmas.

2003-12-19T08:59:00.000-05:00

An Open Letter....

Dear ER docs, nurses, techs, administrators in the Chattanooga area,

I am concerned at the level of confusion in your facilities and would like to help clear things up.

To begin with, EMS did not create the cold and flu season. We would really appreciate it if you stopped treating us as if its our fault that your ER is busy. Neither did we create the current healthcare failures that cause people to use the ER as primary healthcare.

Additionally, the "diversion policy" that your facilities signed off on is available in print and I will be happy to get it to you, since none of seem to have read it. It has many bits of useful information in it (ie a patient can still be taken to the hospital of choice regardless of their divert status). Its a wonderful read, all about state and federal laws and other things that actually pertain to all of us as healthcare workers. Even better reading is the prequel known as the COBRA laws. Its full of drama!! You know you can go to jail for COBRA violations? Of course, in light of your current practices and attitudes, COBRA reads more like the Sunday Morning Comics. For further reflection, try a google search on Memphis and their diversion policy. It may be hard to find though, 'cause they just abolished the whole idea. There is no state or federal law requiring EMS to abide by any diversion policy.

Lastly, I really try my best and encourage all of my crews to be professional and courteous at all times. However, over the course of the last week I have heard the following:

a nurse berating a crew in front of a patient as to why they came there when they are on the " We don't want to have to work this hard" divert.

a nurse berating a crew over the radio, which the patients can hear, for the same reason

a doctor respond to an attempt at making conversation by saying " All these ambulances are the reason we're so busy."

a doctor essentially call us all liars saying we don't explain divert to the patients.

I'm a happy person. Really. I like to get along with people. I want you all to understand.

Fair warning though: the next one of you lazy, irritable, uninformed, holier-than-thou, thinks-they-know-what-they're-talking-about, SOBs calls me or one of my crews a liar or talks to us like we're idiots is going to see how ignorant I can be. And after 16 years in EMS, fire, and the army, I can be pretty F------ ignorant.

And I swear on my mother's grave I will make your day at work a living hell.

Have a nice day.
Andy

2003-12-04T08:32:00.000-05:00

Me and My Wife

Has it really been a month since I blogged?

The following is a conversation that occurred during one of our rare chances to sit down for a meal.

Participants: Me, C., and a new part-timer on orientation.

C: I'll have the small taco salad.
Part timer: I'll have that too. Does it have tomatoes?
C: Yeah, but I just take 'em off.
Me: How can you not eat tomatoes? They're healthy!
C: I just don't like them.
Me: But Why?
C: I just don't! I never have!
Me: But that's not a reason!
C: I don't need a reason!
Me: That's a typical woman answer.
C: SO? Why don't you eat liver?!!
Me: Because liver is high in cholesterol. And it tastes awful. See that's a reason.
C: That doesn't make any more sense then what I said!
Me: Does too!!!
C: Does not!!!!
Me: I hate you.
C: Shut up.
Part timer: So.....you guys work together all the time?

2003-11-01T18:02:00.000-05:00

Being Ernest Hemingway

As if I had not spent enough time away from home (or this blog for that matter), October has become the month for our fishing trip to the Florida Keys. It was quite enjoyable, although we were in five foot swells the first night. I have never been seasick in my life, but this time it really got me. However, you gain a new perspective on small creatures of the ocean as you watch them make use of your stomach contents that are floating off to the Atlantic. Shrimp anyone?

It was quite restful at any rate, and I came back to work quite at peace with myself.

I have had two burn patients this week. Neither of them life threatening, but both looked horrendous. Besides which, we just don't do that many burns, so to have two in one week is very unusual. Not to mention that it certainly seems that generally, if someone suffers a burn, it's their own fault.

The first was an industrial worker at a plant that assembles ductwork. The process involves spraying the inside of the ducts with a glue that gives off fumes equivalent to contact cement, and then arc welding the seams. Apparently, this time he didn't allow adequate time for ventilation, and when he fired up the arc welder the room fired up on him. He had first and second degree burns to 20-25% of his BSA (Body Surface Area). Hhmmm....perhaps they should rethink any process involving liquid toxins and electricity.....

The second one was last night at about three in the morning. This guy gets up and decides he has to have a pork chop. So his pan of Crisco catches fire on him, he runs in to pull it off the stove, wearing nothing but tighty whiteys and a golf shirt, (fashion is NOT a priority when one is dining on pork chops in the wee hours of the morning), and in the process manages to dump flaming Crisco on himself. Ow. It probably didn't help his coordination to be fairly well intoxicated.

Which is why I recommend consuming only precooked pork products while drinking...

Like pork rinds....

Or pigs feet....

Or anything....

JUST DON'T TRY TO OPERATE YOUR STOVE AT THREE IN THE MORNING WHILE YOU'RE DRUNK, YOU IDIOT!!!!!!

2003-10-12T20:39:00.000-04:00

Zen and the Art of Serpentine Belt Maintenance

Several years ago while I was at one of the local gas stations, I was approached by a fairly well dressed black man asking for help. He spoke very well, and related that he was on his way through town to a job interview that had the potential to change his life. The only problem was that his car was broken down and he needed to purchase a new serpentine belt. Being the cynic that I am, I doubted very much that he owned a serpentine belt, broken or otherwise, let alone a car on which to install it. So I politely told him that I couldn't help him, but that I hoped it all worked out with his job interview. I exited wondering if I was too callous to someone who was really down on his luck.

A year or two after this I was again approached by a man asking if I knew anything about cars and serpentine belts.....!!!!!!! Again I got the whole story, and again I told him I couldn't help him. However, I now was reassured that while I am callous, this guy was running a scam.

About a year after this as my wife and I were coming out of a restaurant, I noticed a group of people engaged in conversation with a tall slender black man who looked vaguely familiar.....
I mentioned to my wife that I knew this guy and having finished his conversation with the other people, he turned his attention to us.

" Excuse me sir...."
" Let me guess" I interrupted," You're on your way to a job interview, and your serpentine belt is broken."

A dumbfounded look came over him and as he was at a loss for words, I told him I had heard his story before and that he needed to come up with a new scam. He said he didn't know who I was, but hoped I had a nice day and he turned and walked off.

Several months ago, he approached me again as I was coming out of the EMS administration building. I was walking with another employee and as we approached this idiot, I said, "Watch this. This guy is gonna' spin us a story about a serpentine belt and ask us for money." So I was ready for him. I let him tell his tale, watching my fellow employee try not to laugh as this guy went through the routine. This time around I told the guy that this was the fourth time he had told me the story, and that I was really tired of listening to him, and that he needed to remember my face, 'cause if it happened again, I was not going to be happy or pleasant.

Which brings me to last shift.

As we were getting on to the ramp onto the interstate, I saw him standing outside a hotel parking lot. There was an adult woman in the parking lot with a group of children, and while I couldn't hear what was being said, I was pretty sure it involved a broken serpentine belt. We had rolled about a hundred yards past the hotel and I had the ambulance stopped and was watching all of this in my mirror. The guy obviously got the blow off from the woman, and proceeded down the sidewalk. I kept watching to see if he was moving on or if he would head into the parking lot.

Sure enough, he went on in.

So I decided to go see if I could pick a fight.

I put the ambulance in reverse and backed up the one way street to pull into the parking lot. The woman with the kids, had now spotted me, and I'm sure was wondering what the ambulance was all about. The would be con man had now accosted a man just outside the hotel doors, and was so engrossed telling his tale of woe, he had not noticed the large white ambulance pulling up behind him. I rolled my window down, and hollered out, " I bet your serpentine belt is broken," pouring as much sarcasm as I could into it. He turned and looked at me and said "Yeah." It was comical because he obviously knew he was busted, but couldn't figure out a way to weasel his way out of it. By now I was really at a boil. Anyone that knows me well, knows that when I really get angry I am liable to say or do anything.

I verbally blasted this guy.

"I've heard your story a half dozen times, and I'm tired of it. You need to get moving and quit harassing these people and the next time I see you, I'm going to help you get a trip to jail! Now get movin'!!!"

He moved.

C. had meanwhile climbed out of the ambulance and asked the woman with the kids if the guy had asked for help with his serpentine belt. The woman was quite amazed, and said he had. C. explained that I was familiar with the guy and that I was going to speak with him. At which point C. said she could hear my voice increasing in decibel level even over the diesel engine. C. has seen me get angry, so she knew what this poor bugger was being confronted with. Which, of course, just makes her laugh.

So he has moved on to his next victim.

Now I know that my job is not to enforce the law, and that there are people that are truly destitute, but this guy is nothing but a bloodsucker. He is a blight on the face of society, choosing to spend his time scamming honest, sympathetic people, rather than pick up a hammer, or broom and earn an honest living. I vowed to C. that I am going to persecute this guy at every opportunity. This is my city, and these are my streets, and if he is going to act like that, then he has no right to be here.

I'm considering buying a serpentine belt and keeping it with me. Then the next time I see him, whoop the everloving tar out of him with it. (I've got your $#$@&*! serpentine belt right here!!)

....but then I would have to take him to the hospital.

2003-10-09T08:46:00.000-04:00

I Hadn't Considered That....

There exists in my world any number of unsubstantiated hypotheses regarding phenomenon that occur in EMS.

For instance:

The likelihood that you will get a call correlates directly to
- the last time you ate
- your order has been placed, but food has not arrived
- the last time you used the restroom

or

When I worked for a brief time in Pennsylvania, many of the city houses were 4 and 5 stories. We observed the "Dying/ Height" phenomenon. That is to say, the sicker a patient was, the higher in the house they would climb. Someone with simple chest pain might be on the second or third floor, while an impending cardiac arrest would call 911 from the first floor, then proceed upstairs to the 5th floor, crawl behind the bed, and pile boxes and furniture on top of themselves.

So last shift we worked a cardiac arrest at four in the morning. After all was said and done, C. noted that given the fact that our patient was completely nude, (eew) there must be a dying instinct to remove one's clothing as he begins the final passage. This was the cause for some consideration on my part. I had to admit that given my own experiences, but without any true statistical data, that this did seem to be a frequent occurrence. "But wait," you say, "Can't this be explained by simple human behavior?" Certainly it may seem that way to the casual eye. It seems obvious in this latest example. The man had gone to bed. No indication that there was anything wrong. Even allowing for a percentage of the population that may like to sleep totally nude, it was an eerie coincidence. Besides, as I pondered this revolutionary idea, it seemed that there weremany more times that I had encountered patients in various forms of undress. Throw in the fact that if you are injured seriously your clothes will be removed by those treating you, and the statistics skyrocket. All of this to say that you can rest assured that upon your final moments on earth, some stranger will be seeing your Hoo-Ha. Plan accordingly.

It's also worth noting that since my return from San Antonio, I worked three full shifts before actually having to render any patient care. Last shift I finally gave Nitro and Aspirin, ran a 12 lead EKG, started several IVs, including one on a 1 year old, and intubated our cardiac arrest. So that streak is over.

Much like the USA women's hopes for a successful defense of their title.

2003-09-26T08:56:00.000-04:00

Back in the Saddle Again.....

I returned to work yesterday, full of vim and vigor, ready to take on any challenges that EMS chose to throw at me. The morning was spent catching up on all of the work gossip, and the latest gripes and groans that seem to be part of the American employees passage to "...life, liberty, and the pursuit of happiness." It does seem ironic that as Americans we revel in miserable trivialities in the " pursuit of happiness." One would think that we would try to enjoy our employment more rather than continually trying to stick our head through the fence to taste the elusive, green grass of " When I'm in charge things will be different."

Despite all of that, I work with some of the greatest crewmembers you could have. They remain generally pleasant and, dare I say it, glad to see me back to work.

Having spent the greater part of the last ten weeks sitting in a classroom for eight to ten hours a day, it was refreshing to spend the first few hours at work....in training. In the words of the late philosopher Charles Schulz.....Blech!!! I was quite relieved when that brief period was over.

On to the practice of pre-hospital medicine. Any time I leave work for an extended period, I think part of me begins to sub-conciously hope that when I return, the world will have changed, and that in my absence, I will have become a true hero, a defender of the sick and injured, a crusader against the disease of life. My heart tells me to be emboldened for surely society will have matured. Meanwhile my brain is in hysterics at the idealism of my heart, and ridicules my soul for its youthful folly. I love needling others with my cynicism and biting sarcasm, but it's quite painful to turn that on yourself.

So it was that I went into battle, while the dichotomous internal war raged back and forth with neither side gaining any ground.

During the course of the day, these were my patients:

1)A twenty-two year old female with vaginal bleeding, who was convinced that she was
A) not pregnant
B) not having a miscarriage
despite the fact that she admitted to recent sexual activity, had had a previous miscarriage, and now was having a discharge of tissue as well as blood.

2) A fifty something female who was convinced that she was bleeding internally due to some blood she saw during her bowel movement. (Please note that what I saw looked like s--t to me, and how many of you got to look at someone else's poop yesterday?)

3) A transient that wanted to be transported to a hospital in Georgia because he's managed to piss off all of the local ERs.

4) A sixty something male that simply could not understand that removing one's hands from the steering wheel of a bass boat and looking away, while said boat is moving down river, will allow the boat to go in the direction of its own choosing and ultimately ground the Good Ship Lollipop on the Island of Morons That Should Be Playing Shuffleboard and NOT OPERATING A BASS BOAT!!

5) A crackhead that wrecked his ghetto sled (highly modified Cadillac) while trying to inconspicuously avoid the police.

6) Another bum wanting to go to Georgia, which makes me wonder what it is that Georgia is offering, and could they please keep these people in their state where they apparently are happier?

Final Score: Heart = 0 , Brain = 1

Cest' La Vie

In other news...the USA Women's Soccer Team is undefeated in the World Cup with a 5-0 trouncing of Nigeria....hope springs eternal.

2003-09-20T22:24:00.000-04:00

Home Again, Home Again, Jiggety Jig

I, like Macarthur, have returned. Home that is. I was desperate for material, so I have been saving to give one summary post on my time at Fort Sam.

We finished the "All Corps" portion on the 5th of September. This meant that we would now split off into our separate disciplines. Leave it to the army to create a course where you graduate, and then have two weeks (or more) left. The good thing is that the last two weeks were far more pertinent to what I will be doing for the army than the previous 8. The bad thing is IT WAS THE LAST TWO WEEKS!!!What they were teaching should have been started weeks ago. Then they lay it on you so fast and heavy that you don't have time to digest it all. The class is barely comprehending how the system works at the platoon and company level, and the instructor's talking about building combat support at the brigade and theater levels. Plus, he looked like a cyborg, so that didn't help.

We had to go back to the field for a brief time. Not too bad since we had some cooler weather. On our last day we went to see a DEPMEDS (hospital) setup. This thing is amazing. When complete, it is a completely functioning hospital with 400+ beds. If it has all its components put up, it covers approximately 10+ acres. This doesn't include the full kitchen and dining facility. Setup time is only 7-10 days, and they can of course offer limited care much earlier than that. It is awesome what we Americans have at our disposal. There are whole countries that don't have one hospital equivalent to one of these. And we have dozens sitting in containers waiting to go to war.

Finally in regards to Texas. I have come to the conclusion that it is just not safe to go outside in that state. Every bug, every plant, is able to bite, sting, poison, set you on fire, steal your soul, or give you the Kung Fu Death Grip. They have one very benign looking flower that if you brush against it gives you the equivalent of a burn. Horrible.
Ants....everywhere. and aggressive. Scorpions of every shape and size. Spiders the size of small children.

To top it off, as I am driving out of the state, I get into a swarm of some black bugs that were everywhere and busy copulating as if for their number to drop below 87bazillion would mean that the humans had won.

There may very well be a purpose for the existence of all this wildlife and vegetation, but it's beyond me.

2003-08-26T23:31:00.000-04:00

Greetings

I'm back.

I apologize for the hiatus. We were on a field exercise and they sort of frown on us taking our technology with us to the field.

One or two of you emailed me saying the archives were unreachable. Sorry. They have to be republished on a regular basis or blogger removes them. Anyway, I republished everything, so read away.

What can I tell you about the field?

It's hot, we had less than perfect hygiene, and despite my best efforts, I was still attacked by a horde of chiggers. Nasty little things they are. They have a way of digging in in the places with the most restrictive clothing, which frustrates one's efforts to scratch. The only relief is to find something thin and metal and dig at those buggers like there's no tomorrow. Of course, this opens the door wide to all kinds of nasty infections, but I choose to live for the moment.

The Texas wildlife is something else too. Everything is gigantic down here. Spiders, deer, ants, you name it and Texas has it on steroids. This is all tolerable until you're by yourself in the dead quiet of the bush, diligently trying to figure out where the heck your next land navigation point is, and a jackrabbit the size of a shetland pony explodes from under your feet. Once your heart slows down to 200 beats a minute, you're left to contemplate the fact that they have RABBITS that could pull a small wagon down here!! This is very disconcerting.

The field did offer the chance for a few in depth conversations. One I had was with a female dentist of Japanese/ Mexican birth. Don't see that combo everyday. She told me of a friend of hers with the same heritage, by the name of Yoko Chavez. Beautiful. Think there's a Jose Yamamoto out there somewhere? Mufasa Goldstein?

Life is full of humor. Take the time to laugh at yourself.

2003-08-07T09:48:00.000-04:00

The Alphabet....Army style

So how does the Army system work?

The following is a breakdown of the army system in a very general fashion. Due to the rapidly changing demands of the modern battlefield, this should be considered a very flexible system that can be altered very quickly.

It all begins with the frontline medic. He is located with the Forward Line of Own Troops(FLOT).
As casualties occur, they are evaced back to a Casualty Collection Point or CCP via a Frontline Ambulance (FLA) or whatever is available. The BAS ( Battalion Aid Station) is just behind the Forward Edge of the Battle Area (FEBA), but still within the Battalion Support Area. The BAS sends their FLAs forward to the CCPs to pick up the wounded. The FSMC ( Forward Support Medical Company) is the next stage of evacuation. They are located with the Forward Support Battalion (FSB). They use their own FLAs or the assests with the ASB (Aviation Support Battalion). Since this process could be over many miles, the decision may be made to use an Ambulance Exchange Point (AXP). This is a designated point for the ambulances from the FSMC to meet with the ambulances from the BAS to reduce the distance that both have to travel. When the patient arrives at the FSMC, they are usually serious enough to move further back to the CSH ( Combat Support Hospital). This is essentially the first encounter with what the civilian world would refer to as a Level 1 Trauma Center. The modern CSH has all the capabilities of a modern hospital, to include psychiatric care, laboratory research, optometry, and extensive pharmaceuticals. Or, as we say in the AMEDD: "Hugs, Bugs, Specs and Drugs". The only major difference between the CSH and their civilian counterpart is that the CSH does not hold their patients for an extended period of time. They could certainly do this if needed, but they will keep moving the patient back in anticipation of receiving more casualties from the front. The CSH is essentially responsible to move the patient back to CONUS ( Continental United States) for admission to either a permanent Military Treatment Facility (MTF), like Walter Reed Army Medical, or to a civilian hospital.
Of course there are other variations to this system, like a FST (Forward Surgical Team) or the decision to fly the patient from the frontline directly to the CSH.
So to recap......
The medic uses the FLA to move the patient from the FLOT to the CCP. The BAS uses FLAs to evac to themselves, and then to the AXP, where they meet with either the FLA, or the ASB to move back to the FSMC in the BSA. The ASB moves the patient to the CSH where they are flown back to CONUS.

Got it?

2003-07-31T18:09:00.000-04:00

They Were Expendable

In the continuing discussion on NBC threats today, the discussion came up regarding who on the battlefield would be expendable.

The rule is that once you have passed out of the immediate danger of a contaminated area, the most expendable soldier removes his protective gear first. Usually this would be the lowest private.

I and another prior service soldier had quite a bit of fun at the expense of our fellow classmates ( most of whom outrank us) by prioritizing them as expendable based on their profession.

1) Dentists - they should be the first to go. Nobody likes them and wouldn't we all like to see them suffer? Besides, dental hygiene is a luxury on the battlefield anyway.

2) Optometrists - another medical luxury

3) Laboratory Research - weren't we all beating on these people in high school?

4) Veterinarians - they would have been higher, but they are responsible to inspect the food supply.

Hysterical stuff really.

2003-07-30T17:19:00.000-04:00

Bugs and Nukes and Pool Chemicals

We are entering a period of instruction on the NBC ( Nuclear, Biological, Chemical) threat. Personally, I think the NBC threat is that of a runaway liberal media, but they haven't asked me.

NBC has always been a large part of army training, but I can't help but notice that the emphasis has changed since 9/11. Previously, we looked at it as just something that was out there. We didn't feel that it really was a threat, other than the Russians using a nuke on us. Now you can easily see that this is a very real, and very scary scenario. The focus on this has of course changed for the civilian EMS, fire, and police as well, and comes under the heading of WMD (Weapons of Mass Destruction). For the record, any nation that is in active development and research into biological or chemical weapons, is in my opinion a threat. Maybe it is not their intention to use them in an offensive manner, but by developing this particular technology, they may in essence be doing the foot work for terrorists or a rogue nation that is not quite as discriminating. Biological and chemical weapons have almost no tactical value on the modern battlefield against a prepared military such as ours. Therefore, their only true value is against the unprepared civilian population. The absolute horror that they bring demands that civilized nations do all they can to wipe them out.

Of course the United States is not innocent in this arena. We are probably to blame for most of the research that has been done up to today. However, we are on the right path. The official military policy is to destroy all current stockpiles of biological and chemical weapons and that they are never to be used, even in retaliation. Unfortunately, we must continue to maintain our nuclear capability as a deterrent.

On a positive note, at about 14:00 today, they realized there was a scheduling snafu with the classroom we were in. Hence, we got out of there early.

2003-07-28T17:22:00.000-04:00

The AMEDD

Well, this really is quite the organization. I am quite certain that the scope of medical practice is comparable in the other branches of the armed forces. I say that to not offend those prior service members of another branch. However, I can only speak with authority to the army system.

To begin with, the AMEDD is a 6.6 billion dollar a year corporation, with all the associated pitfalls. It covers the scope of practice from the front line combat medic to the highly specialized surgeon. It also incorporates all of the associated disciplines in laboratory sciences and allied health. Most practicioners are board certified in one or more fields. In fact, the army has a generally higher percentage of board certified physicians than many civilian hospitals.

That being said, it is often difficult to assess where the army is in relation to it's pre-hospital care ( my area of interest of course). Here the military tends to see-saw with the civilian world.

Historically the military discovers something new, then the civilian world improves on it. The military recognized that they could save lives if they had an organization to move battlefield casualties to the hospital ( groundbreaking thought isn't it?). Napoleon was known to have done this, and of course by the time the War Between the States had broken out, the concept of moving the hospitals forward was well established. Of course, they hadn't worked out the whole problem of people defecating where the food was prepared, but life is about baby steps.

The next most memorable contribution was probably the use of the helicopter to evacuate the wounded. Remember MASH? Korea was true, early trauma care. By the time we entered Vietnam, the army system was refined to the point that there was an actual trauma system taking shape. Even if it wasn't officially written down, the field medics and the flight medics were taking advantage of their training and available technology to move the wounded past a facility that could not take care of the patient to one that could.

So what was the civilian world doing? They were busy battling over whether non physicians could provide care, how bad their hospital budgets would be hurt if they lost trauma patients, and how many angels can dance on the head of a pin.

As opinions started to change, due in no small part to Dr. R. Adams Cowley and the Shocktrauma Center in Baltimore, they began to make use of the experience and training that the medics were bringing back from Vietnam.

So when did EMS actually start? Well, that depends on what you consider the start as. In Tennessee, it wasn't until 1973 that municipalities were required to provide EMS.

Anyway, back to the army.........

Everyone who discovers that I am a former army medic, and still involved in army medicine, is under the perception that all army medics come out trained to do highly aggressive skills and perform surgery with a pocket knife and their boot laces. This simply isn't true. While army training is very good, it is only since about 1990 that all medics are required to achieve the National Registry Basic certification. Even then, there are actually very few medics that get enough practice at trauma to become really good at it. Naturally, given a prolonged exposure to heavy combat their skills will improve, but even then they won't perform the same way a civilian paramedic would. On the other hand, you couldn't take a civilian and stick them out with an infantry company and expect them to be completely competent either. A military medic is expected to fight, and take care of wounded. Let's leave it at two unique providers that have learned and borrowed from each other.

.......and I'm proud as hell to be both.

2003-07-24T09:59:00.000-04:00

OBC

So far in this class we haven't covered much regarding the specific functionings of the AMEDD. While this may seem surprising, keep in mind that the class is comprised of doctor's, nurses, entomologists, microbiologists etc., many of whom have no experience in the army. This makes the class both boring, and humorous to someone with my background. Also, the class has a deep vein of cynicism, which suits me just fine.

It never ceases to amaze me how the army/ military manages to bring such a diverse group of people together and make it work. We have Latinos, Koreans, Chinese, Jews, Arabic, and even one international student from Estonia. Education ranges from a simple bachelor's ( that would be me ) to MDs (not me), Master's of Administration ( not me ) to PhDs in Molecular Biology ( also not me ). In fact, I'm one of the most uneducated people here. Still, there is no stigma attached to those of us who do not have advanced degrees. We maintain our own aura by virtue of our expertise in all things army.

For instance: one of the dentists, a direct commissionee was questioning me about living in the field. She had been at the "prep course" where they did a short Field Training Exercise (FTX) which lasted for three days. To quote her " It was awful! We didn't get showers or anything!" ........!!!!! You know this is the army....did you think they made a mistake with that? You should have seen the look on her face when I told her my personal record was a 42 day field exercise, and my first shower was 27 days into it. Never mind the grunts that are currently on the front lines in a dozen underdeveloped nations around the world. At least I didn't have to worry about an RPG attack on the way into the post this morning.

Suck it up America! If any country ever catches up to us in technology, were going to take a whoopin'. Our society and our military has been softened by too much good living, and doesn't have the guts and nerve that it takes to be absolutely brutal when it needs to be. This is a hard world, and on occasion it needs a stiff hand to bring it back in line.

Enough for now.

2003-07-23T11:22:00.000-04:00

Blogger's Fault
Blogger has made some changes in their website and I am still learning, so the last post apparently did not get published when I wrote it. Fortunately, the new format saved my post, so it should appear now.

Let's start with my army career till now.

I entered the army as a Private First Class (PFC), the 18th of May 1989. I had previously spent the last two years in college, which was enough to convince me I needed to get out of school. I of course had become in interested in EMS and felt that that was where my true talents lay. I signed up to be an army medic, naturally and went to Wiesbaden, Germany for my first assignment.
Two and a half years as an enlisted man was enough to convince me to get back to college.

Long story short, I finished college, paramedic school, got out of the National Guard, back into the Guard as a flight medic, spent three years on the UH-60Q helicopter, and went on to OCS (Officer Candidate School). Oh, and I worked full time as a paramedic during the entire time.

Regardless of how much time you have as an enlisted soldier, or how you get your commission, once you become a commissioned officer you must attend an Officer Basic Course (OBC). Which is what I'm doing now. OBC makes you " branch qualified", meaning you meet the requirements for a particular field. The OBC that I am attending will be both general in nature for other medical fields and specific to my field of operational administration.

I have to go back to class so more later.

2003-07-18T20:55:00.000-04:00

San Antonio

If you're wondering where I've been lately....I am currently at Ft. Sam Houston in San Antonio, Texas. I am attending the Army Medical Department (AMEDD) Officer Basic Course (OBC). My plan is to blog some comparing the army medical system with current EMS standards, but since this dial-up connection is costing me $0.38 cents a minute, it will have to wait till I have more economical access. Please keep checking the blog, and I appreciate your faithful support. Now I must go and consume sustenance, or as they say in the south, " Throw some groceries down my neck."
Peace to all.

2003-07-02T19:02:00.000-04:00

You Can Never Get Your Minute Back

One minute. A mere 60 seconds. Time for the adult heart to beat 80 times. Time enough to warm a snack in a microwave. Time enough to win a big game. Time enough for a 9 month old to drown in a bathtub.

She said she only stepped out for a minute. She came back and found the baby underwater.

Why do people do things like this??

What runs through their mind?

What is so important that you would take that risk, to leave your child alone in a tub of water?

I thought we had a chance though. Everything was going smooth. I intubated the kid. C put the intra-osseus (IO) line in. We headed for the hospital.

I had already given the first dose of epinephrine down the ET tube, and that brought the heart rate from about 20 to about 50. I thought I could feel a pulse, but I wasn't sure. I told the firefighter with me to keep doing CPR till I could get the rate up.

That's when Murphy showed up.

As I was pushing the atropine in the port, the entire injection port broke off of the IV tubing. Don't ask me how, it just did. Now I had fluid running out all over the place. So I told the other firefighter to keep his thumb over the hole to keep the fluid in and the IO line patent. While I was changing out the tubing I hear:

" Uh oh....it came out."

Sure enough, the well intentioned fireman had pulled the internal catheter out of the line.

An IO line is placed directly into the marrow of the bone in the anterior aspect of the tibia. The leg if you will. We use it in pediatric emergencies due to the difficulty of getting a regular IV on a child.

So now I had to restart it. I grab the other IO needle and punch in. I pulled the internal stylet out and hand it to the firefighter. The fluid wont flow, so I must have slid off the bone into the muscle. I turn to the fireman to get the internal stylet back and try again, but...he's already dropped the stylet into the sharps container.

Meanwhile, because I'm the only ALS provider, time is passing by and this child needs drugs.

So I start looking for a peripheral access point. None. Not even an external jugular.
We're pulling into the ER by now, so I give another epi down the tube and go on in.

They did get the heart going again, after about 40 minutes. I can't imagine the prognosis is good after that amount of time in arrest.

Is it my fault? No. I did what I could.

I bet the mother wishes she could have that minute back.

2003-07-02T18:37:00.000-04:00

Care of the Wounded

It was a tremendous storm. The meteorologists referred to it as " straight line winds ". Certainly an apt name since the rain seemed to be blasting in sideways.

We saw him after the storm. He had obviously been knocked down by the fury of the wind. The break was terrible, almost completely through and barely still attached. Still, there was no cry of pain, and he did not seek our help.

Initially we left him to himself, but realized that if we didn't intervene, the end would come soon.

Two long board splints and some two inch tape later, we had that little tree standing up.

Hope he pulls through.

2003-06-16T00:19:00.000-04:00

Bessie Smith Run ( part deux )

I was attempting to blog this at work ( always a bad idea ) and got a call. So, if you haven't read the first part, scroll down really fast so you can't read the good parts, and then come back.

The evening went fairly smoothly. Only a few minor scuffles and arrests. It must be pretty hard to get your courage up when there are groups of cops numbering 10 or more together everywhere you look. Less obvious were the rooftop observers and SWAT officers held in reserve. It was very peaceful. At about 10:00 pm they started the sweep. Experience and common sense have shown that the earlier you can get everyone off the street, the less trouble you'll have. The sweep consists of a line of uniformed officers moving down the street shoulder to shoulder, sending everyone home and clearly sending the message that the festivities are at an end. I was stationed at about the mid-point on the Blvd, with the sweep starting to the east, or to my left. The sweep would move the crowd past us, west, towards Market St. At about 10:20 the sweep line had not yet reached us. There had been a group of 5 or 6 city police officers to our right, watching the crowd and visibly beginning to relax now that the event was almost over. Further west, in the middle of the crowd, a commotion began. I still can't tell you what happened, but I have heard that it was a fight, with some of the crowd moving in on the officers who were trying to break it up. The officers apparently then maced the most aggressive members of the crowd. Again, I can't verify that that is what happened, but it would explain what happened next which was.........

ALL HELL BREAKING LOOSE!!!!!

When the commotion began, the officers to our right started peering into and around the crowd to determine what was happening. I leaned out as well, to see what I could see. What I saw was the entire crowd of people, maybe as much as a 1,000, take off at a dead run towards.....me.

In all seriousness, this had to be the single scariest things I've experienced while doing this job.

I only had time to call on the radio that the crowd was running, and I jumped on the back bumper of the ambulance. The next few seconds were spent trying to crawl under the paint on the back of the ambulance.
As I jumped for the truck I glanced over my shoulder and could see little kids, 5,6,7 years old running madly to get out of the way. I still can't believe that no one was killed in that rush.

The next series of events become hazy in their order. There was at least one more rush back west, and then a group of about 100 young, black, teenage males came back east, followed by a hasty skirmish line of police.

The SWAT team was called into action, and formed a line in front of the standard sweep, and began to push the crowd quickly out of the area. At some point earlier, a woman had approached that had fallen during the initial rush. She was pregnant and had fallen and hit her stomach. I don't think there was much wrong with her or her child. The baby in utero is very well protected. There had been some crew changes so I was not with my partner, and had an additional EMT assigned to my unit as well. I told R. to get in the drivers seat and if he heard me yell " PUNCH IT! ", he was to throw it in gear and drop the hammer. I put the pregnant woman in the back of my ambulance, and called for the transport unit to come get her. Meanwhile, another bystander walked up and said there was a man in a store across the street who appeared to have a broken leg. Keep in mind that the street is far from calm. There was a lot of yelling going on, people running and milling around, police pulling out batons and mace. It was right on the edge of a full scale riot. Now I was faced with a decision. I had R. in the driver's seat and since that was my means of egress, I couldn't move him. I had CM with me, but now I had a patient in the truck and one across the street. It's not my nature to tell some one to cross that street. I would rather do it myself, but I had to stay at the truck to coordinate and to try and watch out for the safety of all us. I told CM to take the deputy that had been assigned as our security with him. I pulled another officer over to take her spot. When the transport unit made it to me I told them to move across the street to help CM. I knew that would put the three of them together in the event there was more trouble. I had told CM to evaluate the patient and let me know what his condition was. While all this was going on, the sweep line had reached our position. Now I had three crewmembers across the street, and the only way back to me was to cross between the line and an increasingly hostile crowd. CM said on the radio that the patient was stable. I told the three of them to hold their position till the line had passed, since they were in a semi - secure building. While I was standing there trying to figure out how to get my guys back, my Captain,W, and T. one of my fellow lieutenants showed up. W. and T. are both big guys. Having been raised on a steady diet of football, machismo,( and what do they call that??......oh yeah BACON! ) they both out weigh me by at least 40lbs, a fact which is a constant source of amusement for me I must say. They headed across the street to escort the crew and patient back to me. I moved the pregnant woman over to the transport unit, so that when they came back they could quickly leave. The whole entourage came back about three minutes later, with a man who obviously had something very wrong and probably extremely painful with his leg, indicated by the wierd angle it was sitting at. We loaded him in a very expeditious manner, and the transport unit headed off. Now I at least had my crew back where I could see them.

Then things got worse.......

Calls began coming in of shots fired. No one could really tell exactly where. It didn't matter because the chief was all over the radio telling us we weren't going in until SWAT had secured the scene. See, that's what chiefs do, they give you helpful advice about not running down a dark side street, where there's been a shooting, unless the police get there first.

Thanks Chief, 'cause I was about to go down there, but now I'm going to stay here and put my mouth on the exhaust pipe because that makes as much sense. ( FYI both our chief officers are great guys and I know they're only concerned with our safety, and I would really like to keep my job. )

Finally we got the go ahead to move to Foster and 10th. Since I was standing there looking at the street sign for Foster and 10th is one block south.....Holy @#$%!$!! they shot this guy within a half block of my location. No, I never heard the shots. We pulled up into a perimeter of SWAT officers. Instead of one victim, there's two. One obviously had a large quantity of blood pooling beneath his head. The other I couldn't quite see. As I hurried to them, there was a SWAT officer attending the one with the most blood. He kept trying to get me to come over to him, saying that one was the worst. Yeah I know buddy, I can tell by looking at him. How ' bout I check on this one that might still have a chance? I didn't say that, but police don't calculate that situation the way we do. Besides, I knew CM was behind me and that he would pick him up. When I had seen that there were two patients, I had called for another truck. While we were waiting for them to get there, I took a look at the boy at my feet....gunshot to the chest. I had no one to help me, because the other two guys were with the other critical patient. At that point, the best and about only thing I can do, is get my patient ready to go on the other truck when they get there. I started directing police to get equipment off the truck and to help me, which they willingly did.

When it was all done with, one young black male was dead at the hospital, and another was critically injured.

After Action Review:
1) The local law enforcement community is to be commended for the quick and efficient way they kept the whole thing from escalating.
2) My many, many, thanks to the CPD officers who jumped in to help provide care to the wounded.
3) No offense to CM, but I wish I had my partner there. In this business, your partner is your right hand man, or in this case woman, and not having your partner with you, always keeps you off balance. She knows how I operate and how I think, so she's usually a step ahead of me. Besides, she keeps track of my wallet, keys, coffee, appointments, anniversaries, birthdays, and assorted obligations.

Food for Thought:

The black community has literally been responsible for twice the number of shootings in the last couple of weeks as the CPD.
The wounded boys were both black, attended by all white EMS crews who did all they could to save their lives.
The CPD officers that came to me to see what they could do to help?....white.
At no time did any of us stop to consider that our patients were black. We didn't discuss, nor care, that both were dressed in gang related paraphenelia. Are there racist cops in the CPD? Of course. They need to be held accountable for their actions. I work with many of these officers, white and black, and for the most part they are good, decent, honest men and women doing a dangerous job, for very little pay. The city council pulls down, 16 -18,000 a year for a part time job, while their police officers make 24,000 or so, and are expected to be able to decide when their lives are threatened, and whether to pull that trigger. I don't know what transpired on that traffic stop. I wasn't there. I know this though...don't try to make me swallow that bullshit line about a corrupt and racist CPD that's out to wipe out the black community. Until communities start to reach out, to try and understand, to go out of their way to break down barriers of race, rather than throwing them up with talk of revenge and anger, this old world isn't going to change.

If you have any thoughts or comments, agree or disagree, send them to my Yahoo address and I'll add them to the blog.

Peace to All.

2003-06-12T10:43:00.000-04:00

Bessie Smith Run

Every summer, Chattanooga holds a seven or eight day event known as Riverbend. It is billed as and generally is a family oriented festival, and features performers of both local and national fame. People wishing to attend any of the events, purchase a pin that is worn on the clothing and gives you access to all of the venues for the duration of the event. At the main area, which is located along the river, it is usually very well controlled. There is typically a large police presence, and numerous volunteers monitoring people in and out of the venue. As with any large festival event, there are the usual number of fistfights, petty thievery and the like, but all in all it is a very benign atmosphere.

Then you have the Bessie Smith Strut......

The Strut is a one night event and occurs during the week of Riverbend. The usual site is shut down for the night of the Strut. The Strut has a history of being one of the most entertaining nights and certainly some of the best food is available. On the other hand, the Strut is quickly gaining a reputation as an event to be avoided.

To begin with, no pin is required to attend the Strut. Anyone that wants to walk in, can, carrying whatever they want. There are no gates, no security checkpoints, and fewer volunteers than at the regular venue. Alchohol is readily available. The Strut is held on Martin Luther King Blvd, which runs through one of the higher crime and violence areas. MLK Blvd has numerous cross streets, allowing anyone to enter or exit at any point. It is in an economically depressed area, and of course poverty and crime go hand in hand.

Now keep in mind that this year prior to Riverbend, a black male was shot and killed by the CPD. The shooting occurred during a routine traffic stop for a noisy muffler. While some of the facts seem fuzzy, what appears to have happened is that the driver was outside the car, and reached back into the vehicle at some point. The officer says in his statement that he feared for his life at that point and fired his weapon, fatally wounding the man.

So the scene is, hot summer evening, large public gathering with alchohol, predominantly black populated area, on the heels of a police shooting of a black male. Can you smell disaster brewing?

2003-06-04T02:07:00.000-04:00

Days of My Life

Many of you have commented that I should include some of the more mundane aspects of my career, so here is my timeline of activity for the 3rd of June, 2003
0500 - Alarm goes off
0501 - Hit snooze alarm.
O508 - Alarm goes off again, hit snooze button, make mental note to self to bring sledge hammer into bedroom.
0514 - Alarm goes off again, drag self out of bed, berate self for not learnig a skill more condusive to sleeping in.
0545 - leave house head downtown
0600 - Start two mile run, question manhood when two women pass me like I'm standing still.
0620 - Run is finished, head for station and shower.
0700 - Receive phone call from fellow supervisor reminding me Staff Meeting is today
0701 -0745 Review forty to fifty calls for the Quality Assurance process that I had assumed I had another week to finish.
0830 - Arrive for staff meeting, receive page it is delayed untill 0900
0945 - Staff meeting finally starts
1200 - Take advantage of administrative time, stuff self on sub-par cafeteria food at chain restaurant.
1300 - 1430 Complete station rounds picking up paperwork from yesterday.
1500- Fall asleep on couch, remind self of need for sledge hammer near alarm clock
1600 - Abandon attempts at nap, mental note that sledge hammers are needed next to all telephones.
1700 - pick up 82 year old intoxicated man having chest pain
1730 - pick up man having back pain after flaming chemicals he was cleaning tools with explodes.
1800 - pick up 20 something female faking seizures at correctional facility in attempt to escape felony warrants, debate need for sledge hammer here as well.
1900 - Eat. Pizza. Whoooopeeee!!!
2000 - Pick up woman having chest pain, dispatch info is " ...in a purple Honda, behind the strip mall" ??????
2100- pick up 18 year old faking unconciousness after fight with girlfriend.
2120 - Verbally chastise 18 year old for not acting like an adult.
2200 - Pick up 24 year old white male out of " da Brix" ( housing project ) there with 20 something white female who doesn't know his name, but is highly upset that he is currently walking with one foot in the grave, due to the three bullet holes in his body. One was visible, just under the skin, above the sternum. Pretty cool.
2201 - Commend self for never being in the projects at night, attempting to buy drugs, or whatever he was doing there.
2210 - Work like one arm paper hanger trying to save this kids life.
0000 - Back in station, spend next hour and a half entering data in computer system.
0130 - Blog mundane aspects of life.
0200 - Attempt to go to bed and sleep, vow to revisit sledge hammer concept when I'm better rested.

2003-05-27T03:13:00.000-04:00

Refreshed, renewed, invigorated....for the next 24 hours anyway...
Having just returned from a short hiatus in the mountains, I can say with complete confidence that I don't take enough time off. This was an annual reunion with a very odd combination of college friends, relatives, and spouses.

See, I married Jenny, who's sister is Katrina, who is married to Eric (of glish and GNE fame). The two sisters have two cousins in different branches of their family, Ben and Aaron. Ben married Kim and Aaron married Becca. Kim and Becca were friends with Jenny and Katrina in college. Kim has a sister, Kelly, who went to the same college, and married a guy named Todd (that didn't go to the same college). Todd used to teach at the high school that Kim and Kelly graduated from, but left that job to pursue law school and work for Mark. Mark is of course the father of Aaron, and is Jenny and Katrina's uncle. Brian used to wash dishes with me at the college and married Susan, a high school friend of Kim's. Brian also used to teach at the same school as Todd, but left to pursue work in publishing, where he employs Elizabeth on a part time basis. Elizabeth is the second youngest sister to Jenny and Katrina and is married to Derek who took linguistics with me, Aaron, Joe, and Linnea. Derek helped to start schwa.com with Eric and Aaron. Now then, Andy M. was in ROTC with me for a brief period, and his parents went to college with my parents when the college was in St. Louis. Aaron and Joe were in a really bad band together and Joe married Linnea.

Who's Linnea?

Well, she's the granddaughter of one of the founding members and first president of the college, who worked closely with Max, who is grandfather to Jenny, Katrina, Aaron, Ben, and Elizabeth. They if you will remember.........oh never mind.

2003-05-05T08:47:00.000-04:00

You Have Got To Be Kidding Me!

The address was within a couple of blocks from the station. It was about midnight, and we had had a fairly quiet evening so far. The dispatch information had been for a person with difficulty breathing. As I walked on to the porch I saw the door was partly open. There were no lights on in the house. When I opened the door, she was lying with her head towards the door, arching her back, and gasping for air with a loud rasping noise, reaching for help with an outstretched hand.

Sounds dramatic doesn't it ?

Now let me tell you how the average, seasoned, EMS professional interprets this scene.

No lights on = no one else is home, so the patient has no one else to see this little scene.
Door partly open = We didn't open it, so the patient must have had enough strength at some point to do it herself.
Pt. lying on the floor = People with real trouble breathing, do NOT lie on the floor. ( If you don't believe me ask any MD)
Loud rasping noise = The ability to make noise with your vocal cords is directly related to the ability to inhale, ergo she was getting some air in.

Conclusion? She's full of crap.

This woman maintained this little theater act for the duration, with C and me getting more and more frustated with her refusal to give us information. Unfortunately, due to her overacting, we were placed in the position of having to give her what she wanted, ie. attention, and a ride to the hospital.

We each grabbed under an arm and stood her to her feet, at which point she recovered enough to walk into the other room, get her ID, and tell us very clearly which hospital she wanted to go to. ( refer back to my earlier statement regarding the physiology of noise )
Once I was in the back with her, and we were on the way to the hospital, the little theater show began in earnest again, after a brief letup in walking out the door to the truck.

My assessment:
Skin is warm and dry.
Color is good, with an absence of cyanosis (blue or grayish color at peripheral areas).
Heart rate slightly elevated, but still well within tolerance.
Blood pressure normal.
Lung sounds are clear, with an adequate volume.
Pulse oximeter = 99% on room air. ( 99% of her total hemoglobin is carrying oxygen)

Conclusion? She's still full of crap.

As I continued to question her, she refused to answer me, until she decided I was mean, and wanted my name (speaking clearly now). At the ER one of the nurses met us and opened the door, at which point this woman, decided she was no longer in severe respiratory distress and told the nurse, who knows me well, that I had hit her.

By the time we had wheeled the stretcher into the ER room, she was screaming at the top of her lungs that I had hit her, that she was going to sue me, and that I would pay for the evil I had wrought. Which is scary 'cause I'm quite certain that given her obvious income level of less than $20,000 a year, she has any number of quality attorneys on retainer.

Conclusion? She's even more full of crap than I had thought.

Never a dull moment in EMS.

2003-04-26T22:51:00.000-04:00

Beyond Imagination
The ringing of the phone interrupted what had been an otherwise quiet evening. Sometimes I have a premonition about the phone. Sometimes I just know that the next call will be something horrible. I never would have dreamed of this. The dispatcher told me that I needed to go with Medic 11 on their call.

"What've they got?"

"We have a report of four people shot."

....hmmm.

Now I know that anything can happen, ( and usually does ) and that per capita, one city is just as violent as the next, but come on!! This is Chattanooga, for cryin' out loud! The likelihood of having four people shot is.......well......it's just not likely.

Me: "Is anyone reliable on scene confirming four people shot?"
Dispatch: "Yeah, the city (police) is on scene confirming four people shot."
Me: "Sweet Baby Moses."
Dispatch: "Tell me about it."

We were one of three ambulances responding. Since I was the closest supervisor, it would be my responsibility to give assignments and decide on "priorities of work". That's an army term by the way. Medic 11 got on scene first, and the medic's voice came over the radio.

P: "We've got one in cardiac arrest, one critical and two others."

It just gets better and better.

We were on scene just a minute later. I grabbed a bag and started to the house, trying to process as much info as I could. P came back on the radio:
"Make that two in cardiac arrest."

Me: " C, you get the second arrest, I'll handle the other two."

It was pitch black out, except for the sporadic light from headlights of vehicles and the distracting flash of red and blue strobes. The house was small and run down, cops were everywhere, stringing yellow crime scene tape. As I walked up I questioned a police officer as to what type of firearm they had been shot with.

Cop:" They're not shot, they're stabbed."

Just when you think you've got a handle on things......

When we entered, the first thing I noticed was the blood. On the walls, ceiling, furniture..everywhere. There was so much blood in the carpet that it was squishing under our feet. The next thing I noticed was a 300lb black man just inside the door. He was covered in blood and obviously out of breath. I asked him where he was hurt, and he pulled back his shirt to show me a single stab wound to the right upper chest. Since he was awake, he automatically moved down a notch on priority level. Through the next doorway I could see P and B bending over, beginning to work. They told me their patient had multiple stab wounds, including one to the head. I could see another man lying on the floor by a ratty bed, unconcious, and next to him the fourth victim, on the floor leaning on one arm, shirt soaked in blood and a look of complete horror on his face. I directed C to the unconcious man, also with multiple stab wounds, and turned my attention to the fourth victim. He told me he was not hurt. I made him sit up so I could get his shirt off. There was no way with that much blood on him, and three other badly hurt people, that he was completely ok. Amazingly I could not find any wounds on him.

Me: "Your not hurt at all?!!"
Him: "Well, I did get bit."

...and he showed me his arms with two perfect impressions of a set of teeth, one on each arm. Unbelievable.

After it was all over with the story came out...
One man walks in with a prostitute hoping to sell her to the three others. The other three weren't interested. The would-be-pimp, realizing the immediate breakdown of his supply and demand, market driven economy, decided that he was a communist and that the bourgeois had been unfairly holding out. So he elected to liberate the people from the oppression of their cash holdings at the end of a butcher knife. During this process, there was a common uprising amongst the people, and a coup was staged. The dictator put up a fight, stabbing one in the chest and another in the head, as well as nearly severing his right arm. And of course, managing to bite another one. Twice. One of the rebellious working class, managed to arm himself with a BB gun, and commenced to instructing the dictator with a blow by blow lesson on the right of the people to amass wealth in a capitalistic society. This was the source of the whole gun shot theory. As the police approched the house, they had heard the sound of the metal BB gun crashing against a skull.

The prostitute? She rejected modern thought on both economic forms and set out immediately in search of a less violent community.

2003-03-24T01:18:00.000-05:00

Not for the Faint of Heart
Fair Warning!!!

The following is a graphic, yet humorous account, that should probably be avoided by those of weak constitution.

Chattanooga is a city caught in an uphill struggle to modern urban life. While there has been dramatic growth over the years, the city still muddles through a small town approach to many things. We have a forensic center, and a competent forensic team, but they have never been able to justify full time staff to recover their bodies, so this admittedly gruesome torch must be passed to some other organization.

Guess who that might be.

This depressing situation has often led to some of the most memorable episodes in my career.

Tonight, C. called me to ask me to come help her and R. remove a body from one of our high rise, low income apartment buildings.

R. is a new soul to this world I call a job. He was in the EMT class I taught last year, and has zealously pursued his new calling with energy I haven't seen in quite a while. He's a big fella. About my height and 200+ lbs, he shaves his head smooth, and maintains a cheerful disposition. However, he is a rookie. That means he is fair game for whatever torture I can dream up. On this particular call, he made the mistake of telling me this was the first time he had had to transport a body. This is prime hunting ground sports fans. Let the games begin!

At 300+ lbs, our recently deceased friend had not been a lightweight in life, and being dead several days on his kitchen floor had not really helped matters. Bodies, for the uninformed, tend to swell when left lying around with such devil-may-care ease. Witness the fact that his scrotum was the size of a grapefruit. He was face down on his kitchen floor surrounded by.... How can I say this?..... juice. Most of his body fluids had evacuated themselves onto the linoleum. What had not drained, had migrated to just under his skin, lying in wait for the careless person to give them release. The smell is really beyond description. As we slid (scooted?, poured?) him into the body bag, his skin started to separate wherever we touched him. Streams of blood and interstitial fluid began to flow, and a trail of ..........( insert your own disgusting word ) was left in his wake. As we put the body onto the stretcher I could tell R. was walking a razor edge between dealing with the situation, and becoming a writhing mass of stomach convulsions. So what's a hardened paramedic to do with a rookie needing guidance? What calming words can I offer? What counsel can I give in this moment of crisis, this hour of desperate need? I decided to focus on the positive side.

"At least there weren't any maggots."

I've never seen that particular shade of green before. I wonder if Crayola could market it?

Keep in mind that R. was wearing a respirator that does a pretty good job at blocking odor. I became concerned though, and advised him not to throw up in the mask, as he would either aspirate, or at the very least have to pull the mask off and smell what I was smelling since I was working sans mask.

"....and believe me R. it stinks in here."

As we rode down the elevator nine floors, I tried to ease his hyperventilating.

"Take slow breaths...in through your nose, out through your mouth. Try not to focus on that Taco Bell dinner you ate. You know. Ground beef.
Onions.
Refried beans.
Grease.

I gotta hand it to him. He made it to the truck.

The mask came off, he ran to the front of the truck and here we go.....( Yes folks! We have a winner!! )

I think I peed my pants I was laughing so hard.

Laughter really is the best medicine.

2003-02-10T20:26:00.000-05:00

My February Resolution
Hmmmm.......must type more.

The news report said she had died.
Not too surprising since the last time I saw her she was on her way to surgery.
Chest tubes in. Intubated. Bloody sheets on the bed.
The trauma room is destroyed. Linens, sterile wrappings, surgical instruments abound.
Blood is everywhere.
How much volume did she get anyway? It must be gallons.

Empty vials.

She arrested when we got here.

There's the empty atropine I gave her. Her heart rate was too low.
Let's move!! She's gonna' code!
The ET tube went in easily, thank God. Now we can move that precious oxygen.
Gotta give the drugs time to work. 100mg of Sux. 4mg of Versed.
"C" has the first IV in. Volume, volume. All you can give her.
"Let's get outta here!"
"How many wounds does she have!?"
"We gotta go now!"

Here she is, barely breathing. Precious minutes are flying by.

Get the drugs pulled.

IVs.

"I'll meet you at the truck. We gotta' put her down."
I had taken one look and knew we were already losing the game.
There's "C" already working.

This young girl brutally hacked, her life soaking into this alley.

He did it.

He called 911.

2003-01-03T13:58:00.000-05:00

My New Year's Resolution...
I am determined to keep this thing posted with the start of the new year. So here I am on the third, making an entry. That's just about right.

The last year finished on a rather busy note.

We went to a shooting and were told on the way that the victim was shot in the leg and the shoulder. He was shot in the leg and the shoulder alright.....and the other leg, and the stomach, and the neck, and the chest, et. cetra, et.cetra. Final count was over 20 seperate wounds from direct hits or grazing fire, including one in the head that nobody found till they did a CT on him. Somebody wanted this guy dead. A respiratory therapist friend of mine remarked that this guy needed to thank God for preserving him and find out what he was supposed to do with his life. I replied that I was quite sure this would be a turning point in his career as a drug dealer and he would become a regular pillar of society.

That same night we worked a rollover MVA. The driver managed to flee the vehicle from where he turned it over, and run down beneath the overpass. He was cut on his face, but was not too seriously hurt. He did provide another opportunity for me to lecture someone on the dangers of drinking and driving. Basically I made the point that he was an idiot, which he protested saying he was not, and I of course made the point that he was the one lying on the stretcher, with his car totaled, and an impending DUI charge, ergo, "...your an idiot." He started crying and asking if he had hurt anyone and praying "...god don't let me hurt anyone." I pointed out to him that he could express all of his remorse on his court date, because I was quite sure God would be there.

Happy New Year to All!

2002-12-18T21:50:00.000-05:00

My How Time Passes....
I can't believe how long it's been since I updated this. I'm back working on the unit for a while so maybe some other interesting things will happen.
We had a call several days ago on a construction worker that had fallen off of his ladder on the second story of a building. No big deal except that the only way to him was via another extension ladder. Chattanooga FD came out and used their "Quint" (aerial ladder) to reach the second floor and bring him down. We have also been dealing with an Indian man that has some mental problems. He has been calling quite frequently and their is never anything wrong with him. The other night he called and I went as a supervisor and threatened him with prosecution if he continued to abuse the 911 system. He was living in a hotel and the hotel manager was so fed up with him that he kicked him out. Only problem is this guy moved into MY district now... so that one worked out real well for me.

2002-11-05T21:02:00.000-05:00

My Life
So sorry for not updating this. It's so hard to maintain my own level of genius sometimes.
So what has happened in my life?
Honestly, not much in the way of calls. Several days ago we did run a call at one of the local industrial plants where a worker had been a little too close to some sort of equipment that blew a bolt loose. It went into his right bicep then took out the inside of his arm. I think it pretty much disintegrated the bone. Poor guy was in a lot of pain. Interesting looking injury though.
On the lighter side of things, several of us from work went to Key West on a three day off shore fishing trip. You can see the results here. We are on the very bottom row of pictures in the first picture, and I am the one to the far left kneeling. Please note that there are another 130-150 fish that aren't in the picture. If your into off shore fishing I highly reccomend this guy.

In fact I'm debating changing this site to fishmedicbloggerfishfishfish.blog

More later.

2002-10-16T23:10:00.000-04:00

Language Barriers...and This Seems Very Familiar.....
C. and I went to an unknown medical last shift. Chattanooga, like most American cities, has an ever expanding Hispanic community. When we got to the house, it was the two of us, two very white cops, and a Mexican lying on the floor with a couple of his buddies hanging around. No one spoke or professed to speak any English. We helped the guy up, and he immediately started crying. He starts babbling to his buddies, whom are rapidly increasing in number. You know the little toys where you take the guy apart and there's another one inside that looks just like him only shorter? That's what this was like....only with Mexicans. Everyone that came through the door was shorter than the last guy, until I fully expected to see a two foot Mexican carrying the " Yo Quero Taco Bell" dog. Remember the animated "Grinch" where the feast is served at the end? And the littlest Who walks out on the table?
Oh, yeah...all the Whos were down in Whoville. I'm not being racist, it was just funny.
After about ten minutes of a loud multi-focal conversation, that I had no part of, I looked at C. and made the point that of the 30+ people in the room, we were definetely the least informed.

One of the cops asked if we needed him to sign a refusal for us.
"Brother," I said, "I don't even know why were here."

In service..false call.

2002-10-13T22:24:00.000-04:00

High On the Mountain
Last night I spent about six hours helping take a fallen climber from a remote location in the Prentice Cooper WMA. The call came in as a high fall and while we were headed out there, they made the determination that the call was actually in Marion County, so we canceled. Marion County, like many other small municipalities around the nation, has very limited resources. In fact, at the time the call came in, they only had two ambulances on. Their nearest truck was probably thirty to forty minutes behind us. It may seem nitpicky to worry about county lines when someone's life is at stake, but there are some huge liability issues involved. Basically, you don't cross lines until requested. Fortunately, Marion county did ask for our assistance so we went on in. I have hunted the Prentice Cooper WMA in the past, and it's huge. (30,000 plus acres) We were in a part I had never seen before. When we got to the bottom of the trail, some of the area hikers and climbers told us we had about a twenty minute hike in. Twenty minutes that is for a long haired, sandal wearing, granola eating, tree hugging, bottled water drinking, college student. About 40 minutes later, the short haired, boot wearing, beer drinking, hamburger happy, tobacco loving paramedics, were on the scene. We would have got there sooner, but we had to stop to defibrillate each other on the way up. We had to give one guy an emergency angioplasty, but we sent him back. Anyway, the patient had fallen about thirty feet, landing on a rock ledge twenty to twenty-five feet off the ground. Other than a probable head injury, he seemed to be okay. Our task focused on assessment, calling in resources, and stabilization. My compliments to the climbers that were with him. They did a very professional and safe job. We were able to remove him from the ledge before rescue had gotten there, lessening the time in the woods. The Hamilton County Rescue Cave and Cliff team did a fine job of getting him out of the woods in a safe manner.

Now if I can just find that lung I barfed up......

2002-10-09T22:32:00.000-04:00

To the Blogmedic Faithful....
I didn't realize it's been since the 29th that I updated this thing. So sorry.
Funny call today...
We went to a house on a young girl that had had a mole accidently pulled off and the site wouldn't quit bleeding. Seriously, this is the kind of thing people call 911 for. There she was, lying on the bed, and safely encased in tissue was the offending growth. We suggested she save it for a souvenir. No active bleeding to be seen. All is well. On the way to the call I called J. one of our more cynical dispatchers, and told him he should call the residence back and make sure the mole was placed quickly into a moistened cloth in the hope that surgeons would be able to reattach it later. What? That's standard procedure for amputated body parts.

Many times I am asked for my opinion on TV shows that feature medicine in general and EMS in particular so here is a short, and not neccessarily all inclusive review.

Rescue 88 ( canceled)
This short lived drama was the worst. It had dopey acting, unrealistic scenarios and cheesy subplots. It may be in syndication somewhere on cable and should be avoided at all costs. If you do happen to view an episode, go and dip in the Jordan seven times.

Paramedics ( The Learning Channel)
This is the EMS version of COPS. It's real and features EMS agencies from across the nation. I can't help get the impression however, that my colleagues allow the camera to affect their behavior. Of particular note is the episode filmed during and after an F5 tornado goes through Oklahoma. Pay attention to the paramedic by himself in the gymnasium as scores of patients are brought in. That is hell my friends.

Emergency (may be able to catch reruns on TV Land)
The impact that this show had on the profession can not be understated. While it does have some campy acting and suffers from the limits of 1970's technology, this show is very accurate for its time period and inspired many firefighters and paramedics.
Trivia note: The actor Bobby Troup ( Dr. Joe Early) was a talented jazz pianist and song writer. He penned the song " Route 66".

ER (NBC Thursday)
This show has lost a lot of its early edge by becoming too focused on the developing love stories. It is generally very accurate ( Michael Crichton is a consultant) but the paramedics are often left looking like idiots. No ER is ever that dramatic, except in the amount of sleeping around that goes on, and real life makes the show look like sunday school in that respect. Still, they got me hooked and I "must see tv". Try to see the episodes directed by Quentin Tarentino. They are outstanding.

HONORABLE MENTION:
NYPD Blue (ABC)
While this is a cop drama, the paramedics that make short appearances are real FDNY paramedics. You gotta love a show that does that.

The Winner Is....
The West Wing (NBC)
Fast paced, witty dialogue is the hallmark of this show. It has an above average cast that consistently turns in stellar performances. Week after week it puts you through your political paces and leaves you with the sensation that all the actors fill a supporting role to the star...the American political system. It doesn't feature EMS in any way shape or form. Dammit, its simply good television.

...and that's saying a lot coming from a Republican.

2002-09-29T19:37:00.000-04:00

Remarkably Slow Lately
There has been surprisingly little to relate lately.

I had a conversation the other day with a couple of teenage girls whose questions were focused on "dead people". They seemed amazed that my job often involves death and dying. Of course, in the teen years you are convinced of your own invulnerability and death is a foreign concept. To see this in their faces was at the same time a delight and distressing. A delight in so much as it helps me to recall my own more innocent years where my concerns were cars, superheros and girls. A distress in that I was keenly aware that the reality of the world is so different. When they asked me the "worst thing you've seen" question, I debated: Do I tell them about a 12 year old girl, an honor student, well loved, that burned to death in her bed or do I allow them to avoid those images for a few more years? The beauty of innocence is in it's ignorance, so I smiled and changed subjects. Plenty of time later for morose ponderings.

2002-09-26T16:51:00.000-04:00

After the Interview
I had not told anyone that I work with about this site prior to my interview with the paper. It's been rather humorous hearing reactions from my coworkers. The article was not that in depth, but I did notice an increase in hits. Also, some German website (blog?) has linked to and quoted me. Very funny. If anyone can interpret this for me, let me know.
Had a major wreck in East Chattanooga the other day. Probably a bad head injury. Even full size pickups don't hold up well when plowed by a CARTA bus.

I was reminded the other day of one of the funniest calls I've been on, and for lack of other material I thought I would enthrall Web Land
with it.

It was a dark and stormy night. No, really it was. In fact, we had an extra crew member assigned with us since we were operating in ice and snow. Since this is Chattanooga, Tennessee, the fact that we had ice and snow is unusual enough. Anyway, we went out on a possible DOA (Dead On Arrival), an 80 year old female. When we arrived I happened to walk in first with John and Jade behind me. The family was standing around very somberly and directed me to the back bedroom. As I walked in I saw the body of a young boy stretched out face down on the bed. I immediately turned to my partners " Holy---- It's an 8 year old not 80!!" 8 year old children are not just DOA. So the fact that we were now dealing with a kid changed everything. First, is there a chance that we can resuscitate him, and second, is this a crime scene we just walked into? With a new sense of urgency I quickly walked over to the child to see if he had a pulse at all. I reached my hand out and touched this poor childs neck....and promptly wet myself when the dead child woke up. At this point Jade, who had followed me, points out John standing behind the door next to a hospital bed with the wrinkled corpse of a woman, who was obviously as dead as a hammer.

I got to giggling so hard, I had to walk outside.

2002-09-16T21:35:00.000-04:00

Note to Webheads
I have been overwhelmed by the response to this blog. Granted much of it comes through Eric Costello's glish site, but it's nice to know someone is interested in what I have to say. For any avid fans out there that are frustrated with infrequency of updates, I work 24 hours on and 48 hours off, so its only every third day that there is the potential for something interesting to tell. You may be interested to know that I did a twenty minute phone interview with the Chattanooga times today about the whole blog process. I would have liked to have been less ignorant of the technology, but I think I got the salient points across, to whit:
1) It's free
2) It's true first amendment exercise
3) Did I mention that its free?

One of the things that I would like for people to understand, is that this job is not a constant adrenaline rush, which is why it can be terrifying sometimes. The truth is most of what we do is very routine. Day to day we handle calls that absolutely do not warrant risking the lives of me and my partner, not to mention the innocent drivers on the road as we careen around town. Then your Ho-humming through to the next call and all of a sudden the world is coming down around you. I tell rookies coming in that there are really only three types of patients we handle:
1) Those who don't need an emergency room and certainly don't need EMS to get there. ( very irritating)
2) Those who need an emergency room but could probably still get there without EMS.
3) Those who needed to be at the emergency room 30 minutes ago and needed us to get them there.

This is probably an oversimplification, but it makes for good drama.

Most of you would be amazed to see the percentage of calls that fits in the first category. I would say it is anywhere from 70-90 percent, and that is not an exaggeration. Keep in mind this is happening nationwide not just in Chattanooga. Our total call volume is around 20,000 calls a year. You do the math. Now imagine that happening in a major metropolitan area like New York with a call volume (I think) between 1 and 2 million. That's a lot of tax dollars. Now think about this...if I run a call for someone who's arm has been hurting since last night, my unit is out of the loop for the next 30 minutes to an hour, depending on transport time. That means that if another call comes in for my district, there's a good chance the next truck could take anywhere from 8 to ten minutes to get that call. What if that's your kid that's having a seizure? Or your husband having a heart attack? Or your wife bleeding to death from miscarrying her baby, which is now lying on the floor struggling to breath? See what I'm getting at?
I've had people tell me " I called you, 'cause if you take me in I won't have to wait in the waiting room." (What a shock it is to them when I take them right to triage!) On top of that, I've been cursed at, puked on, punched, kicked, and spit on for moving too slow, too fast, not caring, asking too many questions, and being white. Oh yeah, and once I got complained on for looking too much like a Navy SEAL (which I am not btw). EMS is way overworked and underpaid. Most paramedics make under $30,000 a year. Firefighters and police ( God bless them ) get hired in, and then get their schooling from their employer. EMS workers have to get their schooling on their own ( two years average for a paramedic ) and then get hired. I have to maintain ACLS, BTLS, CEVO and BLS certifications to stay on the job. Guess who makes more money and has more benefits? Believe me, I totally support fire and police, but they receive far more recognition than EMS. How many pictures have you seen from 9/11 that focused on just EMS? A very small percentage I guarantee you. One last gripe...Chattanooga Fire Department has about 20 to 25 pieces of apparatus manned 24/7 in the city of Chattanooga. We have 7 ambulances covering the same area. Why the disparity? Isn't access to EMS as important as fire protection? The fire department is multi-roled and helps us on most of the bad calls, but they're not going to take you to the hospital. So why the numbers? The answer is simple. The home owner pays less insurance and receives other breaks based on the ISO rating of the local fire department, which correllates directly to the number of pieces of equipment, staffing, water supply and other variables. Short answer...money. Imagine a reduction in your health insurance premiums if it were tied to your local EMS. There'd be ambulances everywhere.

Still, I love my job, I have a good employer, and I'm proud to serve Chattanooga.

Enufff already......

2002-09-15T22:49:00.000-04:00

Quiet Sunday
Today was relatively calm. We did have a shooting in the East Lake area. A Hispanic male was robbed at gunpoint. He gave the guy about $65.00....and then the guy shot him. That is not someone tragically down on his luck, or just out to make a little cash. That is someone who just wants to have control over someone else. Fortunately, the victim's injuries were not too serious.
I wondered what it must have been like for him to be robbed in front of his wife and kids. How heartless does someone have to be to rob another person, and then shoot them in front of their family after you have their money? As senseless as it is, there isn't a gun law in the world that would have prevented it.

2002-09-13T00:05:00.000-04:00

National EMS Memorial
I want to add this site as a permanent link, but I have to speak with my blog administrator to be sure it's done right. I have some ideas for sprucing up this site, but I fear I will have to greatly increase my knowledge of html. Not much has happened lately. Today was " Kids Football Injury Day" One little, gutsy, fella definetely had a broken arm, and other than some quiet tears, was holding up well. Personally, if my arm had looked like that, I would have sought refuge in uncontrolled wailing and teeth gnashing. He'll be fine.

2002-08-31T23:29:00.000-04:00

Hug Your Kids
This job rips my guts out sometimes. I worked a three year old that had been pushed off a porch by her younger sibling several days earlier and was now unconcious. Her CT showed a major bleed in her right frontal lobe. Her family obviously did not have a lot of money, and to top it off she was missing all of the fingers on her right hand and most of her toes on both feet due to a condition known as Amniotic Banding where parts of the body develop outside of the amniotic sac in utero. The amniotic sac then causes necrosis (tissue death) to the affected part.
This poor child already had a disability, and now has an injury that even if she recovers from, could still cause brain damage.

As the father of three, I just wanted her to know that Jesus loves her and I know he was in that operating room with her. This is a hard, hard world and sometimes I feel like I'm cleaning up the mess with a Kleenex.

Hug your kids. You never know when it's the last time.

2002-08-29T22:45:00.000-04:00

Another Conversation
Annoying fat 12 year old: Does anyone ever die in your ambulance?
Me: Yeah, sometimes
AF12yo: Who?
Me: Kids mainly.
AF12yo: Really?!! Like babies and stuff?!!
Me: No. Usually kids like you.
AF12yo: Oh.

I love my job.

2002-08-23T09:30:00.000-04:00

Back On
I've been away finishing my OCS program. Glad that little bit of hell is over.
Last shift I was called by one of my crews to perform an RSI (Rapid Sequence Induction) for them. A 53 year old woman had been doing water aerobics in the pool at a local fitness club, when she suddenly became unresponsive. By the time I got there, my crew had her out of the pool and in their ambulance. She was awake enough to look at me when I called her name, but totally flaccid on her right side, but would hold her left hand up over her head if I lifted it up. Now, the thing about RSI is that your giving heavy sedation and paralytics, so if your giving it to a patient you are taking away their ability to breathe on their own, and it is imperative that you get them intubated so you can breathe for them. You can draw your own conclusions as to the outcome if you fail to perform this correctly. I was hesitant to "put her down" as she was somewhat maintaining on her own. Then we noticed that she was slowing her respirations down to an unacceptable level and the percentage of hemoglobin that was carrying oxygen (known as SAO2 and measured with a pulse oximeter) was rapidly falling. So I went ahead.
4 milligrams of Versed and 100 milligrams of Succynyllcholine (Sux) later she was out.

I couldn't get her intubated.

She was very large 270+ lbs with a very short neck and this often is a problem in performing an intubation. By this time we're moving rapidly to the hospital, so we fell back to basic ventilation assistance. Interestingly, given her weight I was probably a little light on the dosage of sux, since after just a few minutes she started to come out of it. Sux doesn't last very long anyway. Our transport was not very long so we just bagged her and rolled into the ER. I told the doc what had happened and he was very understanding. He proceeded to pick up where I left off and six intubation attempts later he was paging anesthesia to come assist. It took them another 30 minutes before the woman was finally tubed and on the ventilator.
I felt vindicated that I had done my best, and it was just very difficult.
Don't let this rattle your faith in medicine, just think of it as another health hazard due to being overweight.
I was certainly sweating it for awhile though.

2002-07-19T15:57:00.000-04:00

We're Only Human
The following is a paraphrase of our morning radio traffic from 17 July 02:
Radio: (unintelligible)
Me: What was that?
Cynthia (my partner): Sounds like some kid on the radio.
Radio: (unintelligible; very loud)
Me: What is that!?!
Dispatch on radio: Last unit with traffic....?
Radio: (unintelligible; again very loud)
Dispatch: 416( training officer) I'm clear you've been involved in an MVA (Motor Vehicle Accident) on Dayton Blvd, can you give a better location?
Me and Cynthia: Oh S---!!!
We hit the door running.
The whole way to the scene my stomach was in my boots. My head had visions of D.P. bleeding to death somewhere.
On the way she called on the radio again, this time with obvious panic and fear in her voice:
D.P: I have bystanders telling me the other party is critical, tell everybody to step it up (hurry).
Apparently, another vehicle had turned right in front of her. With no time to slam on the brakes the impact was tremendous. The other car was crushed. Sadly, despite our best efforts and heroic resuscitative measures in the ER, the 19 year old girl died.
Fortunately, D.P. only had minor injuries.
It's strange to think that awful things can happen to lifesavers too.

2002-07-15T14:14:00.000-04:00

Day One
The first day I worked after setting this blog up was not very interesting. I was filling in for the west side supervisor and that truck is usually fairly slow. However, somehow I managed to end up running 9 calls and coupled with the regular administrative duties I got to put 15 hours in before I could slow down. One rather humorous situation was a head-on collision with a mom and three kids in one car and a mom and two kids in the other. Mom with two was turning around and trying to convince the 5 year old to put her seatbelt on when she crossed the yellow line and slammed into mom with three. Fortunately, the little girl got her seatbelt on before impact and was basically ok. While we were enroute to the call, we came over a slight hill and right in the middle of the road is a man with no shirt and no shoes. I had to slam the brakes to keep from plastering him. He screamed at us that it was his wife and kids in one of the cars and demanded that we take him to the scene. .....yeah, like that's going to happen. I tried to reassure him that the reports on the radio were that everyone was basically ok, but there was no reasoning with him. Finally, I just drove around him and kept going. Once we were on scene, my partner and I spent about ten minutes sorting out kids and moms and what cars they belonged to. Everyone was ok in the end. Oh, and later I took a 75 year old woman to the hospital who was convinced that she had an appointment with the ER doc. At 10:30 at night. There just ain't no helpin' some folks.
More later.

2002-07-10T12:15:00.000-04:00

This whole blogger thing is pretty interesting. I can see where it would eat up a lot of time.

By way of definition:
EMT: Emergency Medical Technician; exists in some form in all states. It is usually the basic level of care, and depending on what that state allows them to do can be very limited or extensive.
Paramedic ; Generally the highest level of pre-hospital provider there is.
All paramedics are EMTs, but not all EMTs are paramedics.
These definitions are not intended to be all inclusive for all states. They are here just here to clarify things for the public.

EMS personnell operate under the direct supervision of a physician. This is because we are not licensed to "practice medicine". Obviously we often do not have time to consult a physician before we act, so our authority comes from a set of pre-established protocols. Essentially these are treatment algorythyms that allow us to do what we feel neccessary to manage a patient.

Our service is fairly aggressive meaning that there are very few occasions that I have to get direct permission or consultation from a physician.

Hamilton county is pretty large(it can take almost an hour to drive from the northernmost part to the southern border). It is basically divided in half by the Tennessee river, which for our purposes, creates the West and East sectors. Additionally, the Central sector is composed mainly of the city of Chattanooga. Each sector is divided into districts; districts 1, 3, 5, and 7, are the east sector, 2, 4, 12, and 8 are the west, and 6, 9, 10, 11, and 13 are central. Stay with me here.......this gets confusing. Each district is covered by one 24 hour ambulance with their own station house. The only exceptions are 9 and 13 which share a station and response area and 11 which is housed in Fire Hall 13 on Brainerd Rd. The shift schedule is 24 hours on and 48 hours off. There are three shifts A, B, and C. Each shift has a Shift Captain, and three Lieutenants, one Lieutenant assigned to each sector. Each ambulance has two crewmembers assigned to it. The three Lieutenants are assigned to units 12, 3, and 9. When a shift is at full staffing, the Lieutenants have assigned to them a crewmember reffered to as a "floater". The floater is the least senior person on each shift. If everyone is working on their shift the floater takes the place of the Lieutenant on the ambulance, and the Lieutenant is in a car or jeep and free to focus on administrative matters or respond to calls as he chooses. If someone is off on vacation or out sick or whatever, the floater is sent to cover the hole and the Lieutenant functions on the ambulance while maintaining his other supervisory responsibilities.
So the numbers are:
30 people to a shift with
3 shifts = 90 field personnell
1 Chief
1 Deputy Chief
1 Training Lieutenant
1 Supply Lieutenant
1 Supply Assistant
1 Training Assistant (part-time)
1 Computer Technician
1 Payroll administrator
1 Secretary

I'm exhausted. More later.

2002-07-10T00:22:00.000-04:00

That first one was relatively easy. I apologize for the uncreative set up, but maybe I can make it more interesting as I go. My brother-in-law is much more familiar with this process, so I'll consult him as I go. If you haven't seen his page go to glish. He is very creative and smart and I was flattered at his suggestion I do this blog. If it turns out as a nightmare I can still strangle him at the next family gathering.

EMS stands for Emergency Medical Service. It refers usually to any organization providing routine or emergency transport of the sick and injured. While we have a lot in common with the police and fire service it should be clear that we are our own unique animal. Many EMS workers are involved with the other emergency services as a side job or maybe EMS is their side job. The point is, this is it's own unique career field.

As a career, EMS has only been around since the middle seventies. EMS (like all medicine) has seen the benefit of the rapid improvements in technology since then, and the EMTs and paramedics of today are trained far above what their ancestors were.

Well, I got distracted. Caleb L. stopped by and I was visiting with him for almost two hours, and now it's after midnight and I'm old and tired so I'll have to pick this up later.

2002-07-09T21:55:00.000-04:00

So....my brother-in-law suggested I give this a try. This first post will be simple introduction and may be oversimplistic in explanation, but I am always amazed at what people don't know.
I am a paramedic for Hamilton County EMS. Hamilton County is located in the southeast corner of Tennessee and encompasses the city of Chattanooga. Our service is responsible for answering all 911 calls of a medical or traumatic nature in the city of Chattanooga and in the rest of Hamilton county. I guess Chattanooga would be considered small to medium sized city. I think the last census was somewhere around 130,000. With the rest of the county, we serve a population of about 250-300,000.