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Monday Morning Quarterbacking

Have you ever seen this video? These guys really screwed up. This was a dangerous and amateurish effort on the part of these firefighters. There are numerous problems that I saw there. Lets review the worst of them.

1 The incident commander apparently failed to recognize that the building was lost. He still had crews operating inside the building during most of the film. Why expose crews to this potential collapse hazard to try and save a building that is already a goner?

2 The building had already self ventilated through the roof, and these guys are still breaking windows. Why?

3 The exposure building on side D (the right) was burning for quite awhile before anyone did anything about it. Have these guys ever heard of exposure control?

4 The ladder that was lying against the building, being exposed to direct flame, was later used as a roof access on the second building. Then the firefighters (and I use the term loosely) compound it by being on the roof without a roof ladder.

The list goes on. In the comments section for the incident, firefighters accuse critics of being “monday morning quarterbacks” and say that if we weren’t there, we cannot criticize. Ridiculous. We kill 100 firefighters a year, and it is time we stop. Lets stop making excuses, and fix this.

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Bad Cops

I saw this on Tam’s website yesterday. There is a discussion going on over there about bad cops.

Then today, from the Orlando Sentinel, comes this story. This cop was caught planning to rob a man he thought was a drug dealer. It turns out the intended victim was an undercover officer. The bad cop was a school resource officer. You know, trusted not only as a cop, but trusted to watch over our kids.

Whenever I see someone caught committing a felony, I have to wonder what they have done in the past that they HAVEN’T been caught doing. After all, I most felons don’t start as felons. Besides, odds are the criminal doesn’t get caught the first time.

Working in the fire department, I know quite a few police officers professionally. On a personal level, the street I live on is almost all cops and firemen. Heck, I went to school with a fair number of my brothers in blue.

Even with “professional courtesy” I have been shaken down twice in the last 10 years by bad cops. I have seen cops do it to others. I can only guess at how often it happens to those without a badge.

There are a lot of good cops out there. There is a minority that is bad. I cannot prove it, but I think that the number of bad cops runs at least 10%. Now that is certainly a minority, but it is enough to give citizens a bad taste for the law. All of us in public safety need to remember that the next time we want voters to approve more tax money for our departments.

To the good guys: Don’t let the dirtbags give you a black eye. Turn them in.

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The 343

On this very day 6 years ago, 343 firefighters died. I have wondered how many of them entered those buildings, knowing that they would not exit. They went in anyway, in the hope that they could save some lives.

I have an envelope in my locker, as many firefighters do. Contained in that envelope is a series of letters, written to various friends and family. There are messages in there for each person. Instructions, goodbyes, all of the things we would like our family to hear or to know, should the unthinkable happen. Those letters were VERY difficult to write. When my locker gets cleaned out and the contents given to my family, those letters keep my family from feeling guilty or ashamed if they forgot to say how they felt.

I was at work myself that morning, going about my daily routine. If the time comes that I am forced to make that decision, I hope that I have the courage to make the right decision, and no matter how things turn out, that my decision is the right one.

Right for me, for my family, and for the people I have sworn to protect.

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Respiratory madness

I have been working for 30 straight hours. I am on the second half of a 48 hour shift. Today, my EMT partner also happens to be one of my paramedic students. Since the class just had their midterms, I tell him that he can run the calls today, and I will only step in if he needs help.

Our first call of the morning goes rather smoothly, it is a woman complaining of vertigo. She has a history of it, and it is a pretty easy call. Our second call of the day did not go quite the same way.

It came in as a non-emergency call for a man who has not eaten in three days. When we arrive, I let my partner enter first. I hear him talking to the patient as I get the stretcher ready. As soon as I finish that task, I enter the room. The patient is cyanotic, he is tripoding, and he has one word dyspnea. He is covered in sweat. I have seen this look before, and a patient that has it never does well. My partner is busy asking about his eating habits and is oblivious to the state his patient is in.

I tell him we need to be moving to the truck. When we get there, the patient has no lung sounds at the bases, and almost no lung sounds at the apexes. He is begging us to sit him up. His SaO2 is 88%. He has COPD is normally on home oxygen, but he says he took it off so he could smoke a cigarette.

He is struggling to breathe, and I cannot believe that he will be conscious for long. I call for backup as we hook him up to the CPAP machine. My partner secures an IV, and as the backup arrives, I tell one of them to get in front and drive us to the closest hospital. The patient balks. He says that he doesn’t want to go THERE, he wants to go to another one almost 10 minutes further. I tell him that I am not going to bypass a perfectly good hospital with a patient who is about to die. He tries to argue, but not being able to breathe cuts him off from too much protesting.

When we get to the hospital 3 minutes later, he is barely responsive. I am trying to keep his airway open, as he breathes 40 times a minute. At least his SaO2 is now 99%. I tell the nurse what is going on, and she tries to tell me that because I put a COPD patient on CPAP I knocked out his respiratory drive. I gave her a stupid look. Right about the time I was warming up to my answer,the charge nurse (who was a street medic himself) saved me from the disciplinary action that was soon to follow my remarks by taking over for nurse clueless.

CPAP is indicated in the treatment of pulmonary edema, especially in the presence of COPD or CHF. In the short amount of time that EMS has contact with COPD patients, oxygen is not going to knock out the respiratory drive of the patient. This was indicated by his respiratory rate of 40.

and the next time my partner sees “the look” he won’t get tunnel vision, and he will know what is coming. That is how we learn, folks.

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More on the Searches

It appears as if I am not alone in my disdain for searches by stores.

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The Best Buy searches

I went to Best Buy and bought a new HDTV. I got a 50″ Plasma, a table to put it on, and a surround sound system for it. I was replacing my 6 year old rear projection HDTV. The new set looks great, but that is not the point.

The Best Buy in south Orlando is set up so that when you leave the registers, you approach the exit from a direction that is completely different from people who are exiting the store that haven’t bought anything. That is, if you are leaving the store from that direction, you had to have passed through the check out.

After leaving the check out, there is a guy that stands there and always wants to look at your receipt. Now, this isn’t just Best Buy. Most stores around here now do this, and it annoys me. It is like the store is saying “We think you are a criminal.”

So, about a year ago, I stopped doing it. When they ask for my receipt, I ignore them and just keep walking. I do not steal, and my stuff is in a bag that has your store’s name on it. You have no reason to search me, so I am not going to allow it. If they don’t like it, I don’t care. I am not breaking the law, you have no reasonable suspicion that I am, and you are not going to search me. The simple fact that I am leaving your store with merchandise does not mean that I stole it. After all, the whole point of you even having a store, is having people leave it with merchandise. I bet hundreds of people leave that store every day with merchandise.

The guard at the store, and the woman next to him, yelled at my back as I left the store. The guy telling me to stop, and the woman calling me a rude jerk. Funny thing is, no one considers it rude to accuse you of stealing and demand that you be searched.

What is wrong with this country that we think this behavior is acceptable and necessary?

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Empty nest

On Friday, my son announced that he was ready to leave the nest. He moved out on Sunday. I am torn about this for a number of reasons.

I am glad that he is now ready to face the world. He finished his AS, he has a good job as a Firefighter/EMT, and he makes decent money for a 20 year old (he turns 20 in November) He started Paramedic school last month, and I am flattered that he is following in my footsteps. It makes me proud that he is doing so well. I know he can’t stay forever, and he must live his own life.

I am going to miss him terribly. We do so much together. We go places, we hang out, we play video games. My life and my home are going to be a little emptier without him around.

I hope he remembers to visit his old man. Next step is being a grandfather. Man, I am getting old.

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Doc in the Box

Wal Mart. You can do everything there. The Wal Mart in our response area sells the normal Wal Mart stuff, plus groceries, and automotive repair services. Inside, there is a pharmacy, an eyeglass store, two restaurants, a bank, a photo studio and a Walk in Medical Clinic.

How poorly do you have to do in medical school to be the Wal Mart doctor? We responded to this “Doctor’s” office three times yesterday. One of these visits was telling.

A man here was on vacation, and sitting near the pool eating is vegetarian submarine sandwich. Less than thirty minutes later, he developed shortness of breath, a tickle in his throat, and a rash known as urticaria. He complained that he “felt bad.” What does the family do? Call 911? Rush him to the hospital? No… They took him to Wal Mart, in the process driving past two fire stations and a hospital.

When he arrived, the Doctor gave him 50mg Benedryl, 1mg Epinephrine, and 125mg of solumedrol. When all of this failed to work, she called 911. When our heroes arrived, we noted that she had given everything except tagamet, so we talked about starting a tagamet infusion (300mg over 10 minutes). The Doctor told us that she would rather we did not, because the patient had been seen a month ago by his doctor back home for chest pain, and that he would need cardiac monitoring before we gave any drugs.

Uhhh- she doesn’t even have a cardiac monitor (we do) and she gave him epinephrine, which was the correct thing to do. However, epi has far more cardiac effect than tagamet does. Yes, there are rare instances of arrhythmias and hypotension with tagamet, but then again epi is to be used with caution in patients with a history of hear disease due to the increased myocardial oxygen demand that epi is sure to cause. The fact that the patient was orthostatically hypotensive was more of a concern to me than an anginal episode of unknown origin a month ago.

We got him in the truck, did a 12 lead, IV, oxygen, tagamet, and went down the road. He had no known allergies, so eating a sandwich will be an adventure for him in the future. Heck, it may not have even been the sandwich. We DO have a lot of biting insects here.

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I can’t believe you are an instructor

A Para-fetus came to me yesterday with a question. It seems that the young one was in paramedic class yesterday, and the instructor asked them if they knew when it was appropriate to use a Kendrick Extrication Device. The student replied, “To move patients while stabilizing the spine, for example, to remove a patient from a car after the roof has been cut off.”

To which the Instructor replied, “If you have to cut the roof off, the patient is probably too critical to bother using a KED.”

Ummm, it is called the Kendrick Extrication Device. You know, to extricate patients with. This is plainly an instructor trying to impress his class with his encyclopedic knowledge. If you want to get into the discussion of hemodynamic instability, and the decision to perform rapid extrication, fine. What I don’t understand is why you would make a blanket statement like that.

Some people who instruct need to think carefully about what you are teaching students before you speak. For reference, here is how I make the decision:

All patients die from the same cause: hypoperfusion. Every death is caused by a failure of the body to perfuse the brain. Therefore, anything that threatens that is a serious concern. A good rule of thumb is to perform a rapid extrication on a patient who is critically unstable and in danger of hypoperfusion.

These patients are easily spotted:

Altered level of consciousness
Systolic BP <90mm hg (in other words, lack of a radial pulse)
Breathing rate less than 10 or more than 30
Serious, uncontrolled hemorrhaging

Most other patients can wait the extra 3 minutes or so to stabilize the Cspine, especially if the patient’s mechanism of injury or clinical signs suggest Cspine injury.

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DirecTV

A couple of years ago, I got DirecTV. I wanted to get the high definition, and I wanted to have digital recording capability. When I originally got the service, the operator told me that the HD DVR’s were too expensive for them to lease, and if I wanted it, I would have to buy it. I did, for $425. I leased two other receivers, for which I had to sign a one year contract. All was well.

20 months later, I bought a new house and decided to move. In order to transfer the DirecTV, they told me that I would have to pay for the installation. Since my house was wired for CATV and not satellite, this was going to be expensive. My year was up, so I canceled and got CATV instead.

My final bill comes, and lo and behold, they charged me $187 in cancellation fees. They tried to say that the DVR was a lease. I pointed out that I was only billed for two leased receivers. The reason I wasn’t charged the $5 a month for the lease was that the first leased receiver is not billed, according to them. Think about this- $425 plus a $4.99 a month for 20 months, plus a $187 cancellation fee= total cost for the leased receiver of $711.80, AND they wanted me to return the DVR.

The paperwork they gave, the hidden service agreements, referenced in fine print, and the confusing terms made my head spin. Large amounts of double talk and half truths made me feel like I was buying a used car. When you deal with these guys, look for the asterisks and the escape clauses.

When I produced the receipt for the DVR, along with the credit card statement, instead of doing what was right, they sent me to a collection agency. I threatened to sue. Three months later, they finally send me a letter, canceling the fees. I now have a DVR that I can sell, along with a resolve to never try DirecTV again, and I will urge others to do the same.