You aren’t as good as you think

Ego. That is what you get when you get a room full of paramedics together. Needing CEUs, I was sitting in an advanced airway class today. During an in-class discussion, the subject of intubation came up, and I remarked that I often use airways like the King tube for intubation, because it allows a provider to manage the airway of a cardiac arrest victim without stopping chest compressions, and there is no worry about missed intubations. This increases survival rates.

A medic in the row in front of me said that he gets enough intubations that he isn’t concerned about that, because he is confident in his abilities. He also told me that he performs RSI in his agency, and he feels like he is good enough that he doesn’t usually bother to prepare a back up airway in the event that he cannot secure a tube. Later in the day, during a break, I asked him how many intubations he gets.
He replied, “Three or four.”
I asked: “A month?”
He says, “No, a year.”

How do you think that you are proficient in performing a very complex skill that takes 30 seconds, and that you perform once every three months? You are so confident that you will give a drug to a patient that makes it impossible for that patient to breathe on his own, without making sure that you have a back up plan in place, in the event that your primary attempt fails to secure the airway?

Later in the afternoon, we had the opportunity to intubate a METI man. (This is a computerized high fidelity mannikin that reacts to medical procedures like a human would.) This medic and his partner were given a scenario where the patient stopped breathing, and were expected to intubate the patient before he desaturated to the point where his heart began to malfunction.

They failed, because they spent over three minutes trying to intubate, and were not ventilating the patient. He blamed the other paramedic that he was partnered with for the failure.

This is what we want to emulate?

A man in the UK died while waiting for an ambulance, because the closest crew was on a government required lunch break. We are told that this is the health care system is the one that we want to emulate, but is this really what we want?

EMAS chief executive Phil Milligan said: “Our practice on meal breaks comply, as they must, with the national NHS Agenda for Change employee terms and conditions, which require staff to be given a 30-minute undisturbed break.”

Andto those who think that EMS and fire, being public employees, should be treated like every other employee, remember that this is what you get when you want them to be like everybody else- when you need them, they might be out to lunch…

like everybody else.

I didn’t think they existed

I actually met an honest to goodness communist. This guy was hard core. He was trying to tell me how the Soviets had found the perfect form of government. We had a discussion, and I kept it civil, mostly because I was fascinated at his grasp on alternate reality.

I pointed out the many flaws of communism, and he actually said to me that communism will work, it just hasn’t because no one that is smart enough has tried it, yet. When I asked him how he would keep people working, once they realized that they got a share of the wealth, whether they worked or not, he said that people should work for the common good, not for personal gain. He said that those who refuse are traitors to the peole and should be imprisoned or killed.

Debt train

During the past year, the United States passed an important fiscal milestone that went largely unnoticed by the media. The United States now has a debt to GDP ratio of over 100%. That means that the sum off all goods and services produced in the United States in a year is not enough to pay off our debt. As of today, the debt stands at 105% of GDP. Here is the chart for the last 50 years:

Why is this significant? Greece has a debt that is 150% of GDP. The only time in US history when the debt was higher was at the end of World War II. Of course, once the war was over, we stopped spending and managed to pay down the debt. That was also before the US was taken off the gold standard in 1972, which allowed the government to create money out of thin air, and spend like, well, like they could print their way out of debt.

Look at the spending versus median household income income:

 
Historically, countries that exceed 90% GDP to debt cannot experience economic growth. It seems as if the US is past the tipping point. From here on out, the problems will escalate.

Here is a campaign ad from the presidential campaign of 1992.

 

The good ‘ol days, when the debt was less than what the government spends in a single year.

Who says this is about justice?

The prosecution in the Zimmerman case has released statements from one of George Zimmerman’s cousins, alleging that GZ inappropriately touched her. When they were 6 and 7 years old. She also alleges that the behavior continued until they were 16 and 17.

Why do events that transpired more than a decade ago have any bearing on this case? Our justice system has become a reality show, where people dial a 900 number to vote for the winner.

EDIT: Come on, people. Here is the money quote:

At one point — the interview isn’t clear on timing — Zimmerman’s
mother said she didn’t like President Barack Obama, the witness said.
“I said ‘why not?’ you know just thinking she was joking,” Witness 9
told investigators. “And she said, ‘Because he is black. I am a racist.’
Just loud and proud.”


This is absolutely ridiculous.

Currying favor from government

A post at Unc’s today illustrates the point that I frequently try to make about business in the modern American age: Businesses are trying to gain market advantage, not by being competitive on service, products, and prices, but by getting the government to tilt the odds laws in their favor.

The sales tax is a way that businesses fund the services that local and state government provide. When I open a business in another state, I do not benefit from those services, therefore I do not pay the tax. (Before you argue about the roads that the goods are shipped on, those are paid for by taxes on the shipping company, a different entity)

So the local businesses were upset that they are at a advantage by having to pay a sales tax, forgetting that they have the advantage of the shipping fees, and the advantage of the customer instantly getting his stuff. The businesses sought to get the government involved, so that they could eliminate the Amazon advantage, thereby tilting the equation in their direction.

Amazon now has no reason to keep their shipping centers remotely located, since the reason that they were remote was to avoid the taxes. So now we have the brick and mortar stores making me drive to the store, offering poor service, and employees that know nothing about the products they sell,  in competition with Amazon, who allows me to buy the same stuff without leaving the house, and able to do it cheaper because of fewer locations and not having to pay the aforementioned stupid and rude sales staff, and using robots to ship your stuff.

So much for trying to use government to eliminate the competition.

Shortages and breadlines

When I was a kid and the Soviet economy was crashing, I remember reading about bread lines- the Soviet people used to stand in line for hours to get a loaf of bread. Shortages were endemic, especially as the economy of that country got closer and closer to collapse. The most active part of the Soviet economy was the black market.

As our own economy falters and gets closer to collapse, we will see shortages get worse. Already, we are seeing significant shortages in medicine, and the ObamaCare changes haven’t even taken effect, yet. Speed completion of your preparations. This is gonna hurt.