The Big Red Taxi

Ask anyone who works in EMS, and they can tell you a hundred stories of people who abuse the EMS system. I have seen my share, and the stories have infinite variety:

The thermostat:
It was 2 o’clock in the morning when we went to this woman’s house for a complaint of “difficulty breathing.” When we got there, the “patient” didn’t want to go to the hospital, she just wanted help. Having just moved into her house, she didn’t know how to program her electronic thermostat and wanted us to show her how. It wsa 82 degrees in her house, nowhere near being a medical emergency.

Incarceritis:
People fake seizures, unconsciousness, chest pains, you name it, in the belief that they will not be arrested if they go to the hospital. The sad fact is that they are sometimes right. The officer sometimes doesn’t want to sit around the hospital for several hours, waiting for his prisoner to be discharged for minor misdemeanors. Felony arrests? Forget it, you are going to jail as soon as the hospital is done with you.

A variation of this was one morning’s call:
A man was required to be in court at 8 o’clock in the morning for a child support hearing. He walked from his home towards the courthouse 10 miles away. (Why he didn’t take the bus is a mystery.) He made it about 3 miles, and then called 911 with reported shortness of breath and chest pain at about 10 after 7. When we arrived, he wanted to go to the hospital that, coincidentally, was two blocks from the courthouse. When we arrived and asked him what was going on, his first words were, “I am trying to get to court because my wife…”

We all knew that this was a fake call intended to get him to the hospital closest to the courthouse, so that he could walk out and be in court faster. Since there is no penalty for failure to pay for the ambulance ride OR the ER bill, this is the equivalent of a free taxi. We decided that the best thing for this patient was to go to a different hospital. Why? Well, if he really was having chest pain, the patient would be less likely to walk out of that one, opting instead to use the ER bill to show the court why he had a medical reason for missing court. IF he wasn’t really having chest pains, then he didn’t need to go anyhow. Besides, to reach the hospital he wanted, we would have had to pass another, closer one, and there was no medical reason to pass a perfectly good hospital to go to the other one.

Lest anyone think that we were being mean or lazy, he still got a complete workup. His vitals were: SaO2 98% on room air, 100% on 2 lpm of O2. HR 82, RR24, BP 142/94. Monitor showed SR, and 12 lead showed nothing important. He was hot and sweaty, but that is unsurprising considering that he was about 60 pounds overweight, and it was 82 degrees with 80% humidity. He still got 325 mg of aspirin, NTG spray x2, and transport to the closest hospital (rather than the one he wanted)

People abuse the system every day. This is why universal, “free” health care will never work.

Gerrymandering

Rigging elections. The Census is now complete, which means that the gerrymandering drawing of districts can now commence. The Democrats are angry because they don’t rule Florida’s electoral process. The areas of Florida that have historically voted Democrat are the southeast coast near Miami, and the area around Jacksonville. (The 2008 election saw other areas in blue, but in my opinion that was more a result of the Democrats all running against former President Bush than a true shift in political power.)

To counter this, the Democrats want to redraw districts to create an advantage for themselves. It won’t work. You cannot thwart corruption in politics.

Follow the money

From a recent Email:

Tax rate cuts don’t give anything to the so-called rich. They don’t “get” someone else’s money. Tax cuts allow people to keep more of their own money to spend and invest as they see fit.

Exactly. Look where the money goes:

The total Federal Budget is $3.7 trillion for FY’10
Income: $2.164 trillion
Outlay: $3.720 trillion
Deficit: $1.556 trillion

Here are the top 5 spending categories and the percentage of total outlays:
1 Social Security $722 billion 19.4%
2 Defense $719 Billion 19.3%
3 Welfare $557 billion 15%
4 Medicare $457 Billion 12.3%
5 Welfare, healthcare (like medicaid) $335 Billion 9%

Add together the money we give people not to work (all of the above, except Defense) and you get $2.071 trillion, or an amount equal to virtually all of the taxes collected.

For 2004 (the last year I could find data) The top 25% of wage earners in the country comprise everyone making more than $139,491 (per return, not per person). That top 25% paid 84.8% of all income taxes.

(Source: http://www.irs.gov/pub/irs-soi/04in06tr.xls)

Yeah, the problem is the rich.

GMAC caught in fraud, has to suspend foreclosures

This year, I have done quite a few posts illustrating how much fraud took place on the part of mortgage lenders. There are many conservative bloggers who have spent a lot of bandwidth spreading the theory that “the homeowners owe money to someone, so they should just pay. It is the homeowners’ fault for taking out loans they couldn’t repay,” all the while denying that the banks had any responsibility in the mess we are in.

Those same people will probably not want to see this:

Some of the nation’s largest mortgage companies used a single document processor who said he signed off on foreclosures without having read the paperwork – an admission that may open the door for homeowners across the country to challenge foreclosure proceedings.

The legal predicament compelled Ally Financial, the nation’s fourth-largest home lender [ed. note: Ally used to go by the name GMAC], to halt evictions of homeowners in 23 states this week. Now Ally officials say hundreds of other companies, including mortgage giants Fannie Mae and Freddie Mac, may also be affected because they use Ally to service their loans.

In other words, these document factories are producing paperwork on demand, as the lawyer handling the foreclosure needs it. Read on:

As head of Ally’s foreclosure document processing team, 41-year-old Jeffrey Stephan was required to review cases to make sure the proceedings were legally justified and the information was accurate. He was also required to sign the documents in the presence of a notary.
In a sworn deposition, he testified that he did neither.
The reason may be the sheer volume of the documents he had to hand-sign: 10,000 a month. Stephan had been at that job for five years.

10,000 times a month, this man testified in a sworn affidavit that he personally reviewed the records, and determined that the person whose home was being taken was rightfully losing his home. TEN THOUSAND TIMES A MONTH. That works out to over 500 people every business day who lost homes based upon FRAUD. At 8 hours per business day, this man reviewed the paperwork for each foreclosure and signed an affidavit swearing it was accurate in an average of 55 seconds per foreclosure. It is obvious that a person cannot review all of the mortgage paperwork and testify to its accuracy in only 55 seconds. For five years. This one man’s fraud and lies were used to take 600,000 homes. 

That is just from one paperwork factory. There are hundreds of these companies out there. But hey, those deadbeat homeowners should pay. The lawyers are never wrong. The courts use this paperwork, generated in less than a minute, to justify holding a hearing under “rocket docket” rules, where each homeowner is given an average of 60 seconds to argue his case, and that even assumes that the bank isn’t granted summary judgment without a hearing, based upon the forged paperwork.

The same conservatives who complain that we can’t trust the courts to safeguard our right to keep and bear arms, our freedom of religion, and our right to free speech trust the court to decide who takes a home and who doesn’t.

Time is not on your side

This illustrates why you should own a gun. Reading the story, I know it sounds like the gun caused the problem in the first place, but looking below the surface, the person on the killing spree caused the problem. The reason why owning a gun would have helped is illustrated by the fact that police did what they always do in a shooting situation: they set up a perimeter and waited.

In fact, they waited for over an hour. Shots were still being fired in the house when responders got to the scene, just after 1 o’clock. They locked down the local schools. They set up a perimeter. They set up a command post. They assembled a SWAT team. At about 2:15, a family member grew tired of waiting, broke the perimeter, and went inside himself. If he had not done that, who knows how much longer they would have waited? How many of those people in the house would have survived if the police hadn’t have waited for over an hour?

If the day should ever come that you are involved in a shooting, will you want to wait for over an hour before the police come to help you? Or are you going to wish that you could take care of it yourself? When seconds count, the police are minutes away, and then spend an hour setting up.

Answer to comment

In response to the comment from this post, Derfel Cadarn made this comment:

How were they to be run over while in their cruisers? 133 shots fired no return gunfire mentioned, should be fired for the poor shooting alone.What about reckless endangerment with depraved indifference.No possibility of collateral damage,oh that`s right those other are only serfs.

I was going to answer in comments, but the length of my reply requires a post. I will answer his comment once sentence at a time:

How were they to be run over while in their cruisers?

Who says they were in their cruisers? How are they supposed to arrest a car thief without getting out of their car? Even in the police remained in their cars, are you maintaining that a person in his car cannot be killed by someone else who is also in a car?

133 shots fired no return gunfire mentioned, should be fired for the poor shooting alone.

Two misconceptions for the price of one. The first one here is that you assume that deadly force is not justified unless someone is shooting at you.

Perhaps you do not understand what constitutes deadly force. Deadly force is defined as: force that is likely to cause death or great bodily harm and includes, but is not limited to the firing of a firearm in the direction of the person to be arrested, even though no intent exists to kill or inflict great bodily harm; and the firing of a firearm at a vehicle in which the person to be arrested is riding.

When anyone is being attacked by a person using deadly force, the person (and yes, cops are people) being attacked has the right to respond with equal force. The police in this case were being attacked by a person employing deadly force, and had the right to respond in kind. Since under the law, trying to run someone over is considered to be deadly force, they respond with deadly force: firearms.

The law is the same in this case as it is for you and I:

A person is justified in using force, except deadly force, against another when and to the extent that the person reasonably believes that such conduct is necessary to defend himself or herself or another against the other’s imminent use of unlawful force. However, a person is justified in the use of deadly force and does not have a duty to retreat if He or she reasonably believes that such force is necessary to prevent imminent death or great bodily harm to himself or herself or another or to prevent the imminent commission of a forcible felony

As for your claim that 133 shots shows poor marksmanship: How many of those bullets hit the car? How many missed? How many of the shots struck the car, but were deflected by the car and missed the driver? How many shots hit the driver, but did not stop his attack?

How good of a shot are you? Are you experenced with firearms? You do realize that a bullet is not a remote controlled punch or a magic talisman? This is real life, not the movies. Guns do not instantly stop people with one hit.

What about reckless endangerment with depraved indifference.

What about it? Missing when shooting at a person does not automatically mean that you met the definition of reckless endangerment. The term you are looking for is culpable negligence.

Culpable negligence. Each of us has a duty to act reasonably towards others. If there is a violation of that duty without conscious intention to harm, that violation is negligence, but culpable negligence is more than a failure to use ordinary care for others.

For negligence to be called culpable negligence, it must be gross and flagrant. The negligence must be committed with an utter disregard for the safety of others. Culpable negligence is consciously doing an act or following a course of conduct that the defendant must have known, or reasonably should have known, was likely to cause death or great bodily injury. See Fla.Std.Jury Instr. (Crim.) 827.04.

 Good luck with that one.

If anything, the decedent is the one at fault here, as his actions were the direct cause of the police having to fire. See Green v. State, 545 So. 2d 359 – Fla: Dist. Court of Appeal, 2nd Dist. 1989. 

No possibility of collateral damage,oh that`s right those other are only serfs.

There are numerous self defense shootings where a private citizen is not charged with missing his target. No one else was hit, so that is a non-issue.

Defending the cops

Anyone who reads this blog on a regular basis knows that I am not shy about pointing out when cops have overstepped their bounds. I am not a cop basher, I just call em like I see em, bashing them when they screw up and I support them when they deserve to be supported. This is one of those times.

Seven months ago, undercover officers of the Orlando police department had been watching a man who was driving a stolen SUV. They boxed him in with their cars to arrest him, but said he didn’t stop. Undercover officers opened fire, but the car kept accelerating. That would mean the tires kept spinning and the engine kept racing. Confused and in fear for their lives, officers said they kept shooting until they fired 133 shots.

There has been a lot of claims from the public, and from some of my friends, that the force used was excessive, and 133 shots is too many. A man trying to run you over, even if all he is doing is trying to escape, is still trying to hurt you.

“Why was my brother killed? Why were guns fired at him when he was unarmed,” questioned Tiffany Breedlove, the victim’s sister. A man trying to run you over is armed with a deadly weapon called an automobile, that’s why. In this case, how can a cop tell the difference between a man trying to escape, and a man trying to escape by running over a cop?

Another point is the number of shots fired. At what point are the cops supposed to stop shooting? 1 shot? 5 shots? Should they stop with 40? What is the magic number that guarantees that the threat to your life has ended? Or do you keep firing until the threat has ended?

After all, it is called DEADLY FORCE when you fire your weapon. It doesn’t matter if you fired 6 shots, or 60, as long as the threat is present, deadly force can still be used. Even if they did fire too many shots, dead is dead.

Paramedicine: New drug problem

About three weeks ago, we ran to a local shopping mall for a 17 year old male who was telling us that he thought he was going to die. Our exam found: HR140 RR20 BP 140/96. Pt was agitated, paranoid, and very restless. He was acting like he was on speed.

Upon further questioning, he admitted that a friend had given him something to smoke, but he was not sure what it was, just that the friend had assured him that it was legal, and that it was called “spice.” This was not only a new one on me, but the cops on scene had not heard of it, either. When in doubt, supportive care and transport. Enroute, the teen got a lecture about how stupid it is to take drugs without even bothering to find out what they are. I am sure that, being a teen, I was wasting my breath. He seemed to think that because it was legal, it was safe.

When we got back to the station, google was my friend. I found a few things, and here they are:
It turns out that although the drug is new to this area (according to my friends in the narcotics unit of the police department) it is a nationwide problem that began appearing in Europe in 2004, and North America in 2009.It is a synthetic cannabinoid, with effects similar to hashish or marijuana, but it is much more potent, due to a stronger affinity for the CB1 receptor.

Because the synthetic cannabinoids found in these products are new, they remain legal in many states. Kansas was the first state to pass a law banning sale of the products; similar laws have been proposed in Missouri, Tennessee, and several other states. It is undetectable by standard drug testing and standard tox screens in the ED. It is sold in head shops, convenience stores, and gas stations in my area, and a quick check of a few showed that about half of the local quikie marts had it for sale. Common brand names are K2, Spice, and Gold.

 Several medics that I know have begun telling me of calls they are running involving this drug, and it seems like it is taking off in popularity. I have personally talked to 8 medics who have run on calls involving this drug in the last week or two. Reported symptoms are: pale skin, vomiting, hypertension, paranoia, restlessness, fever, tachycardia, dysrhythmias (including PACs and PJCs), as well as tremors, combativeness, seizures and hallucinations. The problem appears to be increasing nationwide.

The compound most commonly found in these products is JWH-018. Another compound, is an analog of CP-47,497, a cannabinoid developed by Pfizer over 20 years ago. Known as (1-pentyl-3-(1-naphthoyl)indole), or the more proper IUPAC name of Naphthalen-1-yl-(1-pentylindol-3-yl)methanone, JWH-018 is one of over 100 indoles, pyrroles, and indenes synthesized by the Huffman laboratory to develop cannabimimetics, drugs that mimic the effect of cannabinoids such as THC. The primary goal of these studies was to create pharmacological probes to 1) determine the structure-activity relationships of these compounds and 2) tease out the physiological function of subtypes of receptors we have for cannabinoids: the CB1 and CB2 receptors. JWH-018 binds to the psychotropic CB1 receptor with approximately 4 times the potency of the naturally-occurring THC. Unlike THC, which binds with almost equal affinity to CB1 and CB2 receptors, JWH-018 exhibits a 4-fold preference for CB1 receptors.

What does this mean? Well, the CB1 receptor is the primary means by which cannabinoids exert their psychotropic effects. The CB2 receptor, on the other hand, appears to be more involved in pain and inflammation and is therefore a very active area of research for new therapeutics. So while JWH-018 has four-fold greater potency for CB1 receptors than THC in an isolated receptor binding study, how its effect compares to plain-old marijuana depends on other factors such as the relative amount in the product, how stable it is to combustion, how it’s metabolized in the body, among others. Smoking as little as 150mg has been known to cause symptoms such as tachycardia and hypertension.

Another report I found talked about withdrawals. The report describes a 20 yr old man with a little prior experience with hashish, some hallucinogens, minimal alcohol consumption and about 10 cigarettes per day. No other illicit drugs reported, nor detected in blood tests during the clinical care interval. He was smoking “Spice Gold.” Initially 1 g daily, for eight months. Due to decreasing effect, he had rapidly increased the dose to a final value of 3 g daily–split into 3 to 4 doses, with the first dose early in the morning. Owing to the consumption of the substance, he had often recently been listless and had had problems in thinking clearly. During a phase of abstinence owing to shortages in supply, he had developed symptoms in the form of profuse sweating during the day and especially in the night, as well as internal unrest, tremor, palpitation, insomnia, headache, diarrhea, nausea, and vomiting. Additionally he had suddenly felt depressed and desperate. This had lasted for two days and had only abruptly disappeared after taking the drug again. Therefore, he no longer had the courage to discontinue the drug by himself.

I have no idea what we can do to treat this, except supportive care and treating the seizures. Any ideas?

Wrapping it up.

To wrap up our discussion of evacuation drills: We have the 90 minute and 9 hour drills. These assume a situation where we may never see the house again, but there is some time to prepare. The movie Red Dawn is similar to that. They evacuated the school to their first rally point, Dad’s hardware store. Then they activated the 90 minute plan and headed for the mountains. (I had to throw in the obligatory 80s movie reference.)

To begin, we grab our 9 minute stuff. Add to that: 4 cases MREs, 4 boxes mountain house freeze dried, a case of pet food, and our camping box. This box contains a pair of two man tents, propane stoves, propane lamps, and all associated hoses, fittings, and camp cookware/flatware. Cans of ammo and the rest of the guns fill out the equipment. We also bring all of our important paperwork. That is the 90 minute drill.

The 9 hour drill is designed primarily for hurricanes, and is the same as the 90 minute one, except we take the time to board up the house, pick up debris and stuff outside and store it in the garage along with our second vehicle.

I have used the 9 minute version several times when being deployed for disasters and such, and it seems to work well, even though I refine it a bit every time it is used.

The nine minute drill

This is the next installment in my planning for emergencies series. The nine minute drill is a rapid evacuation, where you need to leave in a hurry and can expect to be gone for 3 to five days. This is good for short to medium warning time threats with medium to high risk, like a neighborhood ordered to evacuate for an approaching fire, a chemical spill, or some other localized emergency.

Planning: We established this plan, where we grab the pets, our emergency kits (below), and we consider also grabbing long guns and ammo. If together, we leave in one vehicle. If not, you text the other that you are headed for (rally point) and go. The other will catch up. Don’t forget to bring your wallet and any extra cash you have. If the power goes out, or it is a banking holiday, you may not be able to access cash or credit cards. I also have a WD external hard drive that has all of the backup files for my computer, and I try to grab that. Our rally points would be a little farther away. Six to 100 miles should do it.

To prepare for this, we had to get an emergency kit together. What I did was to pack emergency kits for everyone. There are tons of opinions on how to do this, and I will just throw out a few thoughts here:

I got pet carriers for our two pets. In each carrier, I put a small nylon bag with a collar, leash, 4 single serving cans of pet food, and 4 half liter bottles of water. A calming aid for pets should also be put in there. This will keep your animal family members calm when needed.

The bags for adults will vary, depending on where you live. For example, a person in Montana needs to worry about sub-zero temperatures, while a person in Florida needs sunscreen. Mine is designed to get me away from the house in a hurry and sustain me for three to five days. I put it in a backpack for easy portability. Here is what I think is a minimum: First Aid, heat and cooking, light, tools, communications, food and water,shelter, and security.

A first aid kit. (Note for you medics: You do NOT need ET tubes and bag valve masks. There is not going to be a need to set up your own EMS agency.) Make sure it does have: Sudafed, Ibuprofen, Immodium (diarrhea can be life threatening), Benadryl, Cough medicine (I like Mucinex, a pill is less likely to leak all over the place) antibiotic ointment (infections are nasty during disasters when health care is hard to come by) some baby wipes, mosquito repellent, sunscreen, Bandaids, medical tape, and small sterile dressings. 4x4s will do. A small container of gold bond powder is a life saver when your feet have been wet for days. Also, a spare pair of comfortable socks, underwear, a hand towel, and a tshirt.

Heat and cooking. Three different ways to make fire. I have waterproof matches in a pill bottle, a lighter, and one of these. Here is one in action.

Light  A flashlight with spare batteries. I got this one. It takes a single AA battery and puts out 200 lumens, but only costs $40. I also threw 4 chem lights in there.

Tools A multitool (like the Leatherman) and a pocketknife are indispensable. So is a compass, and it helps to keep a GPS in the car. I also have good road maps of the entire state of Florida in the car under the seat, as well as AAA maps of Georgia, Alabama, and Mississippi. My pickup truck has a built in 500 watt inverter for charging stuff. There is an inverter under the spare tire that is powered by a cigarette lighter. A pair of gloves to protect your hands.

Communications  I put a cell phone charger for our cell phones inside our vehicles, I put one of these that I bought at a local grocery store for $12 inside my kit, and got a pair of FRS radios that I keep on a charger. The wife and I are going to get a HAM license soon. That will expand our options for radios.

Food and water: I included some energy bars (less likely to melt in the heat than chocolate) oatmeal, granola, or similar bars will do. Four MRE meals, and 8 half liter bottles of water.

Shelter: A space blanket, and a cheap poncho.

Security I put a 20 round box of ammo and an extra mag sealed in a Ziploc bag with a desiccant in our kits. 9mm for her Glock 19 in her kit, .45 ACP for mine. I also put an envelope in each kit that contains $200 (20- one dollar bills, 16- five dollar bills, 6- ten dollar bills, and 2 twenties) and a credit card with a $1000 limit.

Remember that this is an emergency kit, we aren’t trying to reestablish civilization or start a war. We just need a quick way to access supplies for a three to five day emergency. This bag has come inhandy when I had to leave to go somewhere in a hurry. Some stuff gets taken out, and some added, as I use the kit and see what works. For example, I deployed to Mississippi for Hurricane Katrina and discovered the need for Glod Bond. Next post will be about the 90 minute and 9 hour plans.