Divemedic

Shelter in place, or run?

Anyone who is into personal preparedness has go to have a contingency plan. A plan for what, you ask? Whatever happens. One of the best tools in your arsenal is the ability to get the heck out of dodge. There was a man at the World Trade Center by the name of Rick Rescorla. If you are not familiar with the man known as the “man who predicted 9/11,” you can go read about him later, because he is not the subject of this post, but I will say that I admire the man. He single handedly saved 2,700 lives on 9/11 by knowing when to get out, and he gave his own life in the effort.

I was watching a show about him on 9/11, and I was reminded of what happened to folks in the South Tower of the WTC on that day when they tried to evacuate after the first plane struck the North Tower: as they were trying to evacuate, the police herded them back into the building, claiming that the untouched South Tower was safe. They were performing an act called “shelter in place.” Many people returned to their offices, only to be killed when the second plane struck the South Tower 18 minutes later. Those who ignored the cops and left, lived to see another day.

Shelter in place is not put into motion for the benefit of the people being sheltered. Primarily, it benefits the people who are charged with controlling the disaster, who do not need large amounts of refugees underfoot, getting in the way of rescue efforts. Yes, there are times when it is safer to to stay put where all of your supplies are, but there are also times to run. It is up to you to determine when that is, and have a plan to do so. Remember that hesitating will mean you are going to be in the middle of the fleeing herd, or possibly trapped in the disaster area, instead of being safe somewhere else.

When it is time to go, go. Don’t wait, don’t dally, and don’t hesitate. If your instincts are telling you to go, then go. The key to an orderly evacuation, as opposed to a panicked flight is easy: preparation. The first thing is to have criteria that you will use to determine when you will go, and when you will stay. Make it flexible, because when that time comes, it may be an event that you have not planned for.

Evaluate the disasters that will force you to consider evacuating, and rate them according to warning time and risk- with the ratings of low, medium, and high. This is the same system that emergency professionals use:

For example: A fire in your house is Little warning, high risk. A hurricane in Florida’s interior is long warning time, medium risk, but on the coast it may be high risk. Once we do that, we come up with plans for evacuating or dealing with the emergency, based on the time we have to evacuate and the severity of the disaster.

For example, in the event of a break in to our home while we are sleeping, we have plans to “shelter in place” in the bedroom and call 911. Anyone who enters the bedroom gets shot. That works for us, because the police have an average 6 minute response time in my city, and I can hold out for 6 minutes with the two handguns we have in the bedroom. I don’t need to take the risk of clearing the house, I will let the cops do it for me.

On the other hand, we evacuate for any hurricane above class 3 that is due to hit in my area. Being 50 miles inland means that the risk is one I can bear in my location for a three or less.

Our evacuation plans vary. We have four plans, each one named for the amount of time we have to execute it. These plans are: 90 second, 9 minute, 90 minute, 9 hour. The next post will deal with evacuation plans. In the hurricane example I just gave you, we would activate the 9 hour plan (the 9 hour plan includes taking the time to board up windows). The last time we considered evacuating, I boarded up the windows and pre packed my vehicle when we were 5 days from landfall. My neighbors thought I was nuts. I was the only boarded up home in the neighborhood, but had we decided to evacuate, I could have gotten out of here with the 9 hour plan fully executed in only 90 minutes.

More on that later in part 2…

By Divemedic, ago

First guns, then the rest

Once the citizens of a nation lose the ability to effectively defend themselves, dictatorship inevitably follows. History has proven this universal truth again and again.

 So, in the country formerly known as Great Britain guns have been virtually outlawed since 1997. Abuses follow:
Britain bans the free press
Cops in Britain force their way into private hoes to enforce debts
Govt employee Doctors in Britain on house calls inspect homes for compliance with safety and health laws
British right to jury trial is gone

 Ignoring the fact of increasing crime, we should note that the people there are now defenseless against any thing or act the Government decides to do. I have talked about this in the past, and had several British citizens argue that I am wrong.

Let’s see what they say about this:

The UK’s tax collection agency is putting forth a proposal that all employers send employee paychecks to the government, after which the government would deduct what it deems as the appropriate tax and pay the employees by bank transfer.

Once you cannot defend yourself from theft, you leave yourself at the thief’s mercy. It doesn’t matter if that thief is the man robbing you at the ATM, your neighbors robbing you at the polling booth, or a cop with a badge robbing you with regulations. Theft is theft. This is why we have a Second Amendment.

By Divemedic, ago

Interesting details: Officers down, 2010

There have been 121 officers killed in the line of duty so far this year.
 57 were killed in vehicle collisions of some sort
12 died from heart attacks
2 died in falls
1 killed by a person with his bare hands
2 drowned
46 were after being shot by people using firearms. Of these:

3 were actually shot in previous years and died from complications in 2010 (1996, 1998, 2009)
16 were killed by people with guns of a type that I could not identify
1 was killed by a man with a shotgun 

17 were killed by people wielding handguns, including
– one in American Samoa, where handgun ownership is already illegal
– one by an illegal alien with an illegally possessed handgun
– two in Puerto Rico, where permits are required to own handguns

– One, Travis Murphy of the Phoenix PD, was listed by ODMP as having been killed by a man with a rifle, but he was actually killed by a Convicted Felon who was armed with a  handgun.
– One was shot by the son of a police chief using his father’s weapon (in addition to the other four below)
– Four of them were killed by other police officers, or by a handgun taken from a police officer by the suspect
– One by an armed security guard during a domestic disturbance involving the guard and his wife

Of the nine killed by people wielding rifles:
1 died in a hunting accident
One was killed by a man with a .30-30
One by a man with an SKS
Two by a man with an AK-47 type rifle (the only case this year that I could confirm involved a weapon that was on the Clinton gun ban list)

In short,
– more cops are killed in traffic accidents than by gunfire
– More cops were killed by other cops’ guns than by so-called assault weapons
– Of the 43 deadly police officer shootings that occurred in 2010, at least ten of them were perpetrated by people who were prohibited from gun ownership already, and therefore more gun control laws would have been useless. It was already illegal for them to have guns, and making it double illegal would have done absolutely nothing.

Source is the Officer Down Memorial Page

By Divemedic, ago

When does a drunk become a patient?

In a previous post, I discussed the criteria for refusal competency. We covered the reasons why a paramedic would transport a person who has impaired faculties to the hospital. The question we will explore today is another tricky one: When does a person who is impaired by alcohol or other intoxicants become a patient?

This was brought on by a call I ran recently that put my opinion at odds with the opinion of another medic. In this incident, we had been sent to the scene of a home where the caller had dialed 911 because a man was unconscious in his yard, and then woke up and stole a bicycle. When we arrived, a cop was already there. I asked the cop what the guy’s problem was, and got the answer: “He’s an idiot.”

The subject (note that I did NOT say patient) was standing there talking to various bystanders, and only spoke Spanish (not an uncommon occurrence) but the caller/homeowner was translating. The subject also reeked of booze, denied having ID, and was from Mexico (all pretty common conditions in these parts). He denied having been unconscious, and claimed he was just sleeping. He also said that he did not want to go to the hospital. The translating bystander said that his Spanish seemed normal and unslurred.

A brief huddle ensued, and the following decisions were reached:

– The cop didn’t want to arrest him for petty theft, saying the jail wouldn’t take him since he was drunk, until he had been to the ER for evaluation. He also didn’t want to take him to the ER, because it would be hours before the prisoner would be released from the ER to go to the jail, and the cop had better things to do with is time.

– The medics decided that he was not a ‘refusal’ because in order to be a refusal, people who are drunk cannot refuse. Besides, in order to refuse, you must first be a patient.

– An hour later, another crew found him passed out drunk in the gutter, and transported him. This medic was pissed and wanted to know why we didn’t transport him against his will, seeing as how he was drunk.

So what makes a patient? When does a person with whom you have made contact become a patient?

I claim that a person who either has a medical complaint, or a visible medical problem is a patient.

The other medic states that since alcohol intoxication has a diagnosis code, that all intoxicated people are patients and must be transported, even if they have no other complaint or injury. The medic says that drunk people can possibly step out in front of cars, and he doesn’t want the liability.

I responded by pointing out that male pattern baldness also has a diagnosis code, and unless the intoxicated person is drunk to the point where he cannot stand, is passing out, or has some other problem, he is not a patient. I also point out that people have rights, and I am not going to infringe upon them by forcing a person to the hospital simply because they are drunk.

What say ye? At what point does a person who is drunk become a patient? When do you begin the chain of events that forces a person to go to the hospital against his will?

By Divemedic, ago

Redefining rights

A lot of bandwidth has been spent trying to define just exactly what the Second Amendment means. We all know the words:

The one Congress passed:

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

The one passed by the States:

A well regulated militia being necessary to the security of a free State, the right of the People to keep and bear arms shall not be infringed.

The words of this Amendment have been repeatedly debated. One word that is continuously debated and changing is “arms.” The collectivists believe that arms means what the founders had access to: muskets. Many pro-gun people believe that arms means the individual arms of the soldier, and that crew served weapons, artillery, and nuclear weapons do not count. Justice Sotomayor believes that nunchuks are not “arms.”

I believe that arms are – well, arms. That is weapons. All weapons. That includes everything from pocket knives to tanks, artillery, jet fighters, and yes, even nukes. You see, I believe that the Constitution means exactly what it says. It says arms, and it is just as dishonest to redefine the words that were used in drafting it to change it as it is for others to do the same.

If you can redefine “arms” to exclude nukes, then why can’t someone else redefine “militia” to mean the National Guard? Or define free speech to mean only speech within your own home is free? The answer to that is: you can’t.

Now I am not saying that I think people should own nukes. I am saying that the Constitution as written prohibits the Republic from infringing on your preexisting right to bear arms. If you want to add an amendment  that says: “Arms, for the purposes of the Second Amendment to this Constitution, does not include Nuclear Weapons or Biological Weapons” then the problem would be solved, and solved in the way that the founders intended.

By Divemedic, ago

The problem with US healthcare

Pictured is a young physician by the name of Dr. Roger Starner Jones. He works in the emergency room of a hospital in Jackson, MS. His short two-paragraph letter to the White House accurately puts the blame on a “Culture Crisis” instead of a “Health Care Crisis.” This letter appeared in the “Letters to the editor” section of the August 29, 2010 edition of his local newspaper. It’s worth a read:

Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.

While glancing over her patient chart, I happened to notice that her payer status was listed as “Medicaid”! During my examination of her, the patient informed me that she smokes more than one pack of cigarettes every day, eats only at fast-food take-outs, and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman’s health care? I contend that our nation’s “health care crisis” is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a “crisis of culture” a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that “I can do whatever I want to because someone else will always take care of me”. Once you fix this “culture crisis” that rewards irresponsibility and dependency, you’ll be amazed at how quickly our nation’s health care difficulties will disappear.

Respectfully,
ROGER STARNER JONES, MD
Jackson, MS

By Divemedic, ago

Fed to buy $1 trillion in US debt

Monetize the debt. What this means is the Federal Reserve would create a trillion dollars with the click of a mouse, and buy $1 trillion of the US debt. This would increase the amount of money in circulation by a similar amount, and make the dollar worth less.

There is currently $8.6 trillion in circulation. After this move, there would be $9.6 trillion, making the dollar worth 11% less. This is how the Fed is going to improve the debt situation that is threatening the economy, they are going to print our way out. They are taking the expedient way out of paying off a debt that is equal to more money than exists, by simply creating more money. That is why gold closed today at a record $1,270 an ounce. When Obama took office, gold was near $700 an ounce, and when Bush was inaugurated, it was near $300 an ounce.

Hyperinflation is coming. I am thinking it is time to convert those savings dollars to gold, if you haven’t already. My guess is that the big monetization will start after the November meeting of the Fed, scheduled for the day AFTER the election, so the inflation that follows will not affect the elections.

At least the money is going to worthy causes, like the stimulus money that was spent teaching African men how to wash their dicks.

By Divemedic, ago

Ground Zero Mosque, Quran burning, and the First Amendment

I support the Muslims who want to build a Mosque near ground zero. If they buy the property, they pay for the building, and they want to worship there, then that is their right to do so, and I support that. After all, it does not infringe on the rights of one single person. With that being said, the only possible reason for them to do this, is so they can be “in your face” and provoke outrage. I disagree with them. It is still their right.

I support the Preacher who wants to burn Qurans today. If he buys the books, has the burning completely on his own land, and that burning does not infringe on the rights of others, then it is his right to do so, and I fully support that. With that being said, the only possible reason for him to do this, is so he can be “in your face” and provoke outrage. I disagree with him. It is still his right.

The First Amendment protects your right to say what you want, and to worship as you please. I will defend your rights under that Amendment, even when I do not agree with you. That is the real test of freedom: will you defend the rights of someone with whom you do not agree? If you will not, then you are not for freedom, you just want freedom for those with whom you agree, and that is not freedom, it is conformity.

For those who cry that the military will be placed in harm’s way because of the speech of the preacher, I say to you that our military is SUPPOSED to be in harm’s way to protect the rights of her citizens. When I enlisted, I swore to support and defend our Constitution from all enemies, foreign and domestic. That was not an idle promise.

For those who are opposed to book burning, I say to you that book burning is stupid, but in this age of instant publishing, I say that burning a book is more a statement than it is a real threat. I cannot state it any better than Breda has:

In an age where I can carry the complete works of William Shakespeare on a device small enough to fit in my pocket, book burning is primitive and irrelevant. I can download and delete the Qur’an over and over, all day long. It means nothing. And in the end, all books will succumb to the rot of time, crumbling to dust, without the help of a zealot’s flame. There are no sacred objects.

Book burning is wrong, because it has been used in the past to stifle free speech. In this case, it is the opposition to this preacher that concerns me. The police and FBI threatening a man with prosecution for speech is far more chilling and worrisome than his act of burning a few of his own books that he purchased with his own money in a mutually beneficial transaction.

Who could doubt that this looks suspiciously like threats and intimidation?

– Police announce that they are taking down license numbers of all who attend the church’s Koran burning
– Eric Holder states that Terry Jones (the preacher) will be charged with a hate crime if he burns the Korans.
– The FBI meets with Jones on Thursday
– Thursday afternoon, Jones announces the burning is off.

By Divemedic, ago

You can’t stop the signal

There have been some complaints about.. irregularities at gPal. They have a section over at Calguns where people’s posts are reportedly being edited and deleted. At this point, I cannot recommend that anyone do business with them.

Proving to me that CalGuns.net and GPal are criminal enterprises, they have deleted the thread at CalGuns where customers were posting their complaints that gPal is not paying out funds, and is not responding to emails and telephone calls.

This proves, at least as far as I am concerned, that I will never do business with either party, and will advise everyone I know to refuse to deal with them. Dirty business, indeed.

By Divemedic, ago

Wide complex Tachycardias

I want to take a couple of minutes to follow up on my tachycardia post from the other day. I left off on wide complex tachycardias, and I feel like this is a follow up that needs to be done.

As I said in the other post, we assume that all wide complex tachycardias are VT unless proven otherwise. The first question that we need to know is: does this wide complex tachycardia have a pulse? If the answer is no, then we work the patient as if it was a VF/VT code. If there is anything that a person with an ACLS card in his pocket should know how to do, it is work a VF/VT code. For crying out loud, they train cashiers at WalMart how to do most of this, and if you can’t, then maybe you should turn in that ACLS card and throw in an application to WalMart.

Anyway, if the patient has a pulse with this tachycardia, the next question we should ask ourselves is whether or not this patient is critically unstable as a result. There is only one thing that counts: Are we perfusing the brain? There are two fairly reliable indicators that we can use to determine this: mental status and blood pressure.

If the patient has altered mental status, or has a systolic blood pressure of less than 90mm Hg, then this patient is critically unstable and needs immediate intervention. Synchronized cardioversion is the way to go here. Time is tissue. Going with drugs at this point is costing you brain tissue: time to get the IV, time to drip amiodarone over 10 minutes, or time to push the lidocaine is going to cost the patient brain tissue.

If the patient is not critically unstable, then we have time to find out what we are dealing with: Is this VT or is it SVT with an aberrancy? We can tell by running a 12 lead. Run a 12 lead EKG, and if leads aVF and I are both showing negative deflection, then your QRS axis is in the upper left quadrant, meaning XAD or Indeterminate axis. This is an indicator that your patients heart is experiencing retrograde conduction. The foci, or pacemaker, in this heart is in the ventricles, and you are dealing with VT. Otherwise, it is SVT with an aberrant conduction.

Hope this helps. Good luck out there!

By Divemedic, ago