Fall

This week has been pleasant in Florida, with temperatures being typical for a Florida Autumn. The highs have been in the high 70s to low 80s, lows in the upper 50s and low 60s. Pleasant breezes carrying air that is, for the gulf coast, rather low in humidity.

It has triggered some strong, pleasant childhood memories. I remember most vividly a fall day spent watching my mother decorate the house for fall with expanding paper pumpkins and other assorted fall and Halloween decorations, the windows open and cool fall breezes blowing through the house as dinner cooked in preparation for my father coming home from work. It is one of the more pleasant memories from my childhood. I still fondly remember those decorations to this day, 50 years later.

Now, the child is gone. My mother and father are gone, the paper pumpkins are gone. The country that I grew up in is gone. All that remains are the memories of a time that no longer exists in the head of a man who now is old enough to get free coffee at Denny’s and has grandchildren who are older than I was in those memories of an autumn long gone.

I had a tough week at work. Because the weather has been so mild, people haven’t been coming in to the ED for the stupid reasons that they usually do come in for, so we haven’t been as busy as usual. I have been in the critical zones, and my patients have been truly sick. More than half of my patients have been admitted to the ICU, and that makes for a heavy workload and a lot of thinking about life and death.

Combine the battles with death and the upcoming anniversary of my mother’s death and father’s birthday, and you have what I suppose is the reason why I am feeling a bit- nostalgic.

My wife, without even knowing the memories and thoughts in my head, has decorated the house for autumn. It makes me content. I don’t think of myself as an old man, yet. I’m not old enough to be a boomer, but I still feel older every day.

It’s a perfect metaphor. I am in what is probably the October of my life, and missing the time when I was a child. I can feel the chill of an approaching winter, can you?

Recovery Phase

Our highest wind gust last night was 78 mph. We had several hours of 40-50 mph wind. We wound up getting 4 inches of rain in total. There were a couple of instances where I heard something hit the house.

At first light, I went out and surveyed the damage. We had no damage to our house, but a neighbor had a couple of trees topple. I helped him do some chainsaw work. Another lost his roof. All in all, it was relatively painless. Once the breezes calm a bit, I will get the drone up to look at the area.

I set up the propane stove on the back porch, and we are cooking breakfast. Once the clouds are gone, we will go back to cooking on electric. I am just trying to limit electric loads while we are on battery.

We have plenty of food, water, and supplies.

Bright Flash

Update- The winds are now running about 45 mph. A weather station nearby just reported a gust of 120 mph, far more than we were supposed to get in this area. There was a momentary glitch in the power about an hour ago, which caused me to lose Internet connectivity as the modem reset. About 5 minutes after that, there was a bright flash outside and the power went out again, but didn’t come back on.

The power is out throughout the area, all is dark. We are now running on our fully charged Powerwalls. We have enough battery power for more than 24 hours at current consumption- I have turned off the upstairs air conditioner, the water heater, and all other large loads with the exception of the downstairs air conditioner.

I am sitting here watching the back door bow under the pressure of the wind. I’m sure that I won’t sleep well tonight.

FEMA Refresher

From three years ago. I figure this is needed since there is a lot of misinformation about the hurricane response.

Many people see FEMA as some sort of large Federal organization that responds to emergencies. They aren’t. What FEMA is, is a guy with a Rolodex (Remember those? If you don’t, ask your parents, snowflake.) and a checkbook. There isn’t some magical team of Federal Employees sitting around, waiting for “the big one” so they can swoop in and save everyone. That isn’t how it works.

No, this FEMA guy’s phonebook is filled with the contact information of local and state resources that can be called in an emergency. Those resources respond, tracking expenses and man hours used, and the FEMA guy then breaks out the checkbook to reimburse the states involved. The Governor doesn’t call out FEMA for shit. If you want to get technical, FEMA can’t do a thing unless the President tells them to. (Didn’t Trump catch hell for that recently?) FEMA’s largest contribution is writing the check to pay for it all.

After 9/11, the US government came up with the concept of Urban Search and Rescue Teams. They follow a set of guidelines in equipment and training, so that all of them nationwide operate on a similar set of procedures. This makes them interoperable across state lines: a person qualified for one could easily fit into any of the others. A USAR is equipped with everything from power generators to food trailers and rescue equipment. They have medical supplies, fuel, and all other equipment needed to fulfill their mission. Each USAR maintains over 5,000 pieces of equipment and has 140 or so assigned personnel. They can operate independently for 2 weeks, longer with resupply of fuel, food, and other consumables.

While there are some variations in the mission for each team (a team in Florida doesn’t need to be equipped for blizzards, for example) the teams are remarkably similar in training and equipment.

Florida doesn’t need FEMA resources for a building collapse. The state has eight Urban Search and Rescue Teams, all of whom are trained and equipped for that. Each one is centered on a large city, and draws its personnel from surrounding first responders. These first responders volunteer for the team, are sent to special training, and then become qualified for the team. Specialists are trained in HAZMAT, trench rescue, building collapse, confined space, water rescue, dive rescue, high angle, and vehicle and machinery rescue. Every member is certified as an EMT or Paramedic. It takes 2 to 3 years of training to fully qualify for a USAR team, on top of the extra training that they do on a constant basis. Most USAR members are the best of what their employing agencies have to offer. They are the most motivated and able of emergency responders.

To be honest, I loved deployments. Not because deployments meant people were suffering. No, mostly it was because they were a test of all that you had learned. That, and a FEMA deployment usually pays pretty well. I was deployed to Katrina for 12 days and was paid more than $5,000. You want people who bring years of expertise and thousands of hours of training to come save you? You want people willing to live on 3 hours’ sleep a night without bathing while shitting in a bucket and eating old MRE’s for two weeks? It’s gonna cost ya. That kind of expertise and dedication isn’t cheap.

Fire Departments

When talking about libertarian theories of government, someone always comes forward with the example that fire departments be privatized. When I point out that private fire departments were already tried in this country and didn’t work, someone always points to volunteer fire departments as an example.

And they are wrong. Fire departments are a subject in which I consider myself to be an expert, having functioned and worked in half a dozen of them over a three decade period. I have been a volunteer with at least four different volunteer fire departments. Three of them are no longer staffed by volunteers, and the fourth is in a VERY rural area.

The problems with running a volunteer department are many. Let’s start with the reason why libertarians want to use them- money.

Funding

While cheaper than a full time, paid department, volunteer departments still cost money, and in most cases those departments are nowhere near as effective as a career department. There are only two ways that a fire department can be funded: Through tax dollars, or through voluntary donations called “membership fees.”

The tax dollar funding model is self explanatory, so I will spend some time discussing membership fees. In order to become a member of the fire association, each property owner pays a voluntary membership fee, with these fees ranging from $30 to a couple of hundred, depending on the particulars. If a member’s property is responded to by the fire department, their membership fee is all that they pay. If the fire department responds to a nonmember’s house, there are two possibilities:

  • The department refuses to respond to the nonmember’s property. This creates a lot of bad press, as people think that it’s wrong to allow a home to burn down because they haven’t paid. There are those who say “Just let them pay the fee after the house catches fire.”
  • So the department has a fee structure where a nonmember is billed after they have a fire. That is not really workable, because the chances of any one person having a fire is exceedingly small, on the order of 1 in 10,000 or so. Many people will roll the dice in such a situation and wait until they have a fire to pay. If everyone refused to pay until they have a fire, the department would either have no funds, or the fee would be so large that people couldn’t pay it. Even volunteer departments charge fees of $5,000 or more to put out your fire.

All fire departments require large amounts of funding. There are fire trucks to be bought, a fire station, firefighting equipment, insurance, utilities, fuel, and a myriad of other expenses like training that all must be paid for. The larger and busier the department is, the more that costs.

Let me explain:

Volunteer department D: This was a very busy volunteer fire and rescue squad in a large city (over 400,000 people) that had been in operation since the 1950s. Over the years, more and more career firefighters were added to staff the station during periods when the volunteers were unavailable. When I was there, one fire engine and one ladder truck in the station were staffed 24/7 by a crew of 8 career firefighters, while several EMS units and a second fire engine were staffed by volunteers. There are no longer any volunteer firefighters there. While I was there, it was volunteer, but it still was funded by tax dollars and had an ISO rating of 4/9.

Volunteer Department H: This is a volunteer department in a very rural area of the Ozark mountains. It’s staffed by untrained volunteers, and while they work hard, they have almost no money for equipment. The fire engine that they had was a 1950’s era fire truck. In the year that I was there, they had exactly 5 fires: 2 brush fires, 2 chimney fires, and one house fire that saw the house burn to the ground. It had an ISO rating of 9. It is funded through mandatory fire fees that are collected through the county tax office, and has an operating budget of about $50,000 a year, even though there are only about 500 residents.

Volunteer Department B: This was a busy volunteer department that responded to approximately 4,000 calls per year out of two stations that contained a total of four engines, two brush trucks, two ambulances, a pair of tankers, and a rescue squad. The ambulance at each station was staffed by two career firefighters, and the fire engines were staffed by volunteers. The requirement was that one fire engine at each station was staffed 24/7 by two volunteers. Each volunteer was required to be in the station for four 12 hour shifts per month. The funding for this department came from tax dollars. Eventually, the department went to a full time career staffing model. When it was volunteer, it had an ISO rating of 5/8.

Volunteer Department M: This was also a busy volunteer department. It responded to about 1,500 calls per year out of one station. It served a small town of about 12,000 people until the late 90s, when the population (and 911 calls) exploded, with the town going from a population of 12,000 to 70,000 within just three years. The volunteer system collapsed under the weight of increased call volume, and it was taken over by a career department. The station had a rescue squad, a tanker, a fire engine, and a brush truck and was supported by tax dollars. Its ISO rating was a 6/9, but the station is gone and there is a gas station where it used to be.

There are some very successful and large volunteer fire departments. The Thibodaux Volunteer Fire Department is one such department. It boasts 500 volunteers responding to calls out of 10 fire stations, with 150 of those volunteers being active in responding to calls, the rest of them doing fundraising and other services. The department has an ISO rating of 3. However, the city of Thibodaux provides nearly half of the department’s $2 million in operating expenses from tax dollars. This is a great example of the best in Volunteer firefighting, but it still needs to be funded through taxes.

Staffing

The additional fact is that volunteerism is declining in this country, and has been for decades. A lot of factors go into the reasons for that. The demands on volunteers’ time is one- training, maintenance, and increasing call volumes are big reasons for this. Not to mention, it’s easy to get people to show up to the “exciting” calls like plane crashes, fires, and auto accidents. It isn’t nearly as easy to get volunteers to show up to EMS calls, because it isn’t “fun” to show up and deal with the demented old lady who is covered in her own shit. Firefighters, especially volunteers, are adrenaline junkies, and EMS runs just aren’t exciting.

Trust me- I was in charge of retention and response at department M during the end of my time there. We tried a mandatory staffing model like Department B, but there weren’t enough volunteers to do it. We tried paying a volunteer $5 an hour to staff it during the day when the other volunteers were at work. Then we tried paying volunteers $4 each for showing up to EMS calls, but that didn’t work either. The demands on people’s time was just too much to bear. The number of calls that went unanswered climbed steadily, until almost 10 percent of non-fire calls went unanswered. People just didn’t want to run the “boring” calls. As one volunteer told me- “I am here because I like putting out fires. I give the time I want to give, that’s what volunteering means. I am not about to come in at 2 am just to wipe grandma’s ass or deal with some homeless junkie.”

Training

Another demand on firefighter time is training. Everyone likes to do live burns. Those are fun. Where people don’t like to train is in the more dry subjects- classroom time in HAZMAT, medical training, and the hundred other topics that are required to run a fire department. It’s getting more and more difficult to get people to come to things like training. Even paid firefighters hate training- and there is a lot of it. To become a state certified firefighter and EMT in Florida takes nearly 2,000 hours of training, and then another 250 or so hours of training per year. It’s a lot, and volunteers just don’t have the time to engage that much.

It’s tough, and it’s getting tougher, to recruit, train, and retain volunteers. It’s tough to fund their operations without using tax dollars- in fact, it’s almost impossible to do so without some form of mandatory, tax funded source of income.

Day Off

I called in sick to work today. Spent most of the day sick and sleeping. Not seriously ill, just an annoying respiratory infection, one that seems to be making the rounds through the ED staff. We had six nurses call in sick yesterday with it.

Hopefully, I will be on my feet tomorrow.

Work

The hospital laid off 25 nurses from the emergency department last month, and are simultaneously complaining that we are working too much overtime. As I point out the next paragraph, keep in mind the company refusing to pay overtime that was worked by their employees due to their mandatory training.

The mandatory training this month is for ethics in the workplace. Here is the company’s official definition of ethics:

Ethical conduct means acting in a way that follows company values and the law.

What? Since when are laws or company policies ethical? It was the law in Germany to kill Jews. Segregation was the law. Your company policy mandates that we do this gay-assed training, even though you will try to get out of paying us for it.

As a thought exercise, they ask what you would do if you discovered 10 extra vacation days in your account. Would you tell HR, or would you take the vacation? Let me flip that- let’s say that you forced your employees to work an extra 12 hours on mandatory training, but you were already over budget and the company doesn’t want to pay the expense of overtime? Do you simply erase the hours from employee’s time cards, or do you pay them?

Yes, I am looking for a job. Sure there are lots of nursing jobs, but most of them are in the jobs no one wants to do, like home health care or working in a nursing home. No thanks. It’s the hospital slow season because the snowbirds aren’t here, so there aren’t a lot of good jobs available until winter. So, I may not find a job that I like for another few months yet.

Late

So the tenant in my rental was late on the rent, because she tells me that she is short of money this month. According to her social media page, she took her 2 daughters to Europe to see a pair of Taylor Swift concerts.

This is why I have no sympathy for tenants who are late because they are short on money. She bought six Taylor Swift tickets, 3 round trips of airfare, and hotels for a week in Europe, which probably cost in the neighborhood of $7500 or more, but expects me to feel sorry for her and not charge late fees because she doesn’t have enough money for rent.

I don’t care what she does with her money, but I do care that she didn’t pay her rent on time. That’s why I don’t buy people’s sob stories.

Nostalgic

I took the trouble to look up my patient from the other day. Less than 6 hours after I transferred her to the ICU, she passed away. Although I knew she was dying, I fought a battle for her to the best of my ability to keep her alive while simultaneously preparing her family for the inevitable. Even though her family weren’t yet ready to admit that she was about to die, I understood that I was buying time for them to come to terms with her death. They told me that she was “a fighter” and would pull through. I knew she wouldn’t, but I still did all that I could for her and for them.

I grew up in the late 70s and early 80s. I remember sitting in school and hearing the local church bells ring 53 times each day at noon, in honor of the hostages being held in Iran. I remember watching the rockets leave, carrying astronauts to the moon. My father worked with rockets and missiles, so I get to go to mroe than a few launches, including the launch of the Apollo-Soyuz mission. I grew up on bands that made some of the best music:

  • Journey
  • AC/DC
  • Dokken
  • Rush
  • Styx
  • Pink Floyd
  • Aerosmith
  • Dire Straits
  • Men at Work
  • Guns n’ Roses
  • Motley Crue
  • Van Halen

and though I didn’t realize it at the time, there were many other sounds and bands that I would come to appreciate more in later years, including Duran Duran. (It wasn’t cool to like them in the circle I ran with). I still sit and listen to the songs of the time, remembering my youth and the things that I saw. I had the distinct honor of serving in the military under President Ronald Reagan, and some of those songs take me back to my time in Europe listening to AFRN.

For those reasons, this article at Legal Insurrection really hit home for me. It does occasionally sadden me to have lived through some of the best times and the high water mark of the greatest nation in human history, only to see it destroyed. This nation isn’t perfect, but it has raised more people from poverty and has accomplished more great things than any other in human history. Watching it die is like watching someone that you love slowly die of cancer.

Like cancer, what is killing this nation came from within. I understand why some of the readers of this blog still think that it can be saved. I went through a period of believing that the old lady was a fighter. I know better now, and I am saddened at our loss, but also filled with resolve at doing what needs to be done as we venture out into an unknowable future.