This may not be the strangest call in the history of emergency medical services, but it's damned sure the oddest one I've ever gone on.
As you may or may not know, my volunteer fire department covers a very quiet suburban area of my county, so for experience, I'll ride with the local EMS service as a third crew member. Let's call them Big City/Big County EMS System.
So, it's Saturday night and two of my buddies are working at Big City/Big County EMS System. Since I have no life, I decide to ride for a while with them that night. Shortly after I get there, the pager goes off and sends us to an apartment complex for a seizure.
As we arrive, we notice that our adult male caller and his mother are obviously new to the country. Their apartment is an interesting combination of Salvation Army thrift furniture and Southeast Asian bazaar.
We enter the back bedroom and find the approximately 50 year old Asian woman shaking on the bed and refusing to talk to us. We ask the son what's happening and find out his English proficiency is slightly less than the illegal alien who refills your chips at your local Tex-Mex restaurant. After a bit of confusion, we find out out that their language of choice is Burmese. Now, where are you going to find a Burmese speaker on Saturday night in a Texas city?
Easily enough, we call our dispatcher who patches us through to a translation service. We lay down a cell phone and put it on speaker phone. Eventually, we learn that the woman's husband just died and she believes his spirit has possessed her. Thumbing through my protocols, I find that our medical director, in his love of Evidence Based Medicine, has not yet added a protocol for possessions. (Nor has he added Haldol to our protocols, but that's another story for another time.) We then ask what we can do to help her. She asks for a Buddhist priest to perform an exorcism.
Now, I'm all for customer service and meeting patient's needs, but that's one thing I can't pull off. We explain to the patient that we don't do exorcisms and start to leave. As we gather up the various bags used by a modern EMS agency, our erstwhile patient enters the living area, where she begins repeatedly bowing and chanting in front of a family altar. We again ask if she wants to go to the hospital before we leave. She replies in her best attempt at English that she just wants to die.
BINGO! She just said the one thing that guarantees a trip to the ER. We quickly confer amongst ourselves and decide that the closest hospital is a Catholic hospital. Surely they have a priest. Priests do exorcisms, right? And hey, Catholic is as close as you'll get to Buddhist on a Saturday night in central Texas, right?
So we tell her to get on our stretcher and we roll her into the northwest campus of Our Lady of Eternal Fundraising's ER. Amazingly, as we give the patient report to the charge nurse, she looks up from her chart and greets the patient by name.
Only in EMS. Only on a Saturday night.
Saturday, March 10, 2007
A new top 10 list
For those of you who've never taken an EMS class before, you can stop reading right here. I'll throw some random bait to keep your attention though : Britney Spears, Madonna, NBA, Final Four, March Madness, P. Diddy, Michael Jackson, Anna Nicole Smith
There, now we can get to my EMS rant of the evening. For your amusement and entertainment, I've compiledthe Top 10 Bitches, Moans, Gripes, Whines, Cries, and Pisses of EMS Students.
1) You didn't tell us that would be on the test.
2) Can we have a study guide?
3) That wasn't in the study guide.
4) That's not fair.
5) Nobody taught us that.
6) You didn't tell us that would be on the test.
7) Will this be on the test?
8) Why do we have to know that?
9) I have to go early because my daughter has a dance recital/softball game/PAP smear/orbital launch and I'm the only person alive who can get her there. (Thank you for that one, AD.)'
10) I didn't take [INSERT CLASS HERE]in high school. (Usually chemistry, biology, or ANY math class beyond general math.)
Now if you're not in EMS and still reading this, you're probably scared and will never call 911 again. Hmm, maybe I did accomplish something.... Just kidding, y'all....
Seriously, since my friend AD has so many compliments on his "war stories" from the field, I may have to post my one or two really good ones. If anyone's reading this, let me know if you want to read the Buddhist exorcism story before.
There, now we can get to my EMS rant of the evening. For your amusement and entertainment, I've compiled
1) You didn't tell us that would be on the test.
2) Can we have a study guide?
3) That wasn't in the study guide.
4) That's not fair.
5) Nobody taught us that.
6) You didn't tell us that would be on the test.
7) Will this be on the test?
8) Why do we have to know that?
9) I have to go early because my daughter has a dance recital/softball game/PAP smear/orbital launch and I'm the only person alive who can get her there. (Thank you for that one, AD.)'
10) I didn't take [INSERT CLASS HERE]
Now if you're not in EMS and still reading this, you're probably scared and will never call 911 again. Hmm, maybe I did accomplish something.... Just kidding, y'all....
Seriously, since my friend AD has so many compliments on his "war stories" from the field, I may have to post my one or two really good ones. If anyone's reading this, let me know if you want to read the Buddhist exorcism story before.
Friday, February 02, 2007
Bastrop County : Redefining EMS Insanity
Well, it's that time again. Bastrop County and its contracted private EMS service are again parting ways.
Travis County, Williamson County, and even Fayette County made a committment years ago to fund a third-service EMS system in their respective counties, co-equal with fire and law enforcement.
Bastrop County, in an apparent moment of shortsightedness, made a decision to contract out for EMS service. This is all well and good, so long as there's adequate funding for the company.
Unfortunately, though, Bastrop County has never increased its subsidy to its various EMS contractors since the 1980s. While Bastrop County grows, its Commissioners' Court maintains a rural mentality, still believing they run a rural county whose main concerns are the county commissioners' road and bridge fiefdoms and the local extension agent.
Every few years, the local EMS provider will approach the Commissioner's Court and ask for an increased subsidy. The Commissioner's Court will claim poverty (Interesting for a county with several million in reserve funds to keep the Wall Street bond market happy!) and "reluctantly" let the contractor out of their contract. Then a new EMS company comes in and the same drama repeats in a few years. Bastrop County lost Rural/Metro less than 3 years ago. Now, they are getting ready to lose MetroCare. Sadly, MetroCare did the best it could with the resources that Bastrop County gave them, even sacrificing paid contractual obligations in it's Austin operation to send additional ambulances to Bastrop County to cover an excess of 911 calls.
I'm a fiscal conservative as much as the next person, but there comes a time when fiscal conservatism becomes a cult and strait-jacket. Bastrop County has reached that point. Bastrop County will get the kind of emergency medical care that less than $400,000 will buy. Sadly, consultants with EMS expertise told Bastrop County how to figure out a subsidy that would ensure quality EMS coverage. Claiming the cult mantra of fiscal conservatism, Bastrop County dismissed much of the advice and continued on its same path of a low subsidy. The Commissioners' Court again proved the maxim that insanity is defined as repeating the same pattern and expecting different results.
Texas state law allows a county to create a separate property taxing district called an "Emergency Services District" to provide tax funding for fire and EMS services. This would be a solution for Bastrop County, creating a countywide Emergency Services District (ESD) to fund EMS, but for one thing. The county acquiesced as several volunteer fire departments created a Bastrop County ESD #1 to fund their rural volunteer services. Thus, you have a small fire department in Bastrop County with its own portable trailer to replenish air tanks for firefighters, but a county where a 20+ minute response time for an ambulance is not unheard of. Who's being fiscally responsible now?
What will change things? There are two possible solutions I see:
1) A commissioner's family member will die and could've been saved by timely EMS response.
2) The voters will eventually recognize that an idyllic life in "rural" Bastrop County means being condemned to substandard medical response compared to their neighbors in Fayette, Travis, and Williamson Counties.
Call County Judge Ronnie McDonald, Commissioners David Goertz, Clara Beckett, John Klaus, and Lee Dildy. Demand that they enter the 21st century and fund an adequate EMS program for their constituents. Any public official's primary obligation is to protect the safety of the public. Bastrop County's "good ol' boys" have to hear from you. They need to hear that the constant switching of private ambulance services is unacceptable when every other surrounding county manages to fund an adequate county (and city) funded 911 EMS response.
Travis County, Williamson County, and even Fayette County made a committment years ago to fund a third-service EMS system in their respective counties, co-equal with fire and law enforcement.
Bastrop County, in an apparent moment of shortsightedness, made a decision to contract out for EMS service. This is all well and good, so long as there's adequate funding for the company.
Unfortunately, though, Bastrop County has never increased its subsidy to its various EMS contractors since the 1980s. While Bastrop County grows, its Commissioners' Court maintains a rural mentality, still believing they run a rural county whose main concerns are the county commissioners' road and bridge fiefdoms and the local extension agent.
Every few years, the local EMS provider will approach the Commissioner's Court and ask for an increased subsidy. The Commissioner's Court will claim poverty (Interesting for a county with several million in reserve funds to keep the Wall Street bond market happy!) and "reluctantly" let the contractor out of their contract. Then a new EMS company comes in and the same drama repeats in a few years. Bastrop County lost Rural/Metro less than 3 years ago. Now, they are getting ready to lose MetroCare. Sadly, MetroCare did the best it could with the resources that Bastrop County gave them, even sacrificing paid contractual obligations in it's Austin operation to send additional ambulances to Bastrop County to cover an excess of 911 calls.
I'm a fiscal conservative as much as the next person, but there comes a time when fiscal conservatism becomes a cult and strait-jacket. Bastrop County has reached that point. Bastrop County will get the kind of emergency medical care that less than $400,000 will buy. Sadly, consultants with EMS expertise told Bastrop County how to figure out a subsidy that would ensure quality EMS coverage. Claiming the cult mantra of fiscal conservatism, Bastrop County dismissed much of the advice and continued on its same path of a low subsidy. The Commissioners' Court again proved the maxim that insanity is defined as repeating the same pattern and expecting different results.
Texas state law allows a county to create a separate property taxing district called an "Emergency Services District" to provide tax funding for fire and EMS services. This would be a solution for Bastrop County, creating a countywide Emergency Services District (ESD) to fund EMS, but for one thing. The county acquiesced as several volunteer fire departments created a Bastrop County ESD #1 to fund their rural volunteer services. Thus, you have a small fire department in Bastrop County with its own portable trailer to replenish air tanks for firefighters, but a county where a 20+ minute response time for an ambulance is not unheard of. Who's being fiscally responsible now?
What will change things? There are two possible solutions I see:
1) A commissioner's family member will die and could've been saved by timely EMS response.
2) The voters will eventually recognize that an idyllic life in "rural" Bastrop County means being condemned to substandard medical response compared to their neighbors in Fayette, Travis, and Williamson Counties.
Call County Judge Ronnie McDonald, Commissioners David Goertz, Clara Beckett, John Klaus, and Lee Dildy. Demand that they enter the 21st century and fund an adequate EMS program for their constituents. Any public official's primary obligation is to protect the safety of the public. Bastrop County's "good ol' boys" have to hear from you. They need to hear that the constant switching of private ambulance services is unacceptable when every other surrounding county manages to fund an adequate county (and city) funded 911 EMS response.
Saturday, November 19, 2005
Wes's thoughts on Julie Schroeder and Don Doyle
It appears that Chief Knee has received his marching orders from the City Council and City Manager, or that Chief Knee has absolutely no faith in his officers.
The "activists" have demanded the ritual scapegoating of an Austin police officer and the High Priest, Stan Knee, has offered forth Officer Julie Schroeder to absolve the Department of its leadership failures.
It is true that the mere possession of marijuana and/or an active warrant for theft from a person probably do not warrant a summary trial and execution in the field. It is also true, though, that engaging in criminal activity and embracing a criminal lifestyle do have certain consequences. One of these consequences is, inevitably, heightened attention from law enforcement. With such attention and when engaging in criminal activity, the possibility of confrontation does increase exponentially. In short, the risk of being shot, whether by law enforcement or by another criminal, is a very real risk of being a criminal.
Chief Knee claims that Daniel Rocha had no criminal history to indicate violence. He then uses this reasoning to support his allegation that Officer Schroeder should not have shot suspect Rocha. I question this spurious logic. First, the mere absence of a conviction for a crime of violence does not indicate that one is peaceful. In addition, the active warrant that suspect Rocha had for "theft from a person" clearly indicates that the suspect was willing to physically take property from another person. This is but a small (and questionable) step from the violent crime of robbery.
Officer Julie Schroeder and Sergeant Dan Doyle have both been tried and convicted by the media (particularly the anti-law enforcement fishwrapper that calls itself Austin's daily newspaper), the militant minority activists who are nothing but apologists for the thug culture infecting East Austin, and the "civil rights" community which believes in due process for everyone except law enforcement. In such a politically charged environment, Knee was either ordered or placed under pressure to indefinitely suspend (i.e., fire) Officer Schroeder and suspend Sergeant Doyle.
One can only hope that due process will prevail should Officer Schroeder choose to exercise her right to appeal to an independent arbitrator. In fact, her chance of success may be better than expected, as Officer Scott Glasgow was reinstated after being politically sacrificed on the altar of expediency by Chief Knee.
Why does APD have issues with the use of deadly force? I would assert that APD's use of force policy is far stricter than is necessary under Texas state law. I would refer one to Chapter 9 of the Texas Penal Code, which authorizes deadly force in many more situations that APD policy allows. Interestingly, at one point, the Texas Department of Public Safety's use of force policy merely referred the trooper to Chapter 9 of the Penal Code. Second, APD may apparently have a training problem, either in the academy or in the field training program. I find this may be the case, having seen that APD academy staff are at least partially "hand-picked" by APD management to present a politically correct training program. The field training program has been broken for years, namely by the lack of experienced officers remaining in patrol slots, and many of the current crop of FTOs having as few as two years patrol experience.
Chief Knee himself states in his press release that Officer Schroeder and Sergeant Doyle have been truthful throughout the entire investigative process. As I have understood it, the prime quality for any public servant should be integrity. Since Chief Knee had no reason to doubt the integrity of Officer Schroeder, I find it difficult to believe that he does not think her career is completely unsalvagable. Rather, Chief Knee has determined that the firing of an honest officer and the long-term suspension of another is the Danegeld that he must pay to avoid further repercussions from the activists in Austin who will not be satisfied until APD is thoroughly emasculated in its efforts to address street crime.
There are two lessons that continue to ring true in this case. First, engaging in criminal activity has very real consequences, up to and including death. Suspect Rocha chose his path and the results are clear. Second, Stan Knee and his bosses (Toby Futrell and the City Council) choose to pander to a vocal minority who would rather see the police toothless than to see a productive police force. The results of this are clear as well. There are many areas in Austin jokingly referred to as "no white boy zones." This is not racism, but rather a gallows sense of humor in recognizing that a criminal element controls these areas of Austin.
The "activists" have demanded the ritual scapegoating of an Austin police officer and the High Priest, Stan Knee, has offered forth Officer Julie Schroeder to absolve the Department of its leadership failures.
It is true that the mere possession of marijuana and/or an active warrant for theft from a person probably do not warrant a summary trial and execution in the field. It is also true, though, that engaging in criminal activity and embracing a criminal lifestyle do have certain consequences. One of these consequences is, inevitably, heightened attention from law enforcement. With such attention and when engaging in criminal activity, the possibility of confrontation does increase exponentially. In short, the risk of being shot, whether by law enforcement or by another criminal, is a very real risk of being a criminal.
Chief Knee claims that Daniel Rocha had no criminal history to indicate violence. He then uses this reasoning to support his allegation that Officer Schroeder should not have shot suspect Rocha. I question this spurious logic. First, the mere absence of a conviction for a crime of violence does not indicate that one is peaceful. In addition, the active warrant that suspect Rocha had for "theft from a person" clearly indicates that the suspect was willing to physically take property from another person. This is but a small (and questionable) step from the violent crime of robbery.
Officer Julie Schroeder and Sergeant Dan Doyle have both been tried and convicted by the media (particularly the anti-law enforcement fishwrapper that calls itself Austin's daily newspaper), the militant minority activists who are nothing but apologists for the thug culture infecting East Austin, and the "civil rights" community which believes in due process for everyone except law enforcement. In such a politically charged environment, Knee was either ordered or placed under pressure to indefinitely suspend (i.e., fire) Officer Schroeder and suspend Sergeant Doyle.
One can only hope that due process will prevail should Officer Schroeder choose to exercise her right to appeal to an independent arbitrator. In fact, her chance of success may be better than expected, as Officer Scott Glasgow was reinstated after being politically sacrificed on the altar of expediency by Chief Knee.
Why does APD have issues with the use of deadly force? I would assert that APD's use of force policy is far stricter than is necessary under Texas state law. I would refer one to Chapter 9 of the Texas Penal Code, which authorizes deadly force in many more situations that APD policy allows. Interestingly, at one point, the Texas Department of Public Safety's use of force policy merely referred the trooper to Chapter 9 of the Penal Code. Second, APD may apparently have a training problem, either in the academy or in the field training program. I find this may be the case, having seen that APD academy staff are at least partially "hand-picked" by APD management to present a politically correct training program. The field training program has been broken for years, namely by the lack of experienced officers remaining in patrol slots, and many of the current crop of FTOs having as few as two years patrol experience.
Chief Knee himself states in his press release that Officer Schroeder and Sergeant Doyle have been truthful throughout the entire investigative process. As I have understood it, the prime quality for any public servant should be integrity. Since Chief Knee had no reason to doubt the integrity of Officer Schroeder, I find it difficult to believe that he does not think her career is completely unsalvagable. Rather, Chief Knee has determined that the firing of an honest officer and the long-term suspension of another is the Danegeld that he must pay to avoid further repercussions from the activists in Austin who will not be satisfied until APD is thoroughly emasculated in its efforts to address street crime.
There are two lessons that continue to ring true in this case. First, engaging in criminal activity has very real consequences, up to and including death. Suspect Rocha chose his path and the results are clear. Second, Stan Knee and his bosses (Toby Futrell and the City Council) choose to pander to a vocal minority who would rather see the police toothless than to see a productive police force. The results of this are clear as well. There are many areas in Austin jokingly referred to as "no white boy zones." This is not racism, but rather a gallows sense of humor in recognizing that a criminal element controls these areas of Austin.
Monday, October 17, 2005
We are NOT a Democracy!
I'm about to get on a rant this morning. I read a letter to the editor in today's Austin American-Statesman that said that the prospect of a Federal district judge overturning a city ordinance would be "undemocratic" because a majority of voters approved the ordinance.
It's a damned good thing that Federal judges are undemocratic. In fact, I've got news for the dirty unwashed masses. We do NOT live in a democracy. That's a good thing, too.
The last time I checked, we lived in a constitutional republic. What does that mean? What does democracy mean? First, a democracy literally means rule by the people. Well, that's noble, right? In the abstract sense, yes. However, that's a glorified view of mob rule. Do you want the same people who decide on American Idol to decide what rights we have? In other words, in a pure democracy, 50% + 1 of the voting public can decide that the national anthem should become P. Diddy's latest hit. More insidiously, a majority could vote for discrimination against any minority they didn't like. Think it can't happen? Ask any African-American who lived through segregation. The majority of the population in the South voted for politicians who supported segregation. Crass appeals to ignorance, religion, and prejudice work in a democracy. After all, if someone's a minority, they're not "like us." Hence we end up with slavery, Jim Crow, bans on abortion, and restrictions on who can be in a relationship.
Ok, so what is a constitutional republic? A republic means that we are governed by elected officials. A constitution means that we have a supreme law governing how the government is organized and describing what powers the government does have. More importantly, our constitution describes powers that the government does NOT have. For example, the Bill of Rights serves the purpose of LIMITING government's powers.
In other words, it's through undemocractic judges that we ensure we don't slide down a slippery slope into a tyranny of mob rule. Thank goodness that the United States is not a democracy.
It's a damned good thing that Federal judges are undemocratic. In fact, I've got news for the dirty unwashed masses. We do NOT live in a democracy. That's a good thing, too.
The last time I checked, we lived in a constitutional republic. What does that mean? What does democracy mean? First, a democracy literally means rule by the people. Well, that's noble, right? In the abstract sense, yes. However, that's a glorified view of mob rule. Do you want the same people who decide on American Idol to decide what rights we have? In other words, in a pure democracy, 50% + 1 of the voting public can decide that the national anthem should become P. Diddy's latest hit. More insidiously, a majority could vote for discrimination against any minority they didn't like. Think it can't happen? Ask any African-American who lived through segregation. The majority of the population in the South voted for politicians who supported segregation. Crass appeals to ignorance, religion, and prejudice work in a democracy. After all, if someone's a minority, they're not "like us." Hence we end up with slavery, Jim Crow, bans on abortion, and restrictions on who can be in a relationship.
Ok, so what is a constitutional republic? A republic means that we are governed by elected officials. A constitution means that we have a supreme law governing how the government is organized and describing what powers the government does have. More importantly, our constitution describes powers that the government does NOT have. For example, the Bill of Rights serves the purpose of LIMITING government's powers.
In other words, it's through undemocractic judges that we ensure we don't slide down a slippery slope into a tyranny of mob rule. Thank goodness that the United States is not a democracy.
Tuesday, September 06, 2005
Report from the rear area, Hurricane Katrina
I have spent 12 1/2 of the most exciting and rewarding hours of my life. As most of you know, evacuees from Hurricane Katrina have been relocated to Texas, including approximately 4,000 who are temporarily residing in the Austin Convention Center. Our Austin/Travis County Emergency Operations Center issued the request for medical assistance on a regional basis.
I would like to relate my experiences to you. The medical and public safety communities from the Austin area united to provide an absolutely seamless care environment to the evacuees, most of whom have gone several days without their routine medicines or any medical care, beyond that necessary to stabilize any immediately life-threatening conditions. Upon my arrival at the convention center this morning (after dealing with some well-intentioned Red Cross volunteers who believed that they had an official role in screening EMS providers who were scheduled to work), I was quickly oriented to the facility, particularly the medical areas. We had a triage area staffed by nurses and EMS providers who obtained vital signs and a basic assessment prior to referring the patients to a physician. Our transport section was ably staffed by EMS agencies from surrounding counties as well as both private services here in Austin. In addition, our medical area had a section reserved solely to provide insulin shots and tetanus boosters. Another room was a mental health area staffed by counselors and clergy. This room also had an "assisted living" area where medical staff could pay closer attention to those who were deemed unable to maintain themselves. We also had a pharmacy trailer provided by a local drugstore chain.
After a short time in triage, several of us who are EMTs, mostly those affiliated with Travis County fire departments (along with some nurses and nursing students), were organized into two-person "medical strike teams." These teams were assigned to roam the main areas where evacuees were located. Our job was to stop and talk to almost every person there, ensuring their immediate, as well as ongoing, medical and psychological needs were met. We encountered many people with chronic medical conditions that were unaddressed, particularly hypertension and diabetes. We also encountered many cases of diarrhea and rashes. Many of these people were referred to our medical area well in advance of their medical needs becoming acute. We also encountered several acute cases that might not have been observed without the presence of the medical strike teams, notably a severe eye infection and a case of hypotension. In my opinion, the strike teams are a NECESSITY for the shelter environment. I would submit that failure to include the strike teams in the shelter setting only ensures that the triage areas will be overwhelmed later with much more serious conditions.
The only observation for improvement that I would recommend would be to provide for optometry (many of the evacuees needed new eyeglasses) and dentistry (I personally encountered several people with dental complaints.).
For those medical personnel working in the strike team setting, I would make the following recommendations for supplies.
1) An EMS-style fanny pack for supplies.
2) Stethoscope and blood pressure cuff.
3) Gloves.
4) Drug guide. (Many of us in EMS may not always be familiar with the maintenance medications that we will be encountering.)
5) Neosporin along with basic bandaging supplies.
6) Any such OTC meds as your medical control will authorize.
My hat is off to each and every medical provider and public safety provider who I worked with today. While several so-called "rival" agencies were working in the same confined area, egos were absent as we all focused on providing the best possible health care (both physical and mental) to some very scared, very tired evacuees. Thank you each for being there.
I truly am indebted and honored that I had a small opportunity to be a part of these people's lives. At the risk of sounding cliche, this was a life-changing experience. The tears I've been holding back today are tears of joy and compassion. I will always treasure the friendships I made, however brief the contact, with each and every evacuee and professional at the shelter.
I would like to relate my experiences to you. The medical and public safety communities from the Austin area united to provide an absolutely seamless care environment to the evacuees, most of whom have gone several days without their routine medicines or any medical care, beyond that necessary to stabilize any immediately life-threatening conditions. Upon my arrival at the convention center this morning (after dealing with some well-intentioned Red Cross volunteers who believed that they had an official role in screening EMS providers who were scheduled to work), I was quickly oriented to the facility, particularly the medical areas. We had a triage area staffed by nurses and EMS providers who obtained vital signs and a basic assessment prior to referring the patients to a physician. Our transport section was ably staffed by EMS agencies from surrounding counties as well as both private services here in Austin. In addition, our medical area had a section reserved solely to provide insulin shots and tetanus boosters. Another room was a mental health area staffed by counselors and clergy. This room also had an "assisted living" area where medical staff could pay closer attention to those who were deemed unable to maintain themselves. We also had a pharmacy trailer provided by a local drugstore chain.
After a short time in triage, several of us who are EMTs, mostly those affiliated with Travis County fire departments (along with some nurses and nursing students), were organized into two-person "medical strike teams." These teams were assigned to roam the main areas where evacuees were located. Our job was to stop and talk to almost every person there, ensuring their immediate, as well as ongoing, medical and psychological needs were met. We encountered many people with chronic medical conditions that were unaddressed, particularly hypertension and diabetes. We also encountered many cases of diarrhea and rashes. Many of these people were referred to our medical area well in advance of their medical needs becoming acute. We also encountered several acute cases that might not have been observed without the presence of the medical strike teams, notably a severe eye infection and a case of hypotension. In my opinion, the strike teams are a NECESSITY for the shelter environment. I would submit that failure to include the strike teams in the shelter setting only ensures that the triage areas will be overwhelmed later with much more serious conditions.
The only observation for improvement that I would recommend would be to provide for optometry (many of the evacuees needed new eyeglasses) and dentistry (I personally encountered several people with dental complaints.).
For those medical personnel working in the strike team setting, I would make the following recommendations for supplies.
1) An EMS-style fanny pack for supplies.
2) Stethoscope and blood pressure cuff.
3) Gloves.
4) Drug guide. (Many of us in EMS may not always be familiar with the maintenance medications that we will be encountering.)
5) Neosporin along with basic bandaging supplies.
6) Any such OTC meds as your medical control will authorize.
My hat is off to each and every medical provider and public safety provider who I worked with today. While several so-called "rival" agencies were working in the same confined area, egos were absent as we all focused on providing the best possible health care (both physical and mental) to some very scared, very tired evacuees. Thank you each for being there.
I truly am indebted and honored that I had a small opportunity to be a part of these people's lives. At the risk of sounding cliche, this was a life-changing experience. The tears I've been holding back today are tears of joy and compassion. I will always treasure the friendships I made, however brief the contact, with each and every evacuee and professional at the shelter.
Sunday, July 31, 2005
Solutions to homelessness?
In today's Austin American-Statesman, Andrea Ball asks for solutions to homelessness. The following is my attempt at an answer, which I believe provides a pragmatic framework for addressing homelessness in Austin. I'd also submit to you that the advocacy of law enforcement's role in addressing homelessness is not heartless, but rather in recognition of the fact that, at times, there must be a negative incentive to behavior that society chooses not to accept.
Dear Ms. Ball:
In your column today, you asked for workable suggestions regarding the homeless problem in Austin. I'll do my best to take your challenge.
First, I'd submit to you that some of the activists have a vested interest in homelessness. If homelessness is eliminated (or substantially reduced), the activists lose their funding, and subsequently, their employment. In addition, the activists, in order to maintain relevance, have to oppose any quality of life ordinances. These ordinances which control panhandling and solicitation would serve to help limit the ubiquitous visibility of Austin's homeless. Again, that which limits the visibility of the problem limits the power base of the activists.
No one approach will solve homelessness in Austin. Rather, a combination of approaches should be used, providing both an alternative to the streets as well as consequences for those who choose not to abide by societal standards. The city has a somewhat admirable approach with the ARCH center downtown and the transitional apartments downtown. The city has passed some ordinances, although it is very clear from the lack of consistent enforcement citywide, that the ordinance could be considered more as "lip service" to those who advocate a law enforcement solution. The part which I have yet to hear about is mental health care for the homeless. There should be assistance for those with substance abuse as well as a mechanism for the mentally ill homeless to receive the medications which they need to control their illness.
The city has failed to establish one facility that would go a long ways towards addressing both public safety and public welfare -- a detoxification facility for those arrested for public intoxication. Such a facility would provide an alternative to a traditional jail environment for those with substance abuse problems. Combined in conjunction with the Downtown Community Court, this would provide an appropriate mix of social services and law enforcement to those on the fringes of our society, encouraging them to return as productive members of our society.
During the Giuliani administration in New York, the police combined "crackdowns" on panhandling and other quality of life crimes with informing the homeless about shelters and social services. This is the balance that Austin should seek -- providing consequences for antisocial behavior, while providing the help needed to return to society.
In conclusion, the law enforcement model fails on its own as it offers no alternatives to life on the street. The social services model fails because it fails to address that some on the streets, by their actions, choose these behaviors. It is only through a combination of all resources that Austin can address homelessness.
Wednesday, July 27, 2005
Internet List Lemmings
I posted this a while back on an EMS list. I think it bears discussion.
Is it just me, or are a lot of people on this list lemmings? I've noticed that when certain people on this list say something, the vast majority of people accept their word as gospel truth.
Is it just me, or are a lot of people on this list lemmings? I've noticed that when certain people on this list say something, the vast majority of people accept their word as gospel truth.
I've never heard a great deal of clamoring for an EMS Commission outside of a few people, yet once certain people become in favor of it, people magically become in favor of it. The same can be said of recent discussions about movie medics and other topics.
This is exactly why I'm in favor of a liberal arts education being incorporated into the paramedic curriculum. In my opinion, a liberal arts education provides the critical thinking and communications skills to recognize when someone is right -- or when they're just full of it. Heck, I also favor everyone taking a statistics course, not to learn how to do statistics, but to be an intelligent "consumer" of statistical information. Every medic should also take a course in research design and the scientific method to learn how to recognize "good" research as opposed to "bad" research.
For those people on this list who propose their own ideas, keep doing it. I may not support you always, but the free exchange of ideas is what advances our science and profession. For those of you who instinctively agree with ANYONE, ask yourself why you follow the "leader" without question. A lot of Germans in the 1930s and 1940s were blind followers as well.
Professionally yours,
Wes
Education and how to sell it for EMS
In addition to my career as an attorney, I'm a volunteer EMT here in Texas. I participate on several EMS lists. On the lists, several of the "key thinkers" in EMS are constantly pushing for EMTs and paramedics to enhance their education and improve their critical thinking. Yet the majority of EMS providers who post on the Texas EMS list who say they "don't need to learn that, because they need to learn medicine" are the same ones who blindly accept scientific studies without questioning the underlying rationale of the study and whose grammar and spelling border on functional illiteracy.
I'm absolutely confident that courses like English Composition and Latin make me a better medic. Why? Not because Latin or English teach you a thing about medicine. The last time I checked, they don't hide pharmacology lessons in The Canterbury Tales. However, reading the great works of literature exposed me to mastery of the English language and how great minds view the world. Gaining a mastery of the English language helps me to express my thoughts both verbally and orally. That means two things. First, my reports are legible and literate. Second, I can express my thoughts professionally to my healthcare colleagues. (Those two skills, in my opinion, help enhance the professional reputation of EMS.)
As for the critical thinking, a great medic once told me that anyone can do the skills. It takes intelligence developed by critical thinking to know when to do (and not to do) the interventions. Understanding the rationale behind the skills and weighing the advantages and disadvantages of the interventions is true patient advocacy.
Unfortunately, those who don't have the education don't (usually) understand the value of a liberal arts curriculum. Until the EMS community begins to accept the values of a core education in liberal arts, EMS is doomed to be considered a technical degree right up (or down) there with air conditioning repair and welding.
Of course, there should continue to be a "certificate-only" route for those EMS students who already have another bachelor's level degree or who pass an exam of general knowledge.
I'm absolutely confident that courses like English Composition and Latin make me a better medic. Why? Not because Latin or English teach you a thing about medicine. The last time I checked, they don't hide pharmacology lessons in The Canterbury Tales. However, reading the great works of literature exposed me to mastery of the English language and how great minds view the world. Gaining a mastery of the English language helps me to express my thoughts both verbally and orally. That means two things. First, my reports are legible and literate. Second, I can express my thoughts professionally to my healthcare colleagues. (Those two skills, in my opinion, help enhance the professional reputation of EMS.)
As for the critical thinking, a great medic once told me that anyone can do the skills. It takes intelligence developed by critical thinking to know when to do (and not to do) the interventions. Understanding the rationale behind the skills and weighing the advantages and disadvantages of the interventions is true patient advocacy.
Unfortunately, those who don't have the education don't (usually) understand the value of a liberal arts curriculum. Until the EMS community begins to accept the values of a core education in liberal arts, EMS is doomed to be considered a technical degree right up (or down) there with air conditioning repair and welding.
Of course, there should continue to be a "certificate-only" route for those EMS students who already have another bachelor's level degree or who pass an exam of general knowledge.
The post that started it all -- Austin Fire's proposed EMS takeover
April 4, 2002
Dear Ladies and Gentlemen:
While reading the Austin American-Statesman yesterday, I read the article where Austin Association of Professional Firefighter's President Scott Toupin proposed merging Austin-Travis County EMS into the Fire Department. My first impression was that this was a late April Fool's joke. After overcoming my initial shock, I realized that this was a serious proposal. Such a proposal, however ill-intentioned, deserves a serious response.
Before I begin addressing my concerns with Mr. Toupin's ill-conceived proposal, I feel that I should address my ability to tackle this issue. I have a bachelor of arts in government and sociology from the University of Texas, a masters of public administration from Southwest Texas State University, and a law degree (JD) from Texas Tech University. In addition, I have participated in "third-out" rider programs with both Austin and Lubbock EMS as well as a variety of law enforcement agencies. I believe that my combination of academic education with exposure to street-level operations qualifies to speak to Mr. Toupin's idea.
Let me say from the outset that I wholeheartedly oppose a merger of the Austin Fire Department and Austin-Travis County Emergency Medical Services. In the following paragraphs, I intend to explain why such a merger will result in fiasco.
I. The Fire Service traditionally overlooks emergency medical transport operations.
While it is true that many early providers of EMS (e.g., Miami-Dade County and Los Angeles County) were fire services, the history of emergency medical care delivered by the fire service in Texas is fraught with horror stories. Perhaps the most vivid (and recent) of these stories come from the Houston Fire Department. In Houston, firefighters have been suspended for failing to treat a child who later died of an aneurysm. Also, Houston firefighters have been suspended for stopping for doughnuts while transporting a patient to the hospital. Currently, the Houston Fire Department's emergency medical services license is under probation by the Texas Department of Health (TDH) for these, and other violations of TDH rules.
In Dallas, the story is much less horrifying, but shows the lack of commitment to emergency medical care. The Dallas Fire Department requires each of their new employees to become certified as paramedics, and serve a minimum of two years on an ambulance before the employee can transfer to a firefighting unit. Rules such as this lead to a system where emergency medical care is seen only as a stepping stone to being assigned to a firefighting unit.
These instances lead me to the unfortunate conclusion that emergency medical care, as delivered by a fire service, will suffer as a result of being seen as a "sideline business" -- both from a lack of commitment by field personnel as well as a lack of organizational commitment.
II. The current system in Austin is a national model.
Currently, both the Austin Fire Department and Austin-Travis County Emergency Medical Services are recognized as leaders in their field. The Austin Fire Department currently limits its emergency medical delivery to first-response, providing medical care prior to EMS arrival. Austin firefighters are certified at the level of Emergency Medical Technician (EMT), which provides a limited level of care The Austin Fire Department is now fully accredited by the Commission on Fire Accreditation International. This means that an independent group of experts has recognized AFD's high standards. The Austin Fire Department currently limits its emergency medical delivery to first-response, providing medical care prior to EMS arrival.
Field medical personnel within Austin-Travis County Emergency Medical Services are required to be paramedics, the state's highest level of emergency medical certification. Austin-Travis County EMS has been accredited as an Accredited Center of Excellence by the National Association of Emergency Medical Dispatchers. In addition, the STAR Flight program was the first public safety air medical provider to receive accreditation from the Commission on Accreditation of Medical Transport Systems. In addition, the Special Operations unit of EMS (which provides high angle rescue, swiftwater rescue, and hazardous materials rescue) has received many awards both at the national and state level. This is the same section of EMS that Mr. Toupin feels most threatened by. Clearly, it is not a lack of expertise which concerns Mr. Toupin.
Based on the high levels of achievement by both AFD and EMS, the axiom of "if it ain't broke, don't fix it" should apply.
III. It is unclear how this proposal would improve services.
At this early stage of Mr. Toupin's proposal, it is unclear what benefits such a merger would provide. From my initial thoughts on the issue, I am unsure what cost savings would occur as the City of Austin currently handles procurement for both departments and a joint AFD-EMS supply facility already exists. The City of Austin also already has a maintenance facility for both EMS and AFD apparatus.
Further, the standards of care which dictate EMS's treatment are developed in conjunction with the Travis County Medical Society. Such a close relationship has been the fruition of years of effort. It is unclear if the Travis County Medical Society would be equally willing to work with a system under the direction of the Fire Department.
IV. Look at the source of this proposal.
While I do not intend to engage in ad hominem attacks, it is imperative that the source of such a proposal be considered. Mr. Toupin is the elected president of the Austin Association of Professional Firefighters, the local affiliate of the International Association of Firefighters (IAFF), part of the AFL-CIO. Mr. Toupin states about the proposed heavy rescue unit, "Make no mistake about this, it is a threat to our jobs." This came directly from the union website. The IAFF website shows that their organization maintains a paid staff to work on fire-EMS relations. Based on call volumes and types, the fire unions realize that emergency medical care and rescue operations are the majority of responses. To ensure continued funding increases and pay increases, the union feels as if it must get more involved in EMS and rescue operations.
Mr. Toupin must serve his constituency -- the union membership. I am asking that the city leadership considers interests of the public served by Austin-Travis County EMS. Such a proposal should be rejected as little more than a union-backed turf war.
Dear Ladies and Gentlemen:
While reading the Austin American-Statesman yesterday, I read the article where Austin Association of Professional Firefighter's President Scott Toupin proposed merging Austin-Travis County EMS into the Fire Department. My first impression was that this was a late April Fool's joke. After overcoming my initial shock, I realized that this was a serious proposal. Such a proposal, however ill-intentioned, deserves a serious response.
Before I begin addressing my concerns with Mr. Toupin's ill-conceived proposal, I feel that I should address my ability to tackle this issue. I have a bachelor of arts in government and sociology from the University of Texas, a masters of public administration from Southwest Texas State University, and a law degree (JD) from Texas Tech University. In addition, I have participated in "third-out" rider programs with both Austin and Lubbock EMS as well as a variety of law enforcement agencies. I believe that my combination of academic education with exposure to street-level operations qualifies to speak to Mr. Toupin's idea.
Let me say from the outset that I wholeheartedly oppose a merger of the Austin Fire Department and Austin-Travis County Emergency Medical Services. In the following paragraphs, I intend to explain why such a merger will result in fiasco.
I. The Fire Service traditionally overlooks emergency medical transport operations.
While it is true that many early providers of EMS (e.g., Miami-Dade County and Los Angeles County) were fire services, the history of emergency medical care delivered by the fire service in Texas is fraught with horror stories. Perhaps the most vivid (and recent) of these stories come from the Houston Fire Department. In Houston, firefighters have been suspended for failing to treat a child who later died of an aneurysm. Also, Houston firefighters have been suspended for stopping for doughnuts while transporting a patient to the hospital. Currently, the Houston Fire Department's emergency medical services license is under probation by the Texas Department of Health (TDH) for these, and other violations of TDH rules.
In Dallas, the story is much less horrifying, but shows the lack of commitment to emergency medical care. The Dallas Fire Department requires each of their new employees to become certified as paramedics, and serve a minimum of two years on an ambulance before the employee can transfer to a firefighting unit. Rules such as this lead to a system where emergency medical care is seen only as a stepping stone to being assigned to a firefighting unit.
These instances lead me to the unfortunate conclusion that emergency medical care, as delivered by a fire service, will suffer as a result of being seen as a "sideline business" -- both from a lack of commitment by field personnel as well as a lack of organizational commitment.
II. The current system in Austin is a national model.
Currently, both the Austin Fire Department and Austin-Travis County Emergency Medical Services are recognized as leaders in their field. The Austin Fire Department currently limits its emergency medical delivery to first-response, providing medical care prior to EMS arrival. Austin firefighters are certified at the level of Emergency Medical Technician (EMT), which provides a limited level of care The Austin Fire Department is now fully accredited by the Commission on Fire Accreditation International. This means that an independent group of experts has recognized AFD's high standards. The Austin Fire Department currently limits its emergency medical delivery to first-response, providing medical care prior to EMS arrival.
Field medical personnel within Austin-Travis County Emergency Medical Services are required to be paramedics, the state's highest level of emergency medical certification. Austin-Travis County EMS has been accredited as an Accredited Center of Excellence by the National Association of Emergency Medical Dispatchers. In addition, the STAR Flight program was the first public safety air medical provider to receive accreditation from the Commission on Accreditation of Medical Transport Systems. In addition, the Special Operations unit of EMS (which provides high angle rescue, swiftwater rescue, and hazardous materials rescue) has received many awards both at the national and state level. This is the same section of EMS that Mr. Toupin feels most threatened by. Clearly, it is not a lack of expertise which concerns Mr. Toupin.
Based on the high levels of achievement by both AFD and EMS, the axiom of "if it ain't broke, don't fix it" should apply.
III. It is unclear how this proposal would improve services.
At this early stage of Mr. Toupin's proposal, it is unclear what benefits such a merger would provide. From my initial thoughts on the issue, I am unsure what cost savings would occur as the City of Austin currently handles procurement for both departments and a joint AFD-EMS supply facility already exists. The City of Austin also already has a maintenance facility for both EMS and AFD apparatus.
Further, the standards of care which dictate EMS's treatment are developed in conjunction with the Travis County Medical Society. Such a close relationship has been the fruition of years of effort. It is unclear if the Travis County Medical Society would be equally willing to work with a system under the direction of the Fire Department.
IV. Look at the source of this proposal.
While I do not intend to engage in ad hominem attacks, it is imperative that the source of such a proposal be considered. Mr. Toupin is the elected president of the Austin Association of Professional Firefighters, the local affiliate of the International Association of Firefighters (IAFF), part of the AFL-CIO. Mr. Toupin states about the proposed heavy rescue unit, "Make no mistake about this, it is a threat to our jobs." This came directly from the union website. The IAFF website shows that their organization maintains a paid staff to work on fire-EMS relations. Based on call volumes and types, the fire unions realize that emergency medical care and rescue operations are the majority of responses. To ensure continued funding increases and pay increases, the union feels as if it must get more involved in EMS and rescue operations.
Mr. Toupin must serve his constituency -- the union membership. I am asking that the city leadership considers interests of the public served by Austin-Travis County EMS. Such a proposal should be rejected as little more than a union-backed turf war.
Wes's beginning rant on homelessness -- abridged by the local paper
Dear Mayor Wynn, Council Members, Ms. Futrell, Mr. Garza, and Chief Knee:
I truly believe that each of you have the noblest of intentions at heart for making Austin a livable city. Unfortunately though, I am quite concerned that the collective good intentions and rhetoric from city leadership, both elected and appointed, falls far short of approaching the realities of leading and administering a large city.
I have had some qualms about the direction that our city has been taking for some time, but my experience yesterday served to cement these doubts and hesitations. At approximately 9:30 in the morning, I was approached by a homeless person for money at the Exxon gas station at the intersection of Anderson Lane and Burnet Road. As soon as he left my immediate vicinity and I completed my purchase, I contacted 311 to report this incident.
From this experience as well as noting that almost every major intersection in Austin has at least one person holding a sign asking for money or a "church" of dubious origins selling candy, it is apparent to me that the City of Austin has chosen to turn a blind eye to the fact that the chronically homeless have taken over our urban center, and are rapidly spreading throughout the city. Unfortunately, whether by directive from city leadership or by sheer neglect, the Austin Police Department appears unwilling to aggressively address the issues of "panhandling" or "soliciting in a public roadway," both of which are prohibited by city ordinance and/or state law. In fact, I have, on several occasions, witnessed APD motorcycle and Highway Enforcement units working traffic enforcement at Parmer and I-35 at the same time that the other corners of the intersection were occupied by beggars.
Our city seems intent on spending large amounts of public funds to "redevelop" downtown and encourage people to move into the urban core of the city. Unfortunately though, it would appear that this willingness to spend money does not extend to public safety, either through a highly visible police presence or adequate street lighting (I would submit to you that much of downtown is inadequately lit.). Rather, the city has chosen to spend the money on concessions to downtown developers and on social services rivaling those of any Scandinavian welfare state. The city's development of the Austin Resource Center for the Homeless (ARCH) as well as transitional apartments only serve to prove the Kevin Costner adage of, "If you build it, they will come." It is well-known throughout Texas that Austin is a haven for the homeless and anecdotal stories exist of police in Dallas and Houston purchasing bus tickets to Austin for their chronically homeless.
I am certainly not opposed to providing temporary assistance for those homeless people who seek help and wish to better themselves. Alas, though, it would seem from what I have seen that the city leadership chooses not to address the problem of the chronic homeless population who do not wish to receive assistance in making a transition to a stable and productive role in society. Rather than "tough love," our city chooses to lionize some of them. Witness the local celebrity status of Albert "Leslie" Cochran, whose criminal record for petty crime must surely be several pages long.
Mayor Rudy Giuliani and Chief Bill Bratton chose to make New York City livable by aggressively addressing "quality of life" crimes, including panhandling, as George Kelling advocated in his book "Fixing Broken Windows." Our city has chosen a different approach, with the result that our city resembles a Dickens novel in the omnipresence of a perpetual homeless underclass begging throughout the city.
I request the favor of your response to this matter and look forward to hearing how the city leadership truly makes to wish our city livable -- which must inherently include safety.
The trust barrier between Islam and the West
A letter to the editor which I wrote was recently published in the Statesman, so I can't reply to this letters to the editor. However, this one letter must be replied to.
Here's the letter.
Why terrorists attack
The recent terrorist bombings of London subways and buses, which resulted in deaths and injuries of
civilians, are reprehensible and should be condemned unequivocally.
civilians, are reprehensible and should be condemned unequivocally.
As a Muslim, I believe that Islam prohibits all acts of violence against civilians and the taking of innocent lives. The Quran clearly says that killing one innocent human being is like killing all humanity. Those who deliberately kill innocent civilians act outside the laws of Islam.
Terrorists have no religion. They use religion to pursue their ideology or agenda. Innocent Muslims are among the victims of terrorism.
What leads an individual or a group to the extreme action of killing themselves and other innocent people? Perhaps Western governments need to revisit their foreign policies, which include waging wars of aggression, supporting unpopular dictators and failing to find a just solution to the Israeli-Palestinian conflict.
SYED AKHTAR
Board member
Muslim Community Support Services
Austin
My response, if I could reply.
Mr. Akhtar:
Thank you for your effort to attempt to condemn terrorism. Unfortunately, your weak response only shows why the majority of the Muslim community cannot be considered an ally in the war on terror.
Your response is typical of the Muslim community. You condemn terrorism, then immediately attack the policies of the United States and its Western allies, including Israel. Until the Islamic community can wholeheartedly condemn terrorism without reservation or equivocation, there will always be an element of distrust from the rest of America and the West.
When a terrorist commits his crimes in the name of the Jewish or Christian faiths, our leaders immediately condemn the act without any justifications provided. When a terrorist commits his deeds in the name of Islam, it is all too often that his fellow travelers in the West attempt to minimize his acts or rationalize them.
Until Islam takes a stand without hesitation for moderation, nonviolence, and modernity, the majority of Westerners will, unfortunately, lump most Muslims in with the mullahs of Tehran or the Taliban of Afghanistan. Until then, to answer your question as to what leads an individual or a group to the extreme action of killing themselves and other innocent people, the answer is the failure of your community to give no quarter to those who kill in your name. During World War II, Japanese-Americans joined the 442nd Regimental Combat Team to fight fascism in Europe. When I see Muslim-Americans volunteering to join the military, law enforcement, and the intelligence services at the same rates of the Japanese-Americans of the 1940s, I will know that our Muslim neighbors are truly committed to our national values.
-Wes
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