Sunday, July 26, 2009



'Shock' is defined as 'inadequate perfusion to sustain life'. On many, many responses I've arrived at scene to have people tell me "He's going into shock!!" Which, to them means, he's starting to shake. EVERYBODY goes into shock at least once in their lives, usually the first and last time preceeding a lengthy temperature change. Actual shock that gets reversed is not very common.
Obstructive, hypovolemic, neurogenic...there are quite a few things that can hinder perfusion (bloodflow). A block in the lungs. All your blood fell out a hole. Your spinal cord got unplugged so all your vessels dilated, making you die early.
Today's hoist rescue might have been simple dehydration and hyponatremia. It also might have been cardiogenic shock. This guy was 1/4 mile from the top of Iron Mountain hiking through the heat, alone. (thank God for Verizon) Hx hypertension. He's 9 years younger than me; his dad died at 40 of heart disease....
Before I was even on the ground I could see how pale he looked. He also had that pre-death panic. (Some of you know what I'm talking about) Fast beating heart, low blood pressure, would get dizzy sitting up. Decision time----figure this out here and get some medicine in him, or put him through the stress of a hoist and fly him down the mountain to the ambulance below? I spoke to him briefly and told him to turn it all over to me, everything would be fine, we'd be in the ambulance in 5 minutes. He didn't protest. I have a trick where I start telling them some boring story while on the ground,and continue it all the way up to the helicopter (this guy was in town for Comic con so I talked about Groo. He was into that.)
Didn't take long for the IV, fluids, 12 lead, O2, etc. once in the copter- then handed him off to the Poway folks for a quick trip to the hospital. (In this case no time would be saved by flying him there) BP came up good with the fluids, so I'm still thinking dehydration, but that's what the ER doc is for, and as long as his pressure's good the prehospital treatment's the same.
Decision to extract instead of treat---my thinking was, if it's dehydration, staying in the sun won't help and he'll do OK during the hoist. Cardiogenic shock, once he turns the corner I'd really have my hands full with no help, then I'm struggling to get him stable enough for the pick-off. 5 minute gamble and I'll have lots of help. #1 most effective treatment option available to paramedics is rapid transport

Thursday, July 23, 2009

Small world


When I was a rather new paramedic, I was on a rescue team called "STAR" (Special Trauma And Rescue) This was before the fire department had anything to do with paramedicine here in San Diego. The six of us were responsible for SWAT, US Coast Guard, Secret Service, and cliff rescues. It eventually led to what I'm doing now...
In 1988 three college kids were drinking beers on the bluffs high above Black's Beach. One guy fell. The only girl there, Marissa, sent the other guy to call 911 and started climbing down the cliff to see if she could help. The guy went to his car and fell asleep. Next morning he woke up and saw his buddy on the rocks below the cliff, and finally went back to call 911.
I hadn't been a medic long but dude looked pretty dead to me. I rappelled down to pronounce him, and when I got to him he was stiff. I was about to start back up when I noticed a hand sticking out behind another rock.
Marissa had fallen too. Her chest was collapsed, her pelvis was broken. She'd go in and out of consciousness. No blood pressure. I radioed the lifeguards to get a surfboat over; we carried her through the surf, put her in the boat, and motored over to the boatramp. On the way there her heart stopped so I shocked her (the old way, with the paddles) and got a pulse back. That happened on the way to the hospital again, and once in the hospital. After emergency surgery and lots of physical therapy, she was able to bring cookies by the fire station.
So today, AnnaMarie had a lady over for lunch along with her daughter for a playdate. She is new to Julian, and AnnaMarie was asking her life story, and she talked about normal childhood and such, "But there was a major traumatic incident in my life". The more she talked about it (she even mentioned "STAR Team") and she remembered a guy with blue eyes... AnnaMarie figured out the connection

Monday, July 20, 2009

Hoist currency with Dan


Nothing really new here....We got out early for hoist currency training. Dan realy has the touch. I tried to get a pic of the spot he was putting me into but couldn't...It's kind of a shelf in an abandoned quarry.
First you identify the target. While turning base leg, the crew chief operates the hoist to get the rescue medic outside the aircraft. While flying forward towards the site, the crewchief spools out cable, simultaneously directing the pilot and watching the rescue medic's hand signals. When the medic is on the ground he comes off the hook. (After that I put my camera away)

Friday, July 17, 2009

Fixing Healthcare


This week, the problem I'm solving is healthcare. I'll post my fix here, it'll get vetted by my very, very diverse fellow bloggers, then put into action. The only missing piece is any authority to enact it, but I can gloss over that...After all, Obama's administration keeps glossing over a bigger obstacle---no way to fund socialized medicine, and our national credit is maxed out already. So, here goes.
Every place in the world that has socialized medicine also has an upper tier level available for those who can afford to pay. We need to accept this now, then decide how best to have a two tiered system.
Every county gets a government run hospital. If you are un or under insured, that's where you go. There are NO televisions. Smoking is banned. The food is nutritious but bland. You are probably going to have to wait a lot, and if you are admitted, you are in a ward with many others; no private rooms. The actual medical care, though, lives up to government standards. It's the teaching hospital too.
The private hospitals are freed from government regulations. They have the right to refuse service, other than stabilization of the most critical patients prior to transfer to the County Hospital. ICD-9 coding is optional. Red tape nonsense like JCAHO is eliminated. If a hospital is good, it will thrive. If it is dirty and people don't do well in general, it will fail.
The government can set whatever standards it wants. If the care is better in the government run hospital, people will go there regardless of income levels.
Under my plan, no one is denied medical care. If you are sick, you will get treated; kind of like now, with ER care being primary care for the uninsured, but they wouldn't have to clog the ER's. If you chose not to be insured, you don't get a choice of hospitals. It's off to the county for you! If you worked hard all your life and made your future medical care a priority, and you sacrificed to get good insurance, THEN you might get a private room after your surgery you scheduled just last week instead of a year ago. Everyone wins---it's far cheaper since the private hospitals are unburdened with regulations. If you are pro-regulation, you have that option at the County Hospital, with all the regulations Health and Human Services can muster.
We already do this with schools. You'll pay for the government schools whether your kids go there or not. If you don't like the government curriculum, you can pay extra for private schools.

Expensive date


We took advantage of the kids being gone and got a very good hotel deal through a friend. We stayed at the Marriott Courtyard at Liberty Station($120). We biked to the thrift stores in Pacific Beach and filled the saddlebags on the tandem with 'new' clothes ($17). We were going to drive to the farmer's market in Ocean Beach, but the traffic was at a standstill so we unloaded the bike and rode there, too. We ate streetfair food ($13).
AnnaMarie had packed food for breakfast so no expense there. We then rode the bike around a whole bunch of car dealerships. She had an idea what she wanted but wanted to be sure. Car shopping on a bike is great. You can outrun the salespeople.
We looked at Mini Coopers. She sat in one. She test drove another. This one was her pick, but we went out to El Cotixan for lunch ($9) to really think about it; called the salesman back with a lowball offer; well below bluebook.
It's used, a 2007 with 14,000 miles. The dealer claims it's a chick car, and chicks don't drive manual transmission cars so this one wasn't selling. AM prefers stick; this is a 6 speed. It's supposed to get 37 mpg which is a little better than the 12 mpg her Durango gets. (we'll keep the Durango for big groups and snow conditions). The date budget of $160 was blown by 12875%.
AnnaMarie kept going out to just look at her new car. I love the fact that she wanted something that was for her. All her decisions are usually for the family and household. I know, I know---it looks a lot like my first car. Really this is the car she wanted. I haven't even driven it yet.

Thursday, July 9, 2009

This week's idea


When I was stationed at the Fire Department's HazMat team, we had these nifty tools called imbiber pads, and imbiber booms. What they are, is paper towel looking things, or sometimes giant sausage looking things, that suck up hydrocarbons (gas, oil, that sort of thing) but repel water. If you had an oil sheen on top of water, you could throw an imbiber in there and absorb all the oil, leaving just the water.
So here's what I want to do.... Make cigarette filters out of imbiber material. I'd have to figure out how temperature stable the material is, and if any nasty vapors would be released (not that the smoker isn't already inhaling nasty stuff, but I'd rather not contribute to that damage.... Anyway, here's the advantage. First, maybe the imbibing butts would absorb some of the tar while being smoked. The bigger benefit, though, is when the butt is tossed out the car window as they inevitably will be tossed, they end up in the gutter and storm drains. Next rainfall when all the road grime and oil is rinsed down the road, the carelessly discarded butts will help soak up the oil. They'll be collected in the storm drain traps periodically and disposed of in the landfill

Thursday, July 2, 2009

Taking care of 'business'


I ordered my infiltrators and picked them up. If you live in a city, you flush and stuff goes through miles of pipes to a wastewater treatment plant somewhere. If you live in the country, it goes through a few feet of pipe into a two chambered tank where bacteria break it down, then it goes out into the soil in your yard. The traditional method is to distribute it through a few hundred feet of perforated pipe in crushed rock lined trenches.
I'm using infiltrators. They have twice the evapotranspiration area, and according to the data you only need half as much field; the county still requires the full distance. The real saving is, no crushed rock required.
I have to dig 325' of trench, 3' deep. Then these things all snap together, get the county inspection, then covered up-- out of sight out of mind.
Byron---you could use these for decor. If you want a certain style, say the set of 'Aliens', you could cover the walls and ceilings with these and put bright lights behind them. Add a fog machine or two and you're done.



So the Washington Post was caught red handed trying to sell softball interviews to healthcare reform lobbyists (no hard questions) and access to Obama insiders. THose of us with any ability to scrutinize media are not surprised one bit, except in their ineptitude in covering their tracks. If the NY Times caught wind NRA lobbyists bought favorable interviews from national media, there would be hell to pay. My image of the U.S.A. is incompatible with a state controlled media. Whichever side of the aisle you're on, this should bother you a great deal.
Similar is the squashing of EPA documents that don't support the global warming/carbon emmission connection. We are going to further cripple our economy by allowing these lies to change legislation.