Incident Command

Small Town Rescue Squad, to which I belong, has been doing an awful lot of training over the past two months. Actually, STRS has been doing so much training that I haven’t been to a Tae Kwon Do class in the past two months because, for some reason, training can be scheduled only on those days I take Tae Kwon Do classes I am paying for, and not on any other days of the week. Fine. Training is good and training is needed.

Among the classes we have recently taken has been a class given by Dr. J, our medical control doctor and one of the Emergency Room physicians at our local hospital. Dr. J is a fantastic doctor and he’s a pretty darn good teacher as well, which is probably why he’s a fellow at the Academy of Emergency Medicine. So, when Dr. J gives a class, you’d think people would take a little something away from the class. And, if you took anything away from Dr. J’s class on Multiple-Casualty Incidents, or MCI’s, it should probably have been the fact that the first unit on scene becomes Incident Command upon arriving at the scene of an MCI.

True to Dr. J’s fashion, he didn’t just teach us this in the classroom, but he also had us try the concept out at our large, once-annual MCI training scenario at the local high rise. This year, the Medical Simulation Training Center at the local Army base did the moulage kits on our casualties, who were volunteer students from the local high school, which added a heck of a lot of realism.

But the problem with a canned MCI scenario like this one is that everyone knows what they’re supposed to be doing. “Wait,” you wonder, “Isn’t the whole point of this training to ensure that everyone knows what they’re doing? So how can that possibly be a bad thing?” Well… here’s why.

When you run a canned MCI scenario, everyone knows what they’re supposed to be doing because it’s discussed in great detail before we’re ever paged out to participate in the scenario. We know who’s going to be running triage and who’ll be rehab. We know who’ll be at Incident Command and where our ambulances will be staged. Which is great. Except for the fact that you don’t know any of those things when you’re responding to a real MCI.

Cue a real MCI.

Coming back from Search-and-Rescue training with the local K-9 team in Fulton, we were just outside of Small Town when I was passed by MC’s truck, running blue lights and going about 80 in a 55. “Funny,” I thought as I pulled back onto the road, “I didn’t get a page. Maybe it’s just a fire department thing.” After checking CAD Page my phone, I find that the Rescue Squad has been paged out along with the fire department for a structure fire. Hum. That’s a pretty routine thing and usually requires an ambulance to stand-by somewhere while firefighters do their thing. It’s not usually something that requires extra hands.

Just as I was about to turn into the main street, about a mile from the Squad, I got a phone call from KB. KB knew that we were close by because I’d asked hubby to text him when I turned off Route 11 to ask him what the turn was to get to 126 – the one I always miss but that we usually take returning from transports to Syracuse in the ambulance. So he knew I was only a few minutes out. He sounded frantic and wanted to know if I could come into the squad right now because there was a fire in a building with a central oxygen system and one firefighter was already down and the Lifeflight was in the air.

So I headed to the Squad, grabbed my stethoscope and reflective vest from the back of the Jeep, handed hubby the keys so he could drive it home, and hopped into the ambulance, all under the calls of “HURRY UP!” from inside. I saw that one of our rigs was already out and the third was still in the bay, with neither crew nor EMT ready to take it out, which was a little surprising since we usually don’t have a problem getting drivers or EMTs to crew all three rigs when there’s a big incident. (But a lot of our people are also firefighters and went on this call with the fire department, rather than the rescue squad, I assume.)

On the way, KB filled me in on the fact that, apparently, the building on fire was our local hospital – more specifically, our local Emergency Room. That’s not a good thing. At all.

As we pulled up on the road overlooking the hospital, just prior to our turn, I saw that a ton of equipment was already in place. The entire parking lot in front of the Emergency Department was flashing and blinking lights on fire trucks, ambulances, police vehicles, volunteer firefighters’ personal cars, and so on. Two fire trucks were right in front of the ER’s entrance and our other ambulance was backed in to the left of those. We had no ability to join them there with other vehicles and fire hoses blocking the way, so we looped around and staged in the adjacent parking lot, then jumped out to locate command to find out what we were going to be doing or whether they wanted to stage us elsewhere.

As it turned out, the crew of our first rig was comprised of our Squad’s president (and Chief 2), an EMT, and her driver, also an EMT. They were inside, caring for a firefighter who’d been injured in some way and for whom the Lifeflight had originally been called but had since been cancelled. Eventually, Chief 2 came outside to ask for a c-collar and tape, which we handed her from her rig, and a short while later, her driver came outside to inform us that mutual aid was coming but the EMS coordinator had not yet arrived, so he didn’t know where they needed to go or where we needed to go.

Stepping back here a second …

We’re at a scene now with the Fire Department, police, and EMS. Other agencies are on their way for mutual support and there is NO Incident Command framework, at least for EMS, because “the EMS coordinator isn’t here”. What is wrong with this picture?

Meanwhile, we can see four other ambulances from surrounding departments on the high road, about ready to turn toward the hospital and we’ve got no place to direct them to. KB and I looked at each other and told MB, the driver – “You were first on scene, YOU are the EMS coordinator. Make a decision.” KB suggested staging them in the parking lot where we were staged, as it would be easy for them to load and go from there, and once we got a sort-of-committal from MB, I headed down to the police road block at the entrance to the parking lot to direct those rigs into the upper parking lot where we were, which is where they went.

A short while later, which everyone staged nicely and ready to go, MB showed up and told us that we should stage behind the hospital, at the rear entrance, so we all lined up and drove around the building. Only problem being that there isn’t any damn room back there, so having pulled two rigs up to the building, the rest had to be quite a ways back and taking any of the rigs out of there to transport would have required tight, 3-point turns past other rigs, a fire truck, and various dumpsters. And, obviously, this literally put us up against the building … probably not the best place to be, necessarily, in a structure fire. But, we were sent, so we went.

That is, until our Chief came around the building and told KB that he was now EMS command because nobody else more qualified, such as the EMS coordinator, had arrived yet and she “was busy” on the other side of the hospital doing whatever it was they were doing over there that didn’t include becoming EMS Command on arrival as the first rig on scene. With KB becoming EMS command, of course, that also meant I was now out a driver. Another little detail nobody seems to have considered.

In the end, none of the ambulances were needed – luckily. The firefighter injured was treated at the hospital, and the structure fire everyone was looking for had turned out to be “a strong odor” pulled in from outdoors by the ventilation system, possibly from people starting up their wood fireplaces for the first time this season, or someone being dumb enough to burn their trash and plastics in said fireplace (which is not particularly uncommon in these parts, especially now that burning trash outdoors happens to be illegal). The mutual aid rigs were sent home and we stayed on scene for a while longer until we, too, were released. (KB was surprised they didn’t end up forgetting about us.)

Overall, I think it was a lesson learned in how not to handle Incident Command at an MCI. And a lesson learned regarding the fact that taking the classes and required tests (such as all the FEMA classes we have to complete online) does not equate actually know what the heck you’re supposed to do when placed in that situation. It was disappointing to see. Fortunately, nobody got hurt but I don’t think it should have gone the way it did. (But it’s not my place to point that out.)

Customer Service

Why is good customer service so hard to come by these days?

Okay, there are still some places where I have been getting good customer service. My local McDonald’s is staffed by some incredibly nice people who probably know me by name by now … or at least can identify me by my car … and they’ve been giving me pretty good service, save for the occasional mix-up where I’ve gotten a vanilla McCafe shake instead of a chocolate one, but that’s no biggie. But elsewhere around here? Not anywhere near the same amount of service.

Seems like many of the places around here are stocked by people whose give-a-damn is broken but who still expect the customer to be nice to them and even tip them although they provide no service that would be worth a tip, save for the non-monetary kind, such as – “Here’s a tip: provide some customer service if you want me to give you extra money for it.” Remember, kids, the definition of a “tip” is a “sum of money as reward for their services.” It’s a reward. Not an entitlement.

But I digress.

There are a few places locally that have done an overall worse job than others recently, so I’d just like to mention them.

The first is our newly opened Dunkin’ Donuts. It’s been open for less than two months and service is already complete crap. We’ve stopped in once so far and probably won’t be going back anytime soon. Aside from the fact that the place looked like it hadn’t been cleaned since the day before, with straw wrappers and other debris littering the floor, the staff made an equally bad impression in unwashed, wrinkled, stained white shirts, bad tattoos showing on their necks and arms (even in areas where they could have been covered, were they to wear their shirt sleeves down), and very slow, unfriendly service.

The second one is our local Brigade Quartermaster store on base. I went in there with the express purpose of buying a pair of boots. Walking in, I was the only customer. Yet the store clerk was, of course, nowhere to be found to be asked a question. When I finally did find her to ask whether they are able to get the boots in black (so I could wear them for both Civil Air Patrol and at the Rescue Squad) rather than the standard tan, the employee seemed put out that I’d asked her such a difficult question and suggested I Google it, she didn’t know. The rest of the interaction with her wasn’t any more pleasant … like when I stood at the register ready to check out and she was yakking it up with an employee from one of the other stores by the door, completely ignoring me.

Incidentally, I’ve noticed that male soldiers going to this store never get this sort of brush-off treatment I got from the (female) staff in there. Makes me wonder if they work there looking for a date. Or a hubby. At any rate, I wound up complaining to corporate about that particular shopping experience and got a nice email back telling me they’d given both the employee and the manager some additional training. (Whatever that means.)

My latest bad customer service experience was at the local Pizza Hut, which has been offering a $10 for any pizza, any size if you selected takeout instead of delivery. Hubby and I ordered a large Hawaiian, which is our default pizza order, and headed over there to pick it up. We were helped quickly by one of the teenagers working there who brought out our pizza, showed it to us to ensure it was the right thing, and then informed us that the woman at the other register (the “takeout register”) would check us out as soon as she was done.

The woman at the other register was identified by her name tag as the General Manager and she was the only person in the store who didn’t look neatly dressed and groomed. Her hair was disheveled and both her apron and Pizza Hut shirt were wrinkly, stained, and dirty. Not a very good impression from the person who’s supposed to be the manager, especially considering that all the teens working there were well-put-together! Not only that, but she was on the phone. For the next eight minutes! Around minute five, hubby was wondering whether we should be going to Stefano’s (the local Italian joint) instead but I suggested that since we were already here and the $10 pizza was a good deal (and usually very good), we should just wait.

When the Manager got off the phone, she offered no apology at all, not even a quick, “I’m sorry for the wait.” She just started to ring us up. As I handed her the money, I couldn’t help but commenting that “The pizza is probably cold by now.” Instead of apologizing, the Manager said, “Why’s that? Oh… because I was on the phone so long? I can only do one thing at a time.” Which sounded a whole lot like, “Go fuck yourself. I’m the manager and if you don’t want to wait, don’t fucking eat here.”

Needless to say, corporate got an email about that one, too. And I’ll be recommending to my friends on both the rescue squad and both fire departments to order their pizza someplace other than Pizza Hut – thankfully, we do have other pizza options right in town, too.

Have you recently dealt with bad customer service? How did you handle it?

Reasons Why

Buzzfeed, which is a page of essentially random but interesting newsfeeds I read daily via my feed reader of choice, Feedly, recently had a post up titled “25 Reasons Why Police Officers Never Show Up to Tea Party Rallies.” The 25 “reasons” were, in fact, 25 photos of Tea Party protesters carrying firearms during protests. No doubt, the point they were trying to make was that the police were too afraid to arrest these (armed) protesters but are more than willing and happy to play the big, brave cops when faced with the peaceful, peace-loving, hugs-and-granola-types in the Occupy Wall Street protests.

Not quite.

First, there seems to be this huge amount of outrage that Tea Party protesters would bring guns to a protest rally. zOMG. They’ve got guns. The world is gonna end! Revolution is upon us. Fact is, however, that the places where Tea Party protesters have brought firearms to rallies are all places where carrying firearms is perfectly legal.

New Mexico, for example, which is cited in the first article snippet on the Buzzfeed page, allows open carry without a permit of any kind. 25 other states do as well. Overall, 42 states allow open carry (with or without a permit). And as much as the media would like to make believe that only a nut would carry firearms to a political rally, the fact remains (and even the media has to admit) that this happens to be perfectly legal in most places.

The fact that police doesn’t generally show up to Tea Party protests is also a falsehood … police show up plenty to political rallies, whether they’re conservative or liberal in nature. The fact is, however, that they rarely feel the need to arrest people at conservative rallies, such as those held by the Tea Party, because those protesters don’t behave in a way that bears being arrested – they don’t usually present any sort of risk to others, don’t block roadways, don’t squat on private property, and don’t leave trash. When told to disperse, they disperse, rather than shouting and acting like a threatening mob.

You also don’t hear about cases of protesters being raped, assaulted, or robbed at Tea Party rallies. At Occupy Wall Street in Baltimore, on the other hand, they’re circulating pamphlets that discourage women who were raped in the protest camp from reporting their rape. In Seattle, a protester was arrested after exposing himself to children. And, of course, residents of New York aren’t happy having the protesters in their back yards where they add noise, block roads, harass people who are on their way to work, and present a general health and sanitation hazard. I don’t think I’ve seen any such complaints about the Tea Party movement.

If Occupy Wall Street has a sensible point to make, they are missing their chance to do so by allowing the sort of conduct that is being allowed in their protests – squatting on private property, defecating on police cars, rape, robbery, assault, harassing average people going to work, blocking roads and sidewalks, and so on, and so forth.

There are plenty of ways to protest – in public and with signs – that will get the message across and will do so without turning whole neighborhoods against them due to their conduct. There is a reason so many people are thinking of the Occupy movement as a bunch of lazy, lay-about, dirty hippies … for the same reasons people assume hippies are dirty and lazy. Because there are those who give that impression and, as the saying goes, the squeaky (or should that be, the smelly?) wheel gets the grease. The yucky get noticed, basically.

As far as I’m concerned, I don’t think the Occupy movement as a whole has any clue regarding what they are actually protesting for or against. I understand why it started and what the original reasoning behind it was, but then it started to look more and more like every single protester had their own idea as to why they were there and what needed to be changed. And then they completely lost me with the list of demands that seems to be changing by the minute. Some demands are reasonable. Some are ridiculous … like free college education and open borders migration. My personal ridiculous favorite is the call for “a guaranteed living wage regardless of employment.”

Nuts!

But, what really bothers me the most is this “the 99%” claim. How dare these people to presume that they are speaking for me? Or that their interests, whatever they are, somehow represent mine. And I’m certainly not in or anywhere near the 1%.

Adventures in EMS

I think it has probably become a tradition for me to begin every single blog post by pointing out that I haven’t blogged in aaages because life has gotten in the way, and this post is no exception. Of course it isn’t. You should know what to expect from me by now. If you don’t, well, maybe you haven’t been paying very close attention.

At any rate, I don’t believe I have done any blogging at all about working as an Emergency Medical Technician (Basic) since that entry months ago about the very obvious description of paralysis one of my fellow students offered in class once. Since that entry, I’ve taken my final written and practical exams, and (if I might brag for a bit), finished with 93% on the written exam and passed with full points on my practical exams. I also received college credit – 4 hours worth – for the course which is reflected as a 4.0 on my transcripts. Please bear with me while I toot my own horn for a second.

While taking my Basic class, I was required to complete 10 hours of ride time with a local ambulance squad before I was permitted to take the final exams. Ride time is a requirement so that new EMTs, such as myself, get the necessary hands-on experience under the supervision of an experienced proctor, rather than just theoretical knowledge, before they become certified to work as an EMT in their respective states. And while many of us did a fair bit of griping about making that ten hours in time to be admitted to the final exams, it’s an important and necessary thing. While it’s certainly a requirement to have all the theoretical knowledge, it’s a different matter altogether to use it, hands-on, in the field. On a real life patient. In a stressful or rushed situation.

I was extremely lucky during my ride time in that I was paired with proctors who were paramedics with many years of experience in the field. But what’s more is the fact that these proctors didn’t just let me watch – they let me do, under their careful supervision and with their help. And I think that was possibly the best way to be introduced to working (civilian) emergency medicine in the field – being able to do it from the start, with someone to look over my shoulder to ensure I did it right.

I know that many of my fellow students were not so lucky – some were allowed only to watch. Others were paired with proctors who didn’t actively teach and explain, just sort of had the students “follow along”. And a few students figured they’d to the “smart” thing and spend their 10 hours of “ride time” in the ER instead of the back of an ambulance – where, subsequently, most of them ended up watching and making beds, rather than getting any hands-on experience at all.

After finishing classes and receiving my EMT card, I joined the squad I had done ride time at and began my training there. But wait, you say … you just became an EMT. Why are you starting training at the squad? You should already know all that an EMT needs to know!

What they don’t tell you prior to taking the EMT class or even in the EMT class is all that extra stuff you have to learn at your squad that you do not learn in class. A lot of it, such as ambulance operations or working with helicopter life flights or writing PCR’s (pre-hospital care reports) is touched on in class but it isn’t covered in-depth – that’s what your ambulance squad is for. They train you to do these things the way they’re done in that particular squad. And, as I’ve come to find out, squads have specific ways of doing things. Some, for example, now write all-electronic PCR’s. My squad does not – we write our PCR’s by hand, on the state forms, and then enter them into the computer after a run, which submits the PCR to both the state and the company that does our billing. And there are specific ways we do checks on our ambulances to ensure that everything is stocked, nothing is expired, and all is where it should be. And so on, and so forth.

It took a few months, but I finally was cleared to run on my own for both transports and emergency calls. It mostly took “a few months” because of the low call volume – while large cities such as New York or Washington, DC are hopping (in a manner of speaking) all day and night long, our upstate area tends to be relatively quiet and we often have days where we don’t get a single call at all. Naturally, that makes getting cleared difficult because you have to do so many runs with a more experienced person until everyone feels you’re ready to fly solo.

Up here, our bread-and-butter calls are to the local nursing home. And while they’re our most common type of call, they are also our most frustrating type of call, for a couple of different reasons.

One – because the nursing home is located, literally, behind the hospital. It would probably save everyone time and money if the hospital simply built a covered corridor connecting the hospital with the nursing home, and patients were simply wheeled from one location to another. The length of the corridor would be approximately equal to the length of two ambulances. I’m not even kidding. It’s that close.  In the absence of a corridor, a lot of ambulance calls could be avoided if the attending physician took five minutes out of his day and simply walked over to the nursing home to see whether a patient actually needs to be admitted, or whether the nursing staff at the home is trying to send them for no reason other than “acute evaluation syndrome” (patient must be seen now for no good reason at all).

Tw0 – because the local nursing home seems to be staffed entirely by future rocket scientists, which I mean in the nicest way possible. These are the most incompetent people I have ever met in a group, save for our elected representatives in Washington, DC. Whenever we receive a call to the nursing home, it is an absolute given that none of the nurses attempting to tell us what happened were actually there when it happened. They’ve always “just gotten there” and “have no idea” why the patient is unresponsive or bleeding.

Often, calls to the nursing home are for patients who have been in pain or unresponsive for hours and received no interventions. Sometimes we get calls for patients who are obviously deceased and have assumed room temperature by the time we arrive. But if we come and take them, there’s less paperwork for the nursing home to do. Once, we received a call for a diabetic patient who had been unresponsive “since lunch” (three hours ago) and was found to have very low blood sugar. Nursing home staff had then attempted to help the patient by administering oral glucose – for those who don’t speak “medical”, that’s glucose paste inserted in the mouth. One of the first things EMTs learn is that nothing, ever, goes into the mouth of an unresponsive patient – except an airway. Certainly not oral glucose. But those are the things we deal with at the nursing home.

Besides nursing home calls, we do a lot of local “trauma” calls to the homes of elderly patients who have fallen or who are suffering from breathing trouble, chest pain, or abdominal pain. Those are our most common “elderly” calls. Sometimes, we’re called mainly because the person wants someone to stop in and talk to them for a while.

Once, we went to a call three roads from our station – KB (a paramedic), GS (a fellow Basic), and myself – to the home of an elderly lady who had supposedly slipped and fallen. She was laying on the kitchen floor when we arrived and had no complaints of any pain, having hit anything, or having felt dizzy at all. She’d simply slipped and not hit anything on the way down, she just couldn’t get back up.

After our assessment, GB stood her up and helped her into her chair. He started asking her if she wanted to go to the hospital and she said she’d rather stay home and maybe lay down in her bed. Then she looked at me and said, “Can you straighten my bed up for me?” This was an unusual request but, sure, why not … we’re here to help. While I straightened up her bed as nicely as I could and hoped it would meet her standards, she turned to KB, the paramedic, and said, “Is she making my bed? Does it look nice? Is she doing it right?”

A very large percentage of what we do, and where we make much of our money from insurance companies, is transporting patients from our local hospitals to larger facilities in Syracuse and Utica (and, occasionally, Burlington, VT) where patients have access to specialty resources or further diagnostic resources. We’ve got a lot of good stuff up here, but we don’t have a trauma center in our immediate area. We also don’t have cardiac surgeons. For example. Which means that many of our patients are looking at a long, bumpy ride in an ambulance – or, if they’re bad enough, a short ride in a helicopter once the helicopter makes that 30 minute flight to get to us to pick them up.

Transports are not a bad thing – well, for the patient, they are uncomfortable, but they’ll eventually get them to the resources they need. For us, they can be long and tedious. Sometimes they can be quite entertaining. Sometimes they’re just plain nerve-grating. A lot of that depends on the patient. And some of it depends on traffic. But, overall, it’s generally an easy way to get paid and as long as I get paid $50 per transport (before taxes), I’m not complaining about the tediousness of doing basic vital signs on a perfectly stable patient who’d rather sleep the whole way down.

And then we’ve got the small percentage of “interesting calls” – trauma calls such as car accidents, domestic disputes, and all that sort of good and interesting stuff that keeps the days from being same old, same old.

My very first car accident was one I went to while I was still doing ride time with KC, one of our paramedics. As a result, I got to do very little but it was a good introduction to my first ever trauma call. Our patient was a middle-aged diabetic who remembers blacking out and then remembers coming to just to find that her car had gone off the road and was seconds from colliding with a tree trunk that had recently been chopped down and was laying crosswise in the yard. A baffled homeowner, in the middle of chopping down some of the trees along the roadside, had stood on his porch, wondering what in the heck had happened and watching the scene unfold.

The entire roadside was lit up by flashing red, white, blue, and amber lights as several fire trucks, police cars, and our ambulance were on scene. When we arrived, a bystander was in the rear seat of the vehicle holding her neck, a first responder had taken a set of vital signs for us, and firefighters were cutting the patient free of the vehicle. All that was left for us to do was applying a c-collar, extracting her using our KED (which was cool, because we’d literally just done this in class the previous lesson), and getting her to the hospital.

The patient was not seriously injured – she’d broken her ankle but was otherwise intact – and kept apologizing profusely for “being so stupid” to run her car off the road and “making us all come out there for her.” But she was in a fair bit of pain and we wound up linking up with a paramedic from a different squad who hopped in the ambulance to administer medications to her after meeting us by the roadside in his fly car.

I don’t know what happened then, because as I was the only one not doing anything of use after helping to splint the ankle, I was chosen to drive the other squad’s fly car to the hospital, following the ambulance. So here I was, an EMT student, driving the Chevy Blazer fly car, lights and sirens blazing, behind the ambulance all the way into town. It was pretty cool. Until I parked the vehicle and realized I had absolutely no idea in the world how to turn off any of the lights with dozens of switches staring back at me from various locations.

That same day, we also met a helicopter at the landing zone and took the crew to the local hospital to pick up their patient, another car accident victim who was going to the nearest trauma center. When we arrived at the hospital with the flight crew, Dr. J, one of our emergency room doctors, was inserting a chest tube into the patient and asked us to come in and watch. Dr. J is all about teaching and always likes having his medics come in and observe emergency room procedures.

We’re extremely blessed to have Dr. J because he is a fantastic doctor with many years of experience in both civilian and military medicine. Dr. J was a responder in New York City on 9/11. He was an emergency room doctor in San Antonio, TX. He is a fellow at the Academy of Emergency Medicine. We could not ask for a better mentor, teacher, and doctor to work with. (Nor could we ask for better Medical Control to call up when we need something!)

Aside from vehicle accidents on our local roads, we get a fair number of our more interesting calls from nearby Fort Drum, which is one of our “mutual aid” locations. If Fort Drum sees a large accident – like a HMMWV rolling over in a training area or two trucks full of troops rear-ending one another, chances are that we’ll be out there for the call and transporting patients.

It has been my misfortune to always be as far as possible from the location of the call when the most interesting calls come in. Trauma call that requires a helicopter to be called? I’ll be in Watertown, getting my shopping done when that happens. Hunting accident that ends in a fatality? I’ll be just pulling off base after getting my shopping done at the commissary. It’s really quite frustrating because calls never seem to happen when I’m at the squad or at least within a reasonable distance to respond. (Though it never fails that we’ll get a call while we’ve got training classes scheduled … our MCI class, for example, was interrupted by an MCI.)

Well … here’s to interesting calls in the future.

Happy Halloween

I’m a bad, bad cat mom.

I made Finn dress up for Halloween. He’s being “fat Puss-in-Boots” from “Shrek Forever After.” What can I say … it was an easy choice and an even easier costume, and the similarities are uncanny. *snerk*

EFMB Fail

The Army has enough “what in the heck?” moments on an ongoing basis that there’s a whole website dedicated to them, aptly named “Army WTF Moments“. There’s also an accompanying Facebook page and Twitter account. Let’s just say that between the things I’ve personally observed and the things I’ve gotten second-hand via those sites and the stories of friends, there’s very little that surprises me any more when it comes to soldiers doing dumb stuff. And then along comes a story like this one, reported by the Reuters -

Forty-three soldiers at Fort Bragg, North Carolina were evaluated for heat-related illness on Friday after taking part in a 12-mile march, a base spokeswoman said. Thirteen of the soldiers were admitted to Womack Army Medical Center, including one who was admitted to the intensive care unit, said Fort Bragg spokeswoman Jackie Thomas.

(…)

The injured soldiers were among 56 service members vying to earn an Expert Field Medical Badge, a competition that began September 18 and includes a grueling series of hands-on tests. The march represented the culmination of the competition. The temperature at the time of the test this morning was about 72 degrees Fahrenheit but officials said the soldiers were carrying heavy packs.

Let me first point out the obvious math – when 43 out of 56 soldiers have to be treated for heat-related injuries, that means just about 77% of soldiers became heat casualties. That’s an awfully big casualty statistic. There were probably instances in World War I where units took fewer casualties, percent-wise, walking into German machine gun fire. Of those 43 soldiers, 13 were admitted to the hospital – that’s 23%. Almost a quarter of all soldiers on this road march.

The thing that really, really bothers me about this are not the ridiculously high numbers of heat casualties, but the fact that these soldiers were setting out to complete earning their Expert Field Medical Badges. Testing for the EFMB is limited only to US Army medical personnel. Let me repeat this – medical personnel. MEDICAL. Let me spell it out … M E D I C A L. You know, those people who are trained to recognize and treat illness and injury in soldiers. Like, oh, say, heat exhaustion, for example. Or heat cramps. Or heat stroke.

I don’t think there is any excuse whatsoever for medics competing for their Expert Field Medical Badge to suffer this amount of casualties due to heat exhaustion, or heat stroke, or any other heat-related issue. They should probably recognize the symptoms as they come across them … if not in themselves, then in the guy next to them, and take appropriate action.

As far as I’m concerned, I think the entire class should fail and not be awarded their EFMBs. I don’t care how well they took on their tests. I don’t care how well they did at any other portions of the test. I do care that these medics fell out like flies. This indicates to me that they either don’t recognize the symptoms of heat-related illness in others, or don’t give a rat’s ass, or don’t have any common sense.

Look, I get it … the EFMB is tough to earn and everyone wants to earn it. Especially under the current climate where we’re facing cuts of thousands from the Army, either because it’s become more difficult to get promoted before hitting your retention control point, or because they’re plain looking for reasons to kick people out, whether it’s via quality review boards or chapters, so every accomplishment helps. But I wouldn’t want a medic next to me who’d let his fellow medics fall out left and right to earn a badge.

 

EMT Playlist

Because I’m a big fan of lists, I made myself an EMT playlist that contains vaguely medical-related songs. It’s alphabetical, even … through the power of Excel.  If anyone has any suggestions that might fit into this list, please feel free to suggest away.

Bad Religion – Anesthesia
Bad Religion – Sanity
Beatles – Help
Ben Folds Five – Hospital Song
Buckcherry – Rescue Me
Donots – Good-bye Routine
Donots – Room with a View
Evanescence – Bring me to Life
Flogging Molly – The Worst Day Since Yesterday
Foreigner – Urgent
Fray – How to save a Life
Green Day – Restless Heart Syndrome
Gregory Isaacs – Night Nurse
Johnny Cash – The Man Comes Around
Kill Hannah – Lips like Morphine
Kill Hannah – Mouth to Mouth
Massive Attack – Teardrop
Matchbox 20 – Disease
MEST – Cursed
MEST – Take me Away
Ohrbooten – Keine Panik
Paramore – Emergency
Pink Floyd – Goodbye Cruel World
Pink Floyd – Keep Talking
Placebo – Haemoglobin
Placebo – Special K
Prodigy – Take me to the Hospital
Rolling Stones – Ventilator Blues
Scissors Sisters – Comfortably Numb
Sequoya Rain – The Angel
Shock Stars – EMT
SixxA.M. – Life is Beautiful
These Green Eyes – Paramedic
Three Days Grace – Pain
Thrice – The Artist in the Ambulance
Van Morrison – T.B. Sheets
Voivod – Ravenous Medicine
White Stripes – St. James Infirmary Blues

Health and Welfare

Have you ever had one of those moments where you thought to yourself, “Self, I need to blog about this right now because it’s incredibly important and relevant, and I need to rant about it, but if I don’t do it right now I probably won’t remember it later!” You have? Me, too. That’s why I’m here, blogging now … except that, in the time it took me to open the WordPress “Add New Post” page, I forgot what I was going to blog about. So, I’ll give you a completely random entry instead.

While sitting in line at McDonald’s drive through this afternoon to pick up lunch for the hubby and I, I noticed something peculiar on the drive-through menu. There’s a little corner on the bottom right where all their salads are listed. (The bottom right corner is an apt place for said menu since most people who do eat food from McDonald’s certainly are not there for any salad.) The font for all of the menu items is white … except for the Asian salad. The Asian salad font is yellow. And while probably unintentional, you do have to wonder just a little bit if that isn’t racist toward Asians.

The reason I was at McDonald’s is because I had been just down the road from McDonald’s at my doctor’s office. Since we moved from Gouverneur to Carthage, I’ve had to change my TRICARE Prime primary care manager. Which is a good thing, believe me, because I’d been considering changing primary care managers anyway.

My previous PCM, Dr. H, was not exactly high up on the list of favorite people on the face of the planet. I don’t know whether that was largely due to the language barrier – Dr. H being of Middle Eastern origin and perhaps not quite as good at speaking English as a doctor practicing in the United States with English-speaking patients ought to be – or whether his manner just rubbed me the wrong way. I consistently got the impression that he was talking down to me and did not really care to address any concerns I may have. That, and the fact that he was forever going on about my weight. His initial “diagnosis” was one of obesity … considering I’m 5’6″ and was less than 200lbs, well…

At any rate, I am glad to have a new doctor now and I am really liking the new practice. It’s a much bigger practice and it offers a lot more services right there than my previous doctor’s office did. At the previous office, I had to go to the hospital on the other side of the parking lot to give blood or urine samples. At this one, they do it right there. The last one would give me a written prescription and send me on my way. This one faxes it to my pharmacy. And the staff at this one are very nice. As is the doctor. Actually, this doctor told me that as long as I exercise regularly and try to eat healthy, I shouldn’t obsess about the number on the scale.

Anyway, I’d gone to an initial visit at my new PCM’s office about a month ago, at which point they took some blood and some urine to see where I was at, health-wise, and where I was at with the thyroid medication my previous doctor started me on. (My thyroid had been under-active – hypothyroid, in medical terminology – which may have been one of the reasons why I wasn’t losing any weight no matter what I did.) And this visit was a check-up to see how I was doing. I’m happy to report that all of my systems are running normally. I’m producing happy blood, apparently, with happy blood cells of the right size and consistency. My kidneys are functioning happily, as is my liver. My blood sugars are normal, as is my thyroid (with the medication). I am, in other words, perfectly healthy. Which makes me a happy camper.

I have noticed that my blood pressure has done an interesting thing since I started working out more … whereas it was normally around 120 to 130 over 80 to 90 (that is, between 120/80 and 130/90), it has been down to 116/68 recently. I don’t know if that’s partially due to the fact that I’m much more relaxed at this doctor’s office versus the old one, where I was stressed out the second I walked through the door, or whether it’s actually related to exercising more, but I am definitely making an effort to exercise more.

Matter of fact, I just earned my second green stripe on my yellow belt in traditional Chung Do Kwan style Tae Kwon Do. On Tuesday, to be exact. It wasn’t a hard test, either – demonstrate the forms for yellow belt, intermediate yellow belt, and advanced yellow belt; demonstrate my 7 step-sparring techniques and 9 self-defense techniques. And break a board with a front kick. I’d never thought of my front kick as being a particularly powerful kick because it (still) feels awkward to be striking straight out with the ball of the foot, but I guess it’s a solid enough kick to break with. First try, too. Yeah, that felt pretty good.

I also recently started taking American Kang Duk Won Karate, which is an American form of an amalgamation of Japanese martial arts and Korean Tae Kwon Do, for lack of a better description. It’s an odd beast, at any rate. Many of the techniques are the same, in principle, as the techniques we use in Chung Do Kwan style Tae Kwon Do, although it seems that Kang Duk Won is a whole lot less formal. There’s less of an emphasis on perfect stances and big chambers and more of an emphasis on speed and power. Which is fine … but if I had to compare coming from Chung Do Kwan to Kang Duk Won and starting out in Kang Duk Won with no previous instruction or experience, I would probably not have the technique (or the speed, or the power) that I do have now.

The biggest thing that kills me about American Kang Duk Won is the fact that they do not do Poomse forms, as we do in traditional Tae Kwon Do, but Palgay forms. Where the rest of the techniques and even the self-defense does not vary much between the two separate disciplines, the forms are a killer. However, because I do know all the techniques and the self-defense techniques, once I’ve learned the first Palgay form, I’ll be able to test for my yellow belt at Kang Duk Won.

Besides forms, there are differences between the two schools as well. It’s the difference between learning from Mister Miyagi and training at the Cobra Kai, to use a pop-culture reference. Both teach martial arts. The Mister Miyagi technique of teaching, so to speak, focuses on good citizenship, avoiding fights, and perfecting technique so one would be able to fight if needed but not looking for a fight. The Cobra Kai technique of teaching focuses on bringing people in the door, teaching technique, and increasing speed and power in technique.

Being that I have been doing Tae Kwon Do and am new to Kang Duk Won, I find myself comparing the two, especially where my brain tells me that things could be improved or should be different, based on my previous experience. One thing that bugs me in particular is the lack of a student creed or bowing to the flag in Kang Duk Won. My Tae Kwon Do class starts every lesson by bowing to the American flag, then to the instructor, then reciting our student creed, which goes as follows -

 

1. I will develop myself in a positive manner and avoid anything that would reduce my mental growth or my physical health.
2. I will develop self-discipline in order to bring out the best in myself and others.
3. I will use what I learn in class constructively and defensively to help myself and my fellow man, and never to be abusive or offensive.

 

I think that, especially in the children’s class, this sets a good foundation regarding what martial arts is all about. It’s about learning something for the purpose of defense but doing it in a way that is focused on doing good for other people. It also means teaching each other and being a good citizen. Which is what a martial arts class should be – especially a kids’ class. It isn’t about kicking and punching, nor should it be. (Although that’s the fun part.) The absence of this in Kang Duk Won bothers me. Not that it isn’t there – there’s a bit about it in the manual and the instructors talk about it in class, but it’s not a formal part of classes in the same way.

Overall, I find that Kang Duk Won at the particular dojang I go to lacks structure and discipline, especially for the younger students in the class. Whereas my Tae Kwon Do class will not accept children under a certain age and will ask parents not to bring their children back if they are clearly too young to focus and participate properly, my Kang Duk Won class does not seem to have any such restrictions. I see a lot of fidgeting and looking around from younger kids at Kang Duk Won that would never be tolerated at Tae Kwon Do. I’ve even seen kids walk out of the formation if they got bored, or just sit back and watch the class instead of participating. I understand that the instructors don’t want to lose kids from the class, but I think they need to set limits and enforce discipline somewhere. When you’ve got kids that have yellow belts (or higher) and they’re talking in the class or goofing off, it just looks bad.

Because my Tae Kwon Do class is a lot smaller than the Kang Duk Won class, it tends to progress in a different way. Tae Kwon Do, where I take it, is about perfecting technique. Getting everything down to the millimeter, ending forms in the same place you began them, doing forms under a specific amount of time yet with a good amount of power. We do a lot of work correcting foot-position or hand position in our basic moves. Kang Duk Won … not so much. I see purple belts in class who don’t know to keep their knees tucked in when doing a back kick, which takes away a fair amount of their speed and power. And I see instructors not correcting them (or not noticing).

My Kang Duk Won class is more of a workout than my Tae Kwon Do class because we do a lot of repetitions of all the moves … like 100 Karate pushups at the start of the class, which are an awkward combination of stretching the inside of your thighs and your lower back and a pushup. They’re more stretch than pushup, at any rate. And we do a lot of repetitions on our forms … most dreadedly (by me, anyway) the center punches from a horse stance. Anyone who’s ever spent 20 minutes in a horse stance will understand why that’s one heck of a workout. (Oy, my thighs.)

I guess I will eventually need to make a decision as to whether I will continue with one or the other. Cost is about the same. The biggest difference is the distance – 3 minutes’ versus 45 minutes’ drive. Which becomes especially relevant once it starts snowing in the near future. In the meantime, I’m doing both.

Toe Shoes

The Army, in all its glorious wisdom, has decided to ban “toe shoes” from PT. Because, to our Army, it’s more important that we all present a soldierly appearance than it is that we could be preventing injuries and increasing performance.

But let me step back for a minute.

Both Brian and I own two pairs of Vibram Five Fingers, which is the actual manufacturer’s name for these shoes commonly known as “toe shoes”. My two pairs are a set of black Classics, which are the original style that Vibram came out with when they debuted these “barefoot” shoes, and a set of white Jayas. Brian has a pair of the “camouflage” KSOs, and a pair of blue Bikilas.

Both Brian and I bought our first pairs while he was home on leave from Afghanistan last fall, and he subsequently took his back to Afghanistan with him where he used them to work out at the gym, run on the treadmill, and walk around the base. His second pair, the Bikilas, are specifically for running, although both pairs of his, just like both pairs of mine, can be worn anywhere other running shoes or sneakers can be worn – hiking, working out, shopping, you name it. Basically anywhere you might wear shoes.

So what, you might ask, makes these any better or worse than any other sneakers? Simple – body mechanics.

As someone who has grown up walking barefoot for much of her childhood, both inside and out, I learned to use my feet in the way which nature intended. I use my arches for arch support because that’s what they’re designed for. I use my toes for pushing off, because that’s what they’re designed for. And when I run, I ball-strike, instead of heel-striking. The latter is particularly effective at reducing injury and strain to the ankles, knees, hips, and spine because your muscles act as shock absorbers, whereas heel-striking causes the force to be absorbed by the joints and bones instead of the muscles.

There are plenty of medical studies – Zipfel and Berger’s “Shod vs. Unshod” is a good one to get started with – that support the notion that going barefoot and allowing feet to do the things they were meant to do is healthy for people and that going barefoot more often can alleviate painful foot and joint conditions, improve balance and agility, and even increase performance in runners.

This is where Five Fingers come in – they’re basically a covering for your bare feet that allows your feet to still do what they’re meant to do naturally, but provide protection from sharp rocks, broken glass, or any of those other fun things one comes across on the ground going barefoot these days. (Well, not just these days … ask me about the scar on my foot from stepping through a broken glass bottle at the playground …)

You would think that the Army would not have a problem with shoes that not only increase the runner’s performance, but help prevent injuries as well – not to mention give our much-beleagured feet a chance to rest and heel. As Brian puts it, “I’ve spent the better part of the last 25 years wearing combat boots … and these shoes have made all the difference in building up muscles I didn’t realize I still had and alleviating knee and back pain.” There’s just one problem – the Army figures the Five Fingers “don’t present a professional appearance.”

I would understand, to some extent, if the Army said that there are serious concerns regarding injuries with these shoes – after all, someone who didn’t grow up going barefoot a lot would need to re-train their feet and their body to use these muscles and run properly (striking with the ball of the foot, not the heel). If you’ve never been shown how to properly run barefoot, you increase your chances of injury. And, of course, you’ll find yourself being quite sore at first.

But the Army didn’t really worry about Soldiers getting injured in these shoes – they worried about how they look. If injuries were a concern, all minimalist running shoes, such as Merrell’s Trail Glove, would be banned along with Vibram’s Five Fingers because they, too, have no cushioning and require different body mechanics to wear and run in. Instead, the Army is concerned with looking bad when in formation … because, you know, droves of civilians and reporters line the streets when Soldiers do PT in formation at 5am, worrying how professional our Army looks (or doesn’t look).

And you know, if the Army is really worried so much about looking professional during PT, let’s talk about that for a second.

This is the same Army who’s given us the “enhanced” Physical Fitness uniform, the only “enhancement” of which was the addition of reflective lettering and modern materials … certainly there were no enhancements made to the fit. The average female has to buy PT shorts three times larger than what she normally wears, since they’re “unisex” in design and most women happen to be shaped differently than men … Of course, in PT shorts, we all look like we’ve got a package down there, thanks to the incredibly unflattering cut and style of the uniform.

And let’s talk about some of the fatbodies out there at PT… If your stomach hangs out over your waist belt in ACUs, you’ll never present a soldierly appearance in your PT uniform, regardless of the kinds of shoes you wear. You’re going to look like a fatass squeezed into a sausage skin, topped by a reflective belt.

And, lastly, let’s talk about the soldierly appearance presented by the Army’s pet physical activity – combatives. There is nothing soldierly about the appearance of Soldiers practicing combatives – they wear their ACU bottoms, T-shirts, and tops. No shoes – just socks, with the ACU pant draw strings hanging somewhere around the ankle. No belt. And the ACU tops are worn inside out, so nobody gets hurt by getting scratched with a zipper or snagged on a pocket. In this “soldierly” outfit, they then wrestle around on the floor – and that’s supposed to be training them for hand-to-hand combat. Yeah … not so much.

If the Army is worried with looks, they need to start somewhere other than the shape of footwear. For example, they could figure out a way to design PT uniforms that actually fit and breathe. Taking a look at items currently available from Under Armour or Reebok at the local sporting goods store would probably be a good place to start. Or they could set standards in regards to the color of footwear – so we won’t have people with lime green running shoes detract from the rest of the formation. Or maybe we can come up with an actual martial arts outfit for combatives so we don’t look like a bunch of morons wrestling around the ground? Just saying …

Army Wives

No, I’m not talking about the TV show. I’m talking about the real thing. Heaven knows the two have absolutely nothing in common. For one, I’ve not met very many Army wives who look like those gals on that show. Nor do any of the homes on that show really resemble military housing or the kind of crap you’d have to put up with in actual military housing … like the grass gestapo and those neighbors who are under the impression that walking around your apartment requires them to call the military police to file a noise complaint.

No, I’m talking about the real thing. The actual Army wives. Though ranting is probably the better word for what I’m about to do, because I am sick of Army wives. Not all Army wives. Just that kind of Army wife. The kind I’m going to rant about.

In our first category, there are the Army wives who are under the impression that they and their husband are actually the very same person. The ones who, if asked what branch their husband is in, answer with, “We serve in the Infantry.” Really? We serve in the Infantry? Do we both get up at 0500 to make it in to PT in the morning, or does one person in this we actually sleep in and spend the day doing housework while the other person in this we is the one who has to get up for PT, and goes in the field for two weeks, and deploys overseas?

Reality check – Unless you are or have been a Soldier, you don’t serve. Period. Yes, Army wives stand behind their husbands and support them. They spend many weeks and months being lonely while their husbands are away, and they have to pick the slack up at home when it’s a single-parent home while the other person is deployed. But that does not mean that you are serving in the military and it does not mean you are wearing your husband’s rank. It’s a completely different kind of serving.

Speaking of serving, I have a hard time buying into the “there’s something special about me because I am married to someone in the military” bit.

Let’s face it – when you’re home alone while your husband is deployed, you are doing something that hundreds of thousands of single women do every damn day – taking care of the home and the kids, and in many (but not all) cases going to work and/or school. And you don’t even have to do it on a single income – you have that housing money that comes with your husband’s paycheck. And the medical care. Heck, even lots of other services that most people don’t have at their disposal.

So some may say, “But the average single woman doesn’t face having her husband killed or maimed in combat.” And you know what I say? Statistically, the chances of your husband getting killed or maimed on his drive to work is greater than the statistical chances of your husband getting killed or maimed in Afghanistan or Iraq. And that’s a fact. More people die on America’s roads in a month than have died in the Global War on Terror since it began. That’s a fact, too. As a matter of fact, more people are hit by ambulances in the United States in a month than have died in the War on Terror.

And, you know what, those women whose husbands are Police Officers and Firefighters should have more of a worry that their loved ones will be killed (or injured) at work than women whose husbands are deployed overseas. And they don’t get that extra family separation pay and combat pay or tax-free paycheck, either. And they’re out there everyday risking their lives.

The real problem, and the real reason there’s so much “woe is me” about deployments from military spouses is that they are not prepared for deployment because they never get themselves ready for deployment.

If you and your husband usually share the chores, having all that additional work seems to be a huge thing because there’s now a lack of support from your loved one and it’s now all on your shoulders. Even worse if, as in many military homes, the husband “handles” things on an everyday basis – paying bills, keeping up with bank accounts, doing car maintenance, and all that sort of thing. When the husband is then gone and the wife has no damn clue about what needs to be done (or how), that’s when issues arise – both for the wife who is overwhelmed and clueless, and for the Soldier who can’t help her with it while he’s deployed, and, in many cases, financially when payments aren’t being made.

But that’s not the Army’s fault and that’s not an issue limited to military life – this one’s on you. If you and your husband can’t communicate enough to ensure that each of you can handle (and knows how to handle) the everyday duties that come with grown-up life, such as paying the bills (and knowing what they are and when they’re due), you’re failing as a married couple. Simple as that. It’s nice to have the other person to take up some of those things that need to get done, but you both need to know how to do them in case the other person can’t – and that holds true whether the husband is deployed or whether one of you gets sick or needs to go away for a couple of weeks for school / training / conference / whatever.

And let me be pretty clear – nobody owes you any damn thing just because you’re married to someone who is serving their country. Your husband did a great thing when he decided that this is what he wants to do for his country, and he knows and understands the risks that come with every re-enlistment. He chose to do this. You chose to marry him. You are already getting a boatload of benefits and you have a boatload of services at your disposal that can help you, from Army Emergency Relief to financial counseling to well-equipped gyms and pools that are free for your use, to many programs for your kids, to help with getting an education right on base. Just to name a few. And military discounts on tons of stuff. All because your husband is serving. You don’t even have to do anything to get all these things, except be married.

So please don’t tell me that people “owe you” because you’re an Army wife and life is haaaard. Life is hard for everyone. In many different ways. And you’ve got more resources at your disposal (if you cared to find out what they are) than anyone else I can think of. Certainly, the spouses of police officers and firefighters get nowhere near this much … but their husbands are much more likely than yours to get injured or killed.

And don’t get me started on the women who are under the impression that being an Army wife is a lifestyle. It’s not a dress code. You don’t have to run around post wearing your husband’s fleece jacket (my favorite – the ones who leave all the name tags on), and an Army Wife T-shirt, and one of those stupid camouflage purses. You don’t need to cover your car in Army wife stickers – “Half my Heart is in Afghanistan”, “I love my Soldier”, etc. Really, you don’t. It’s just tacky.

And yes, I am an Army wife. However, I am not defined by the fact that I am married to a Soldier. And that’s the difference between those Army wives and the kind of Army wives I like to be around.

</rant>

Oh, and you know what? Sitting around bitching about how hard things are while your husband is deployed is not supporting your husband. Ensuring he gets a care package every week is. And making sure you don’t whine, whine, whine about your hardships every time he gets a chance to call, that’s support. Trust me, your “hardships” are nothing compared to his. And he doesn’t want to hear about how you didn’t know where to take the car for an oil change. He just wants to say hi and hear your voice. Your nice voice. Not your whining voice. Incidentally, the consistent onslaught of things on the homefront that he can not help with while he’s deployed are the number one contributing factor to stress and breakdown in deployed Soldiers.