Two pair of boots.

Although at present I am a desk-riding, coffee swilling, paper-pushing, lamentable Pogue, I haven't always been. I have had the fortune of experiencing two very different worlds. I am a Medic, and I am also a Paramedic. When I say "Medic", I mean: ["Doc", Corpsman, Combat Medic, Healthcare Specialist, Medical NCO], that is to say, Military trained, combat tested. When I say "Paramedic" I mean the obvious. I am both. This is not to say this is rare, but it is certainly not the norm. The majority of my EMS counterparts have not seen the types of things I've seen as a Medic. On the other hand, not many of my Medic colleagues have the training, or the experience, or the background of dealing with the things we see and treat as an Advanced Life Support Provider on the streets.

The two worlds are very different, and not necessarily complementary. As a matter-of-fact, none of my jobs, though related, are necessarily complementary, but that's not the point right now...

My counterparts in both careers frequently discuss the advantages of being dually trained. For Me, it works. I enjoy both, I try to excel at both, I get a little taste of everything. However, I don't necessarily believe that being dually trained will make you better at either job.

Combat Medicine is, imagine this, predominately Trauma. Penetrating. Burn. Blast. Primary, Secondary, Tertiary impacts. Barotrauma. Life. Limb. Eyesight. Every incident is approached with Triage, and mass-casualty potential. GSW to the thigh? Hold pressure, self-aid/buddy-aid, return fire, I'll get there when I can. Scene safety is a little different in these parts. Quit whining, put rounds downrange. Suppressive fire for your buddies, gimpy. If you let them down, I have more patients.

Medical problems exist, but they are not the bulk of the load. Heat Exhaustion, Behavioral Emergencies, the occasional First Sergeant with Chest Pain. These are exceptions to the rule.

Street Medicine, as you all know, is Medical ailments, with the occasional trauma mixed in. ABD Pain, Asthma, COPD, CHF, CP, Diabetes, DOE, DK, FDGB, GIB, HA, LOL, N/V/D, SOB, Syncope, TMB, SI, NAD, WTF. Trauma is generally a small slice of the pie. And what trauma we do get for the most part is MVCs, assaults, Falls, various blunt trauma, and the occasional penetrating trauma.

Trench Medicine resides somewhere between where [PHTLS, ITLS, BTLS] left off, and ATLS begins. The Medic is trusted to do whatever it takes, in the absence of orders. Your assignment is to save lives. If you don't have a PA, or a MD, or a Senior Medic, you're It.

Street Medicine = ACLS + PALS + DOT + PEPP + AMLS + Protocols + OEMS x 'Handcuffs'. Patient needs a surgical crich? No way. Bougie? Not in your Protocols. This post is not about protocols though. They have their place, and they have their reasons. Besides, Rogue Medic does a better job talking about them.

To me, the differences between these two Worlds is abundantly obvious, crystal clear. Yet it seems to some folks, the difference between Urban and Rural medicine is more apparent than the difference between Military Medicine and Street Medicine.

Civilians, for the most part, don't suffer from shrapnel wounds. Their MVC wasn't caused by an explosive-formed projectile from an improvised explosive device.

Soldiers, for the most part, shouldn't have underlying cardiac conditions. They are not diabetic. They've never even heard of Fibromyalgia. They are otherwise healthy-ish, and between 17 and 40 (for the most part...)

Civilian ailments require thought. Differential diagnoses. (Sorry...clinical impression...) Their illnesses and plights run the gamut. Soldier's life threats are typically pretty obvious.

Trauma vs. Medical. Action-Thought vs. Thought-Action.

Discuss?

Sweaty, Inconsiderate, Offensive, Effeminate

...or "Things that Bother Me at the Gym".

Of late I've gotten off my lazy ass, and begun somewhat of a fitness regimen. Now, I use "lazy ass" somewhat relatively. I wouldn't categorize myself (past or present) as your stereotypical EMS Provider. I'm sure my readership (all 2 of you) will agree, that [Providers/Professionals/Employees/Workers] of Emergency Services [Public Safety] , in general aren't always in tip-top, peak, physical condition.

Conversely, I am not a Gym Rat. I don't work at the gym, I don't spend half my life at the gym, I don't receive my cable bill at the gym. Everything in moderation. Some of those freaks need a social life, or a hobby that doesn't involve rosin, full-length mirrors, and Bosu balance balls. But I digress. The following is a list of things that irk me at places of fitness, in no particular order.

Mandex. Pretty much self-explanatory. Chances are, if it was ridiculed 5, 10, 15, even 20 years ago, it's probably still a No-Go. Don't get it twisted, just because UnderArmour and similar product lines are all the rage, doesn't mean your lower half needs to be wrapped in painted on synthetics. Unless you're in contention for the Tour de France, involved in some sort of aquatics, or are an up-and-coming Luchador, leave the Lycra to the Ice Capades. Even if you participate in an activity where form-fitting clothing is appropriate (i.e. Triathlon, Greco-Roman Wrestling), it still does not belong in a gym. Sorry Mr. Unitard, but if you can buy your gym clothes at the same store that sells a man-sized Mr. Incredible costume, there's been some sort of disconnect. Hell, even Richard Simmons had enough common sense to wear man-panties to cover up the unsightly protuberance of his grapes.

For a moment, let's remain on the subject of the jewels. It's warm in the gym, you're going to get hot, and perspire. Your Boys are probably going to descend a bit lower than normal in an effort to keep your swimmers at the appropriate temperature. Please keep that in mind when making your apparel selection ante-workout, or when pondering whether "today is a good day to go Commando". I believe I speak for everyone when I state we'd rather not see your knackers pasted to your left leg in the middle of a workout. Find out where Spandex Guy bought his mantyhose and wear some support under your daisy dukes. Thank you muchly.


In MY society, where we shower regularly, cologne and perfume are purchased with two people in mind. The person who is wearing it, and the person They are trying to impress. Maybe some folks are trying to impress people at the gym, or trying to pick someone up, but the over-powering cologne is nauseating. In any setting it's inappropriate, but a gym should smell like sweat, disinfectant, rubber, and metal. Hey, Davidoff, it's a place of fitness, not the goddamn center aisle at JC Penney. Your eau de toilette is awful, tactless, and inconsiderate. And as far as the hottie on the elliptical is concerned, you'd be better off with chloroform. P.S., Let me know how that hair gel works out IF you manage to break a sweat.


Proceeding in the vein of attempting to impress folks, STOP Posing. STOP Strutting. You might look good. You might not. Yay! There're lots of mirrors. I understand that two large groups of people that frequent gyms are the insecure and the overconfident. EVERYONE wants to see their improvements, and their hardwork paying off. I don't hold that against you. Regardless, striking Mr. Olympia poses in the mirrors, or pacing laps across the gym while strutting like a peacock is obnoxious. Chances are, if people ARE looking at you, they will snicker, and make snide remarks. If that's what you're going for, drive on.

If YOU are the person who's attention has been captured, don't gawk. It's infinitely more sketchy to stare at someone at a Gym than it is at the mall. Seriously, people are half dressed, sweaty, and more vulnerable. You're are the very reason Curves, and other Female-Only gyms have opened.

Everything you need to know, you learned in Kindergarten. If you use something, put it back where you found it. It's not that difficult to place things in their proper place. Why is it that as soon as people enter a Gym they become Anal-expulsive? It seems like every weight rack has an odd number of each measurement, and there are weights randomly strewn about, in places they don't belong. I shouldn't have to go to the Spinning room to find a plate, nor should you have the curl bar in the pilates area. And quit leaving equipment on the floor.

Adam Sandler throw-back, you know, before he started doing romantic comedy. "Having Sex, or lifting weights?" Quit making so much damn noise during your workout. Grunting out the LAST rep in order to avoid moving your bowels is forgivable. After all, I wouldn't want you to soil those sweet control tops. But groaning and grunting on every repetition is not ok. It sounds like a tennis match in a roman bath house.

That's all for now.

A Lack Thereof

EE apparently misses reading my sweet voice, and has queried whether I would ever write again. Yes, I reckon I will. It's been a frustrating few weeks. Between battling the urge to throttle civilians, swearing at my baseball team, and trying to square away finances and paperwork, among other demons, I haven't exactly been in a blogging mood. My cynicism is palpable, but it's not FUN cynicism.

Hopefully, as I wander through other people's blogs, or get out a bit more, something will strike me as subject matter. Until then...

Would you like Blog Fodder with that?

Being from the Northeast, part of my morning routine typically includes a trip under the Pink and Orange sign of Dunkin' Donuts. Trips to any type of fast food, coffee shop, or convenience store will inevitably give you reason for pause. The service gets progressively worse, the [people behind the counter] get more and more "interesting", and for some reason the wait seems to get longer every day.

Whether I visit the drive-thru or the counter, my order is pretty standard, pre-meditated, and delivered clearly, concisely, and in some semblance of the English (perhaps an issue) language.

PC: "G'Morning. A Large [hot, iced] coffee, black, with 2 Equal, please."

Occasionally, I'll throw in a flavor shot. I might even double my order. I do not, however, deviate from the formula. I tell them what cup to grab, what temperature, and what to put in it. I intentionally order in that sequence because that's the sequence in which they will perform the tasks required. I do not speak quickly, and I intentionally annunciate (I remember my previous experiences). Further, I generally visit the SAME shops. Usually more than once a day. Now I'm not saying remember me, but shit, remember past orders that you've screwed up (MINE).

Somehow, I don't think the Franchise owners and Management take into account how important coffee is when they go through the hiring process. Seriously.

Ok, now on to what motivated me to write a post about my morning routine. As I placed my order in the drive-thru the other morning:

PC: "I'll just have a LARGE, ICED coffee, BLACK, with two(2) equal, please."

The tinny, electronic voice comes back with:

DD: "Would you like to try our new flatbread sandwich?"
PC: "Nope. Just the coffee. Thanks."

Now, I've noticed this is common practice just about every place you go. Little buttons that say "If I don't offer you a strawberry-mango smoothie, IT'S FREE". Drive-thru attendants "Want to try a muffin today?" That poor little "Ding-fries-are-done" kid offering "an apple pie with that". I get it, it's what they do.

But has anyone EVER been inspired via drive-thru to try something like that? Much less a "flatbread sandwich" from a coffee shop? Honestly? I've never heard something from that little speaker that just tickles me enough to say "Well, the picture turned my stomach, reading the description nauseated me, but now that you MENTION it, and I hear you asking me if I wish to try it, HELL YEAH, I'll take TWO!"

Poster Children

Are you fucking kidding me? I loaded the JEMS Web Site this morning, and was greeted by an "interesting" photo. Now, I'm not going to get into the finer points of splinting, or the fact that we "stabilize" C-Spine FAR too often. Those topics have been covered ad nauseum.

That being said, how is it that the Journal of Emergency Medical Services feels it is appropriate to use THIS photo for an article on splinting procedures:

Whiskey Tango Foxtrot, over.

Emergency Medical Slobs

You've all seen them. Shirt unbuttoned, t-shirt stretched out with the lapel mic, mustard stains, boots [un-tied, unzipped, un-laced], unshaven, unbathed...the list goes on.

Sometimes you'll see them in line at the Dunkin' Donuts. Sometimes at the ED charge desk. Sometimes sitting on the diamond plate of their [emergency response vehicle], smoking a cigarette. Looking like dogshit.

There is not a valid excuse that any of you creative writers could come up with for these people looking the way they do. I don't give a damn if they're on the back-slope of a 48 hour shift, I don't care if they just worked a code for 48 minutes, I don't care if the ambient temperature is 127 degrees Fahrenheit, and it's even hotter in the back of the [emergency response vehicle].

Don't get me wrong, if you're on scene for a prolonged extrication, I understand if your shirt comes untucked. I won't hold it against you if you're actively doing push-ups on the 350lb, 3 decker carry-down code, and you look a little 'tousled". If it's late one prom night, and you just got painted with the baked ziti and rubber chicken, mixed with a little Mike's Hard Lemonade and bottom shelf tequila, I understand.

But that's not the case.

At 0715 the other morning, I witnessed your stereotypical stretcher-slinging mule. I use derogatory terms to refer to this individual because that's the image they conveyed. Individual weighed in at a modest 300lbs. Shirt untucked, unbuttoned. Pants wrinkled, no belt, and dipping below the waistline. There is no reason to look like this coming out of Dunkin' Donuts at 0715. I know full-well that this particular [emergency vehicle] was going to a local post/detail assignment. Anyone wanna chime in with some possible reasons for looking like that?

I take pride in my appearance. It's how I was brought up. It's my background. It's one of my calling cards. There are times where I look a little disheveled, but only in the middle of a call.

-If you have time to light a cigarette, you have time to tuck your shirt in.
-Unbuttoned shirts DO NOT have a slimming effect, lardass.
-Wear a belt. There is nothing professional about plumber's crack, or a drag-chute.
-Laces and zippers are devices to fasten footwear to your feet, use them. If they're broken, replace them.
-You don't HAVE to shine your boots, but at least attempt to maintain their intended color. Scuffed up boots don't make you "salty", "experienced", or "old school".
-Your shirtfront is not a napkin.
-If you have holes in any part of your uniform, replace that component.
-T-Shirts stretch. Do not hang things from the neck of your t-shirt. No one wants to see your nipples through your neck hole.

Every single EMT or Paramedic has heard co-workers lambast (verbally of course) "newbies", "wackers", and "sparkies" for trying too hard to "look the part". They ridicule Bat-Belts, wacker pouches, and the habit of carrying too much gear. However, never has an over-enthusiastic trainee detracted from our professional image simply because they have 2 sets of trauma shears (...and a flashlight, and a rappeling harness, and a gas-mask...but I digress). It's not often enough that a fellow EMS worker makes a comment, pulls aside, or outright embarasses someone for looking like Roseanne's husband Dan in an EMS uniform.

But you're right. Calling the [emergency response vehicle] by a slang term is what truly detracts from our professional image. After all, REAL bus drivers would never look this sloppy.

David Bowers wrote an article back in '05, just saying.

Colloquialisms

TOTWTYTR doesn't like it when you call your Emergency response vehicle a "bus". In the spirit of sticking with topics presently in my head, I will discuss slang terms. Besides, I like discussions, and none really occur on this four day old blog. Maybe poking the hornets nest will bring me some more company.

Personally, I see no harm in such terms, I like colorful language, and slang. But then again, I come from a mixed Mili-Fire-Medi-etc background, and slang terms, like potty mouth, are a fixture. I do agree that in the wrong arena, or context, slang terms (just like f-bombs) can detract from a professional image, however, in other settings it is harmless.

Obviously, on-scene, using slang can come across as unprofessional. You generally wouldn't refer to a "patient well-known to your facility" as a "frequent flyer" to the patient, their family, or in your entry note, but they are what they are. In the [station, garage, quarters, crew-room, barn, base] you might discuss "LOLFDGBs", "welding", "skells", "tubes", "darting", "sticks", "jakes", and "blue canaries". When, on scene, you really mean "elderly woman s/p fall", "cardioversion", "less-fortunate, unemployed, unbathed citizen", "advanced airway", "needle thoracentesis", "intravenous attempts", "firefighters" and "law enforcement officers". No harm in the appropriate arena. I'm pretty sure none of your co-workers are going to gauge your professionalism based on verbage and dialect, just like they probably won't be offended if you say "fuck-fuckity-fuck-fuck". However, in a patients [house, apartment, car, scene of emergency, domicile] you probably ought to sideline such terms. Same thing with in the ED.

Other terms are harmless, regardless of the setting. Some terms that vary from region to region, job to job, person to person, are not offensive to anyone, but may cause some confusion. Despite the fact that NIMS and ICS are the standard, you'll never take the dialect out of emergency services. You do, however, need to be mindful of it, just as you need to be mindful of slang terms on-scene. I can think of a thousand examples of such dialect within my experience, I won't bore you with a list.

"Hey Tim, go to the [truck, rig, rescue] get the [jump-kit, first-in, aid-bag] the [monitor, defib, lifepak] and the [stretcher, cot, bed]."

Ambulances have MANY different titles. I call the various Units I run on "Ambulance-[Number]" or "A-[number]". "Paramedic-[Number]" or "P-[number]. [Town] Rescue, or Rescue-1. CJH in Brick City refers to his units as "MIC-4", or 2404 or some variation thereof. We all have our labels on the radio. As long as you know what vehicle to get in, and [dispatch, control, fire alarm] knows who is assigned, labels don't make much of a difference.

What you call the vehicle in the inner sanctum doesn't matter. Just don't be a jackass and act unprofessional in front of outsiders.

Personally, I am far more offended by the term used in some regions for a handicapped vehicle with a lift. We call them "chair cars" or "chair vans" in my region. I've heard the term "Handi-Van" utilized. But tell me, WHO THE HELL thinks it's OK to call them "Invalid Coaches". Yeah, this means you New Jersey. That shit ain't right.

Back to ambulances, maybe, growing up around the [industry, profession, lifestyle] I had a skewed perspective, but I always pictured a Wheeled Coach when I sang...

"The wheels on the bus go round and round..."
"The doors on the bus go open and close..."
"The suction on the bus goes swish swish swish..."
"The siren on the bus goes waaaaa-waaa-waaanh..."
"The Psychs on the bus go 'I AM JESUS!"

Oh wait.