Saturday, June 13, 2020

Unify!

My old boss, Lowell Weicker, former US Senator and Governor of Connecticut, when questioned about Congress being corrupt,  used to say that Congress was representative of our democracy.  If there were bad apples in Congress, they were likely the same portion of bad apples in every other profession and in the country as a whole.

I feel badly for most police officers right now.  Most have dedicated themselves to making their communities better.  They put up with amazing amounts of s---t everyday, and most maintain their calm.  I have seen them exercise incredible patience and also show incredible kindness.  But like in every profession there are bad apples who tarnish it for everyone else.  It seems everyday I turn on the TV there is another example of police bad behavior.  Cops killing people, cops pushing down old people.  Cops lying. Cops taking naps while neighborhoods are being looted.  It is hard to not instinctively judge all officers by what is shown.

I remember a number of years ago, there was a news story about an EMT in Springfield, Massachusetts punching a patient .  He was caught on camera,  They showed him leaning over the patient and then winding up and punching him.  I don't know whether the patient said something to him or spit on him, but the EMT punched him and there was no excuse for it.  He got fired.  I remember thinking how bad it made all of us in EMS look.  The guy worked in another division so I didn’t know him and didn’t know if it was aberrant behavior for him or his modis operandi.  I hope it was the former.

I felt the same when an EMT in our state was arrested and admitted sexually molesting an unconscious patient.  Shameful.

No matter what line of work you do, there has to be a way to get the bad apples out, and with particular regard to law enforcement where one individual can hold such great power over another, there need to be ways for good cops to out bad cops without fearing for their own jobs.

I am hopeful that all that is happening in America today will make it easier for people in all walks of life to speak out more easily and without fear of retribution when they witness abuse or racism.

When I took my EMT class in 1989, we had a guest speaker from the local ambulance service who came in all done up in pressed uniform and shiny brass.  He told us what it was like working on Saturday nights in the city with the spicks, the blacks, and the junkies.  We laughed nervously and I wondered what I might be getting into.  When I first started on the streets,  a few of the EMTs I worked with carried night sticks and could be a bit rough with patients.  There was a lot of grabbing people by the shoulder and saying “Come on buddy, let’s go!” if a patient we had been called for was intoxicated or high and didn’t want to go to the hospital.  Back then the fire department didn’t respond with us, and the police only rarely responded. Some EMTs prided themselves on their bullet-proof vests, and their self-defense/take down moves.  I witnessed a paramedic one evening wrestle a combative diabetic to the ground as if he were in the state championship match. I didn’t think it was necessary.  It wasn’t self-defense, it was aggressive machismo.

Over the years, I have noticed that new people in any line of work tend to follow the culture of what they see around them.  Again, many years ago when things were different, one EMT I knew, beat up a drunk and then took pictures of it, and showed them to people in his paramedic class.  He was looking for affirmation,  Instead, he was fired.  Another EMT tried to hold a pillow over a spitting patient’s face in the ED triage line.  He was reported and fired.  Gone, just like that.  We had a chief paramedic at the time who was willing to stand up and hold people to a standard.  In the battle between good and evil, good managed to weed out the bad and the culture changed.  

I remember one night I was outside the Hartford Civic Center when a concert was going on and many of the band’s followers were mobbing the streets.  One kid was tripping on something and fighting everyone.  I was called to assist a BLS crew who was having trouble containing the patient.  I got in the back of the ambulance and was working on calming him down when a crew from another division(up for the standby) burst into our ambulance and one of the crew members tried to wrestle the patient and tie up him in a very safe unsafe position.  I stopped it and kicked the other medic out of the ambulance and told him we didn’t treat patients like that in our city.  He was pissed at me thinking here I was scorning him and he, the hero, had come to help.  That’s not help.  But that was probably how he was taught and it was acceptable, even laudable, in the division where he worked.

I went down to Mississippi in the aftermath of Hurricane Katrina, and one day we got called for a woman out of control.  It was a skinny black woman who they said was on crack.  She was screaming  “It’s a lie!.  It’s a lie!, I didn’t kill myself!” My plan was to sedate her.  The fire department before I could say anything, threw her face down on the stretcher and placed a long board on top of her to hold her down.  It evidently was common practice there.  They couldn’t believe I announced I was going to sedate her and when I got to the ED the doctor there questioned my practice.  In the emergency situation of Katrina out-of-state emergency providers were allowed to operate under our home state protocols, and in Connecticut I was allowed to sedate out of control patients without a doctor’s order, something not done in Mississippi at the time.

The guys, who sandwiched the woman, were not bad people, they were just following what they had been taught and what they had seen done by others.  One of them later said he wished that they could just sedate people like that.  It seemed more humane.

Nowadays when we are called for a shooting, an assault or even an emotionally disturbed patient, we are often told to stage for police.  We don’t go in until the scene is safe.  I frequently come upon officers holding people down.  Most of the time the officers are very professional and respectful.  Sometimes, the officer lets a patient’s comments or movements get him riled up as if it is an affront to his manhood and he responds inappropriately to “show who is boss.”  If he is a junior officer, he is usually warned to calm down.  The problem is when a senior officer is out-of-line, it is difficult for a junior one to speak up.  I try to be a peacemaker. I ask the police to keep holding a fighting person down but not to agitate them and then I sedate them, and then we wait.  It works so much better than tying them to the stretcher and fighting with them all the way to the hospital with a police escort.  

I would like to think that if anyone who works at our ambulance service saw a coworker act out-of-line, they would report it, and it would be investigated fairly with no retribution for the complainant. I would hope that more of us will speak up if or when we see acts of aggression by police officers.

But I still have to go back to what my old boss said about the bad apples.  They are few and they are in all walks.  The police are not evil.  A few of them are, and they are the ones who we need to focus on.  And we need to focus on systemic changes that prevent them from damaging others.  Banning choke holds.  Preventing the officer who chased another down from being the first one to lay their hands on the person.  Very important, as the emotion and adrenaline of the chase can often lead to bad decisions.  Citizen review boards.  Whistleblower protections.  Body cameras.  Increased training.

I worked yesterday and interacted several times with the police.  

Here’s what I saw:

A minor motor vehicle accident.  The driver of one car and the driver and passenger in the other car were shouting and screaming at each other and a crowd of people who had witnessed it were all taking sides and screaming.  In the midst of this chaos, three police officers did their best to find out what happened, if anyone was hurt and to try to keep order.  People were yelling at them, ignoring them.  Screaming and shouting with nobody wearing masks, and the officers all kept their cool and got their job done, and looking at their eyes, I could see the toll the work takes.  I imagine them as I often do myself, just thinking, my goddess, this world is crazy.  People don’t act normally in the street.  Sometimes police and first responders have to disassociate in order to get their jobs done.  They don’t hear the names they are called, they don’t respond to the spittle in the air.  They don’t react when someone ignores their orders to be quiet and go stand over there by the telephone pole the first, second and third time.  They just keep calm and gradually, get things settled.

A violent psych throwing things and yelling at people on the street.  By the time I arrive everything is under control.  The officers talk calmly with the woman who has been drinking and has stopped taking her psych meds.  By now she is smiling and agrees to go to the hospital to be evaluated.  If these officers didn’t receive training in mental health care, they learned it in the street and they are good at it.

An opioid overdose.  A young man in a spare apartment with a needle still in his arm, hours dead.  The officers are somber, respectful.  I give them the information on the time on my presumption of the death.  They are left to deal with the grief of family members and friends who are gathering.  This is something they do every day.

Don’t demonize. 

There is a saying that you never talk religion or politics at work.  Yesterday when I went in, I saw one of my old partners, who like me, is of the liberal bent, in a line of work dominated by conservatives.  I talked with him to get his thoughts on what is happening in our world today, and I confessed the struggles I feel to come to a truth.  While he is more to the left than I am, I do respect his opinions.  But I wasn’t just interested in his thoughts on the questions I asked, (Do you assume when we are called to evaluate a man in handcuffs that the prisoner is guilty of a crime?  Do you think minority EMTs get a fair shake at our company? Are all white people the problem or is racism the problem?  What do you think of the terms White Privilege and Defund the Police?  I was also interested in observing the reaction of others in the crew room to our conversation.  

I got a sense that people (taken from things they chimed in to our discussion and to expressions that other people made) don’t like wide categorizations.  People are against injustice, people are against racism, but blindly lumping everyone together (all whites, all police) plays into the hands of Donald Trump.  Four years ago, I saw it in the people I worked with.  They felt forgotten by the Democrats.  They see rich people getting richer and poor people getting welfare and they work two and three jobs and can’t pay their bills.  They work in the medical field, taking care of others, but when they get sick, they go into debt and their fellow employees have to put up a big glass jar by the operations window to solicit donations for them from their coworkers to help with their struggles to get by.  They wanted someone to stand recognize them.  Not that they are happy with what they got, but they don't see great alternatives.

When I came home from work yesterday and stripped my contaminated uniform off and tossed it into the hot washer, and showered all the city off my skin, and finally settled onto the couch to talk to my family, when I tried to share my thoughts of the world with one of my daughters, we ended up in a fight about white people and police (They are the problem! She declared) that caused her to leave the room, and it made me remember how when I was young I thought my parents were responsible for all the social ills in the world.

I want a better America,  I want an end to racism. I support Black Lives Matter. I believe wholeheartedly in affirmative action.  I think we need a vast investment in education, particularly in our inner cities.   I want to reform our system of policing.  I want to see an end to violence. I want to end the war on drugs. I want affordable health care for all. (And I’ll support higher taxes to make the world a better place).  I want substance users to be treated with compassion and not stigmatized.  I want a coordinated response to the COVID epidemic.   And I want a mature adult in the White House who will bring us together and not divide us. 

We have to be in this together, rich and poor, white and black (and all the colors of the rainbow), young and old, liberal and conservative, police and nonpolice. Let us come together and let us not demonize anyone.

The left shouldn’t make the same mistakes the right has.

Unify!

Fight Racism!

Fight COVID-19!

Fight Addiction!

Fight Violence!

Let's live up to our promise as a nation that all people are created equal.

We are all in this together.

Power to the people!

Peace, love and respect to all! 

Friday, June 12, 2020

Worry

 Hospitalizations in Connecticut continue to drop.  Only 246 people with COVID remained hospitalized.  And again only two percent of those tested for COVID tested positive.

COVID-19 Update June 11, 2020

Next Monday phase two of the state’s reopening will kick off, including gyms, pools, youth sports, and tattoo studios.

But today, I am worried.  As I write this, I watch TV and hear reports of skyrocketing cases in other states and countries who have reopened with many fore-saking social distancing. 

The latest models show predict deaths skyrocketing.

170,000 US coronavirus deaths projected by October, with uptick in daily deaths in September

Last night I had another COVID dream.  It was the first one I have had in well over a month.  It was a dark dream with COVID not as a Sponge Bob gremilin or even a roaring tiger, he was a sci-fi alien dinosaur reaper hurling firey spiked black holes at me in a life and death game of intergalactic dodgeball, and I was losing badly.  I tossed wildly in my bed, awaking with my heart pounding.

Today, the stock market finally nosedived after an inexplicable rise.  They say the stock market sees the future.  Was it simply profit taking or the realization of what a second wave can do to this country, not to mention what the first wave has done.

4,116 residents of this state have died or roughly 10% of those who have tested positive.  There is no evidence that Connecticut is anywhere near possible herd immunity (estimated to be about 60%) nor is there evidence that the immunity a person who has had COVID had gained will last.  Nor is there solid probability of a vaccine that will work.

The only thing we have is safe practices, testing, isolation and contact tracing.  I am not saying we can’t open things up safely.  I am just saying we have to be safe about how we open up.

Connecticut has largely been an example to the nation so far of how to do it right (after a bit of a slow start).  I am going to the pool, to the gym, and hopefully to some of my daughter’s youth sports games.  I may even get a new tattoo, but I am going to keep my guard up.

I will be back in the city working EMS tomorrow.  It’s going to be humid and 85 degrees.  I will have my PPE on.

White Priviledge

I don’t like the term “white privilege”, although I agree with what it tries to describe –that most white people have a systemic advantage over black people.  The term “white privilege” is poorly chosen and makes me defensive, and more importantly it makes other white people who may not have stopped to reflect on the imbalances in our nation, defensive.  I know, poor us, but come up with a better term.  I also don't like the term “defund the police.”  Seriously.  I agree radical changes are needed immediately in our police system.  But the “defund the police” movement doesn’t call for abolishing the police, which is what “defund the police” sounds like, and many people won’t even lend an ear when such a term is brought up.

I am really happy with how this country as a whole is responding to the George Floyd’s death and the accumulation of crimes against minorities that have gone on for too long. I believe change is happening.  I mean today, NASCAR banned the Confederate flag at races!  Who could have seen that coming?

I fully stand with BLACK LIVES MATTER!  I will never respond “all lives matter” because I understand that our society has often devalued black lives and that needs to change.

I have spent a great deal of time lately thinking about my life and the advantages I have had.  I have thought about how I have changed over the years and have been trying to write about it.  I know this blog is supposed to be about being a paramedic and in this blog I have tried to "stay in my lane," but these are extraordinary times, and even though I have a small platform, I want to use it (at times) to talk about race in America.  I will do at times from what I have seen as a paramedic and as a private citizen.

I am working on some essays about different periods in my life and how I went from growing up in an all-white suburb who, as a ten year old, volunteered for Richard Nixon’s campaign and who, as a thirteen year old, rooted for Joe Frazier to beat that loud mouth Cassius Clay to a 61- year old man who has had an Obama cut out in his kitchen since 2008, has a beautiful black wife and three beautiful black children, who teaches them to idolize Muhammad Ali and who still admits I have farther to travel along freedom road to help make the world better for them and all kids.  I may end up not posting these essays (they are not close to being done), but I am working on them, and they have been teaching me surprising lessons and insights as I revisit the past.

Today, I read an article called: 6 Things White People Say That Highlight Their Privilege

I thought I would briefly respond to each of them.

  1. “It’s not my job to fix racism because I’m not racist.”

I disagree.  It is all our jobs.  Even if at times, I may find myself guilty of unintended racism, it is still my job to try to fix it.

  1. “I don’t see color.”

I don’t see color when I look at my kids or when I look at my friends, but I see color all the time when I look at others.  I may wish it were not true, but it is how I have been conditioned.

  1. “There’s no need to worry about the police if you’re not doing anything illegal.”

I disagree with this also.  One of my essays is about the times I have been either pulled over or questioned by police (pretty much all in my younger years).  Let’s say this.  If I was black, I would have been in much bigger trouble than I was.  Still despite being white, police make me nervous.  I think most of them are great, but they pull you over, they hold power over you, and it is a nerve-wracking experience, but clearly much less so for me, than for a black person.  I have never had to worry about being shot,  Not close.

  1. “I don’t want to post about racism on social media because I’m scared of the backlash.”

True.  I am very nervous about writing about race.  I am worried if I write my truths, I will draw the ire of white and black alike.  Still, I am willing to engage regardless.

  1. “I don’t have white privilege.”

Like I said, I don’t like the word, but I clearly have had major advantages in my life as a middle class white person.

  1. “I’m not sure when I should start talking to my kids about racism.”

I have been talking about race with my kids, another subject of an essay.  I learn more from them than they learn from me.

Thanks for putting up with this.  As readers of this blog know I have tended over the years to get fixated on topics – capnography, pain management, STEMIS, the opioid epidemic, COVID and now racism in America.  The last three I will continue posting about and try to get in some regular paramedic topics as well.

Peace to all,

 

Peter 

Thursday, June 11, 2020

ASAP

 I was at a meeting where in the closing minutes the question was raised about EMS testing for COVID-19.  A person wanted to know if EMS services were going to be required to get their employees tested for COVID-19.  And if they did, was there a recommended manner of getting them tested?  And what should the service do if they tested positive?  And what should they do if a great number of their employees tested positive? Another speaker mentioned that the hospital where he worked was planning to test 10% of its employees each week to ensure that they wouldn’t suddenly lose too many people.

I spoke up then and suggested that all EMS employees should get tested ASAP.

There was prolonged silence and then the next voice said “Move to adjourn,” and that was it for the meeting.

I hadn’t expected the topic so I was not prepared to fully state a position, but here it is now it.

It is shameful that most health care workers and first responders in our state have not been tested.  While it is true at the beginning of the epidemic there was a shortage of tests that limited them to the sickest of people with high suspicion for COVID*, there is no shortage of tests today nor has there been a shortage for some time.  The state health department has identified first responders as among the groups most likely to cause transmission and spread and thus are a priority to be tested.

Where do I go to get tested for COVID-19? How do I know if I should be tested?

The fact is one EMT who is positive could interact with ten patients on one shift, not to mention entering multiple nursing homes. They also interact in a closed confined cab with their partner, who could then go on and spread COVID to additional patients and nursing homes, as well as their families.

COVID-19 testing is free.  If you have insurance there is no copay.  If you don’t have insurance, the state will pick up the cost.  It is in the public interest to get tested.

If you test positive, you should quarantine until you test negative or until you go a specified number of days (10) without symptoms.  The state health department should issue directions or point to the CDC guidance .

Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19 (Interim Guidance)

I suspect that services and hospitals may not want their asymptomatic employees to get tested because it may cost them money and lead to holes in their scheduling.  That is my belief.

The worry that massive numbers of employees will test positive isn’t much concern right now in Connecticut where only about 2% of everyone tested is testing positive where many weeks ago the number was in the 30% range.

The idea that you test only 10% at a time to start is amoral.  It is basically following the what we don’t know won’t hurt us school of thought.  No one who has COVID should be actively treating patients or interacting with their co-workers.  We have to stop the epidemic.  Testing is quick and easy today and results are usually available within 24 hours.

This all reminds me of the same early argument where people were told not to wear masks because it would deny them to health care workers and where health care workers were told to wear surgical masks instead of a proper N95 mask unless doing high risk procedures because otherwise we would run out of PPE.  It is the same line that said you can be in an ambulance with someone with COVID for 15 minutes without any mask at all and it won’t be considered an exposure, so you wouldn’t have to miss work.

We know that asymptomatic and presymptomatic people are capable of spreading the disease.

Asymptomatic? Get tested.

Expediency should never come before truth.

Testing, identification and quarantine of positive patients is the only way to stop this epidemic.  Health care organizations should step up, do their part, and get all their workers tested ASAP.

 

*Emergency departments had to call the state health department to get permission to test specific patients for COVID.  In order to get approval to be tested the patient had to be admitted to the hospital.  Sick patients who were not being admitted were referred to out-patient clinics for testing.

Preparing for the Next Wave

 I read a great article about how to improve our response to COVID-19 when the second wave arrives (as most people believe it will) in the fall or sooner if social distancing and state reopenings fail.

How the world can avoid screwing up the response to Covid-19 again

I would like to add how EMS can improve its response during a second go-around.

  1. Test the EMS workforce for COVID-19, and then maintain testing on a regular basis. Quarantine those employees who test positive even if they are asymptomatic.
  2. Provide comprehensive and updated education to the EMS workforce on COVID-19, not just so EMS can understand the signs and symptoms of the disease and how it is most easily transmitted.
  3. Provide education to the EMS workforce on COVID-19 so EMS can then teach patients who we encounter on the safest practices to reduce risk.
  4. Induct EMS into the public health army. Consider training EMS workers to administer COVID tests to those with limited access to health care.
  5. Put non-transport protocols with strict medically approved criteria into place to be activated should hospitals start to be overwhelmed.
  6. Accumulate sufficient stores of N95 masks so EMS workers do not have to wear substandard surgical masks.
  7. Have hospitals equip their ambulance bays with “foggers” that can be used on ambulances to decontaminate the rigs in between trips. Many hospital EDs defog the ED rooms in between suspected COVID patients.  Ambulances, which have much more confined spaces and see more patients over the course of a day, could also benefit from “fogging.”
  8. Provide early warning to EMS of upticks in cases. I know already many in EMS are slacking as our case load as significantly dwindled. We have seen more failure to wear PPE in recent weeks for patients who turned out to be COVID positive than we did when everything was going crazy and everyone was assumed to have COVID.  When cases start to rise again, put out alerts.
  9. Tell us the truth. Don’t bend the laws of science to protect the the availability of the workforce (or service) by putting individuals at risk.  Don’t tell us surgical masks are safe enough.  Don’t tell us that being in a confined space with someone with COVID while not wearing a mask is not an “exposure” if we were only there for 15 minutes.  Respect us.
  10. Work to see that testing positive for COVID-19 is covered by worker’s compensation and that EMS doesn’t have to prove they received COVID-19 on the job versus off-the-job.

Note:  These recommendations are not targeted at a specific service, but meant as a general response to all services and hospitals involved in EMS, as well as public health experts and state and federal officials.