CSI: Fairview - Assaults

The fourth crime scene I'd like to address is the assault (it should really be called battery, but that's a whole different blog post). Assault calls can actually be shootings or stabbings, but typically they come in much more innocently. While shootings and stabbings are definitely assaults, you'll typically be looking at a hand-to-hand combat situation or a blunt trauma injury. Like shootings and stabbings, your patient's (and bystanders') emotions will probably be running high and there are a lot of issues to consider.

Once again, stage until the scene is as secure as it can be. Enter carefully and preserve as much evidence as possible. Search for weapons and all that fun stuff.

So as you scan for evidence and evaluate the scene, approach the patient and conduct the initial assessment. Assaults frequently involve the use of alcohol, so you may need to brush up on your Drunkenese to conduct a thorough assessment.  Also keep in mind that the story you get may not necessarily be the truth, as the assailant and victim know each other much of the time. Especially in the case of domestic violence or family fights, the victim may downplay their injuries in an attempt to lessen the consequences for the perpetrator.

Shootings and stabbings are felonies and the detectives will conduct a very thorough investigation. Most assaults are misdemeanors, though, and the investigation will likely be conducted by a uniformed officer. The officer also has a great deal of discretion when dealing with misdemeanors, so the attitude test will have a huge impact on how things go down arrest-wise. There are three big exceptions here: the first is domestic violence, as many jurisdictions have a mandatory arrest provision; the second is aggravated assaults, which can often be charged as felonies; and the third is sexual assaults.

Many patients know that their version of the story can make the perpetrator's consequences greater or lesser, and they may change their story to some degree when giving a statement to the police. They often will then give a slightly more honest account to fire/EMS if the cops are out of earshot.

The type of weapon is an important piece of your puzzle. In my Nailed It! post, I quickly learned that a 2x4 can easily be modified to inflict grievous injuries, so it always pays off to take a second and take a look at the weapon if you can. Again, pictures can paint a great picture for the docs and nurses at the emergency department, but don't get yourself in trouble if your employer prohibits them. Also, don't take the weapon from the scene.

Speaking of pictures, the law enforcement officers on scene will likely want to take a picture of the patient's injuries prior to treatment and transport, and as long as that doesn't negatively impact the patient it's best to accommodate that.

The patient's injuries may be very superficial, and the pictures that the cops want to take could very well be the only physical evidence that the prosecution will have available if the case makes it to trial.

In a 'simple' assault, the mechanism of injury is typically a hand inflicting a punch or a foot inflicting a kick. Sometimes there will be bites. There could also be a shove, resulting in contact with a wall, furniture, the floor or the ground. Even a single blow can cause devastating injury, so be sure to be thorough in your assessments.

In these cases, you'll want to determine the size and physical capabilities of the assailant. A 5'9" 170lb MMA fighter possesses a much greater potential for inflicting serious injury than a 5'4" 170lb housewife, so try to get a well informed idea of the aggressor's potential to cause injury.

In the aggravated assaults/assault with a deadly weapon/assault with intent to cause great bodily harm calls, the greater injury/potential for injury allows for felony charges to be filed, and weapons are typically involved.

The weapons in more serious cases can range from brass knuckles and beer bottles to baseball bats and lamps. Furniture and even vehicles can be weapons, too. People can be very creative when it comes to hurting each other.

Just because there aren't bullet holes in the patient's clothing doesn't mean there's no evidence potential. Ripped or torn clothing can still be important evidence, and in the event that you need to remove clothing to treat the patient, do so very careful and avoid cutting through the rips. Don't dispose of the removed clothing.

Clothing will be extremely important evidence in the case of sexual assaults, so do your best to minimize any disturbance of the clothes. If the patient is wearing the same clothes that he or she was assaulted in, there is a very high probability that valuable forensic evidence is on the clothing. While the patient will probably want nothing more than to shower and put on fresh clothes, such actions will destroy a huge amount of that evidence. Do your best to attend to the patients physical and emotional needs, and try to convince them to remain in the clothing.

Especially in the case of head injuries, the patient may be altered or otherwise combative. Remember too that the patient might not be an innocent victim - they could be the perpetrator. Watch their hands, and be cautious of weapons.

Again, the patient may be suffering from multiple wounds, so the importance of a thorough physical exam cannot be stressed enough.

My earlier points about patient statements being important evidence still apply, so be sure to accurately document the patient's account of the circumstances, perpetrator and weapon, if applicable. Document everything else thoroughly as well.

The common theme throughout the CSI: Fairview series has been, and will continue to be, this: treat your patient appropriately and professionally while maintaining vigilant situational awareness, preserving the evidence and thoroughly documenting the circumstances.

Put it into practice on each and every run, and it'll soon become second nature.

If you have anything to add, I welcome your input.

Be safe!

I Really Hate Drunk Drivers...

Here's a copy of my incident report about why I was late to work the other day. It was my regular day off, but I agreed to come in to cover for one of the other guys. He got super bent out of shape about me being 8 minutes late. Good times.

* * * * *

On the afternoon of 30 November, 2011 at approximately 1308 I was driving from my personal residence to my assigned shift at Station 3.  I was headed northbound on 88 just south of Greenville in the #2 (slow) lane.  A small silver Toyota passed me at approximately 85-90 mph. The vehicle began swerving into the center divider and #2 lane, and slowed abruptly about 1/4 mile ahead of me, nearly having multiple collisions.  I slowed my vehicle in anticipation of further erratic driving behavior and matched my speed to the other vehicle.

I then observed the driver and passenger hitting each other, which was causing the vehicle to swerve and brake in an even more erratic nature than before.  I was unable to determine whether the two were assaulting each other with malicious intent or engaged in horseplay, but either way the situation created an extreme and unacceptable safety hazard to the two of them, the back seat passenger, myself and all the other motorists in the area.  The driver braked hard and cut back into my lane, and I was able to obtain the vehicle's license plate number.  The driver sped up quickly, pulled to the shoulder and nearly stopped. He then accelerated quickly back to 85-90 mph, rounded a bend and disappeared from my view.

At 1309 I called Greenville PD's dispatch to advise them of the situation.  They didn't have any units in position to initiate a traffic stop and transferred me to the Highway Patrol. I was on the phone with the SHP dispatcher for 4 minutes and provided a complete description of the vehicle and the circumstances, as well as the vehicle's last known direction of travel and speed. I advised her of my current location and she told me that she would update the units in the area.

I continued northbound toward Fairview and did not see the vehicle again as I passed through Winchester and approached Georgetown.

At 1319 I received a call back from the state police. The dispatcher asked me if I still had the suspect vehicle in sight, and I told her that I did not. She told me that she had a trooper preparing to initiate an enforcement stop on the vehicle. The dispatcher requested that I stop in a safe position behind his patrol vehicle and wait for him to make contact with me and obtain a statement. I gave her a description of my vehicle and told her I would park in a safe place when I came upon the traffic stop.

I continued northbound through Georgetown and saw traffic begin to slow on the south side of Meadowbrook.  At 1328 I rounded a bend just north of the Fairmont Rd exit and observed multiple patrol vehicles on the shoulder with their emergency lights activated. I got closer and saw a silver car in front of the patrol cars, so I slowed down, signaled my intentions and came to a stop approximately 30 feet to the rear of the last squad car.

I sat in the vehicle for about 15 minutes before a trooper approached my vehicle. I identified myself and gave him a detailed account of what I saw. He took down my information and telephone number, and told me that he suspected that the driver was driving under the influence. He thanked me for the call and advised me to drive safe and have a good shift at work.

I left the scene and continued into Fairview to start my shift.

After further followup with the dispatch center, I determined that the trooper arrested the driver on suspicion of  driving under the influence.

* * * * *

Fortunately I was only a few minutes late, and while the boss knew I was going to be a little late, the guy I was relieving had been having a lot of attendance issues himself lately. The boss just wanted me to have the report ready in case the other guy complained to headquarters. I hate being late and pride myself on my attendance, but I figure this was a great reason to show up late. I have no idea why the guy was drunk at 1 in the afternoon or why he and the passenger were smacking each other, but I'm glad the driver ended up in jail before he hurt anyone...

The Ride of a Lifetime...

or, the Excellent Embraer Excursion...

Back in September I heard about a newish company based on the West Coast called JetSuite. 

JetSuite is an ARGUS Platinum rated Part 135 on-demand operator of Embraer Phenom 100 VLJ (very light jet) aircraft that currently serves the Western United States.

In plain English, that basically means it's a top-notch jet charter firm that has a growing fleet of brand new luxuriously appointed 4-passenger jets.

The ARGUS Platinum rating is awarded to aircraft operators that demonstrate the highest level of aviation industry best practices throughout all levels of the organization, and JetSuite earned it very quickly. Looking at the folks in charge, though, it's easy to see why.

JetSuite's pedigree is very impressive - Alex Wilcox, JetSuite's CEO, brings decades of experience gained at Southwest, Virgin Atlantic and JetBlue to a perhaps not-so-predictable destination: the private charter world.  Mr. Wilcox is in good company, too - Tony Hsieh of Zappos.com and Gary Waldman of SideStep.com (now Kayak.com) are just two of JetSuite's talented executives.

Right about now you may be wondering what happened to the normal Traumatic License content, but don't worry - it'll all make sense in a second.

I love to fly. I love everything about flying. Whether I'm in a huge commercial jetliner, a small private plane, a helicopter or even a blimp, I'm happiest when I'm off the ground. So when I read an article about JetSuite around Labor Day, my interest was piqued.

While at first glance JetSuite might seem to be like every other charter operator out there, there's one distinct difference: affordability. JetSuite offers an on-demand charter product that, while still expensive by coach class commercial airline standards, is similar to what you might expect to pay for first class seating. They've upped the ante considerably, though, with their SuiteShares, SuiteSavers and SuiteDeals. A one way SuiteSaver flight on a 4 seat private jet can be had for $999 - $250 a person - and the SuiteDeals allow you to steal a flight for just $499. The SuiteDeals are posted between 4pm and 6pm Pacific Time through their Facebook and Twitter pages, and that $125 per seat price point is impossible to beat.

Now, the SuiteDeals are only available the day before the flight, and the route is non-negotiable. The $499 covers all 4 seats, your luggage, your snacks and beverages - everything. With the 7.5% federal excise tax, you're looking at $536.43 out the door for 4 adults. You can even bring a child on your lap or your pet in the cabin, and the luggage compartment easily accommodates skis or golf bags. If a given flight works for you, it's the best possible way to fly. While Fairview isn't typically served by JetSuite, I've kept an eye out for the last few months hoping a SuiteDeal would come up for me.

And wouldn't you know it? One finally did.

I was visiting my dad in Pleasantville a couple weeks before Thanksgiving. As an AWESOME recognition of our veterans' service and sacrifice to the country, JetSuite offered FREE flights to veterans. My dad retired from the Air Force, so the potential for a free ride was definitely there.

I not-so-patiently waited for the Veteran's Day SuiteDeals to be posted, and when one looked like it would work out with my schedule, I started to get excited.  I talked to my dad to see if he was up for a crazy adventure the next day, and he said he was intrigued. I withheld details, but since he didn't have any plans for the day I got to work.

I checked out Google and looked at cab fares from the airport to the Amtrak station, and went to Amtrak to figure out their schedule and fares for a ride home.  The Amtrak fare turned out to be about $80 and the cab was gonna be $50ish. So this excursion could be had for the low, low price of $130, plus food for the day. I figured around $200 would get us decent food and a great story to tell, and I got in touch with the JetSuite folks to try to make something work.

I followed the SuiteDeal request process, and when I called in to talk to them about it everything went very smoothly.  I had a great conversation with Lauren, one of JetSuite's amazing Client Services professionals, and we worked out the details of the flight. She emailed me a quote, I emailed her a picture of my dad's military ID, and I was suddenly one of the 1% (aviation industry analysts report that less than 1% of Americans have traveled by private jet, and it's JetSuite's aim to triple or quadruple that)

I then got an email with an FAQ that explained everything in detail. It was quickly followed up with an email from Robert, who gave me the particulars for the two FBOs we'd be using at the origin and destination airports. FBOs are the fixed base operators - they're often the place you'd go for a flight lesson or hangar rental, but in this case they were both very upscale private jet terminals. Robert also checked on my need for ground transportation, but since I figured I'd be hailing a cab I told him I was squared away.

With the flight booked and the address of the FBO in hand, I called my dad to set up a time to meet up for breakfast. I filled him in on what exactly my plans for us the following day were, and I went to bed feeling not-unlike a kid on Christmas Eve.

The alarm found me reasonably well rested 7 hours later, and I went through my morning routine. I figured comfort and respectability were going to be important, so I opted for khakis and a polo shirt. I picked my dad up and saw that he had the same idea - business casual was the theme of the day. I asked him where he wanted to eat and he threw a curveball my way. He really just wanted wanted fast food and coffee, so we ate a quick breakfast and headed to the airport.

Since we didn't have a normal sit down meal, we arrived at the airport about an hour prior to our scheduled departure time. I assumed we'd read magazines or something in the FBO's lounge since we were early, but all thoughts of reading disappeared when we passed the commercial terminal and approached the FBO.

I saw a number of aircraft on the ramp, ranging from little Cessnas and Mooneys to a helicopter, a Lear or two, and even a Gulfstream V.

But there amid the group was a sleek and beautiful Phenom. The red stripe was unmistakable, and my anticipation swelled. I pointed it out to my dad and told him that it was our plane - at least for the morning.

I parked about 50 feet from the FBO's front door and we walked in. It was pretty amazing. My previous FBO experience was all either greasy hangars that smell like AvGas or small operations where we'd wait for a medevac plane to come in... in other words, much more utilitarian than this. My dad went to grab a glass of water while I walked to the reception area and told the pleasant woman behind the desk that we were there for the JetSuite flight.

She asked us to wait a moment while she invited the flight crew to meet us. The pilots walked out of the pilot's lounge within seconds and introduced themselves to me. They were both very friendly and professional, and by all appearances were the most competent pilots on the planet. They wore black slacks and black polos, which was a nice touch - all the other pilots milling around looked like your typical commercial pilots. Commercial pilots look respectable in their white shirts with the gold epaulets and all, but the JetSuite look was sharp AND stood out from the rest.

Martin spent a few minutes getting to know us while Carey prepped the aircraft. We were an hour early, so I'm sure if we had showed up 15 minutes prior to departure it would have all been done by the time we got there. I think it worked out better this way, though, as Martin is a very friendly guy and we had a great conversation. He's a Royal Air Force veteran himself, so he and my dad traded stories and had a fine time.

After a few minutes of talking, Martin asked if we wanted to leave a little early. With no set plans, my dad and I were happy either way - after a quick discussion, we decided to leave early. Martin asked about ground transportation, and I told him we were good to go.

We headed to the security checkpoint and waited in line for 45 minutes for TSA to make us take off our shoes and leave behind our bottles of water and tweezers out the door of the FBO and on to the ramp. As we approached the aircraft I had to pinch myself. Were we really going to get into this beautiful plane and fly? On a private jet? For FREE?

Martin asked us if we wanted a picture together before we got on the plane. We grabbed the quick picture, which looked something like this:

We boarded the Phenom and took a look around. Here's what the cockpit and passenger compartment looked like:

Cockpit picture courtesy of Embraer. All rights reserved.

Cabin picture courtesy of JetSuite. All rights reserved.

Pretty nice, huh?

Carey sat in the cockpit and started the pre-flight checklist while Martin gave us the typical pre-flight safety briefing. Seatbelts, exits, floatation devices, liquor cabinet.

Wait, what? Liquor cabinet?

Since it was early in morning - and I didn't really feel right eating and drinking a bunch on a free flight - I opted for water and my dad had a Diet Coke. Martin told us to feel free to help ourselves to any of the beer, wine, booze, soft drinks, water, or snacks we'd like. He told us about the XM satellite radio and the Bose noise cancelling headphones. He asked about ground transportation at our destination again, and I missed the hint and said we were all set up.

He joined Carey on the flight deck and my dad and I settled into our cushy leather seats, grabbed our beverages and prepared for takeoff. Which, in this case did not involve shutting off cell phones, wishing for that crying baby to settle down or trying not breathe in other passengers various body odors. We quickly taxied to the runway and were on our way. One of the 9,426,874 benefits of flying charter from a smaller airport, I learned, is that you don't have to wait long - or sometimes even at all - for the tower to grant you takeoff clearance.

As we accelerated down the runway, I'm sure I was grinning like a complete fool, but we rotated smoothly and climbed out quickly. During the 6 or 7 minutes it took us to get to our cruising altitude, we played with the Bose headsets and listened to the Police sing about stalking somebody. We didn't take this trip to listen to the radio, though, so we put headphones away and stretched out. I'm over 6' tall but I had plenty of leg room and headroom. The overall cabin height is a hair under 5', but once you get seated there's plenty of room.

The ride was amazingly smooth. We spent a couple minutes looking out the windows and enjoying the flight. Conversation was surprisingly easy, and while the engines were loud enough to notice we were able to talk without any difficulty at all. Martin looked back to check on us a couple times, and we were able to talk to him easily, too.

For a small aircraft, I was amazed at how well insulated and quiet it was. One of the inherent issues with the very light jets is engine noise - with the jet engines and cabin being so close together, there is bound to be some engine noise, but the Phenom kept it to a minimum.

At our fastest we got up to around 375 mph (325 knots), so we made it to our destination pretty quickly. We started our descent much sooner than I would've liked, and caught one brief and surprisingly gentle bit of turbulence on the way down. We fell into the traffic pattern and lined up for our final approach a couple minutes out. Martin and Carey brought her down so gently we couldn't even tell when our flight officially ended.

After a quick roll down the active runway, we made our way via a couple taxiways to our final destination. Martin and Carey brought the plane to a stop and we gathered our things. We stepped off the plane and back into the real world. A short 50 foot walk later and we were at the door to the FBO.

We walked through the door and were immediately greeted by the aroma of fresh baked chocolate chip cookies and still-popping popcorn. As we grabbed a cookie, Martin thanked us for choosing JetSuite, and we thanked both him and Carey for safe a safe, comfortable and pleasant flight. When he found out that my grand plan for ground transportation was to hail a taxi, he excused himself to speak to the FBO's concierge. He returned moments later to let us know that our car would be there in fifteen minutes. He told me to let him know my ground transportation plans and needs next time and they'd have the car waiting for us on the tarmac. Talk about door to door service.

My dad grabbed an iced tea while I took a seat on a couch in front of a huge and yet somehow still tasteful big screen TV to catch up on the news of the day. We were there for less than ten minutes when we were told that our car was there. We stepped outside but found no cab. Confused, I turned back toward the FBO. That's when I saw the Lincoln Towncar with the driver holding the door open. We jumped in the car and the driver slid behind the wheel. He already knew our destination - the concierge must've told him - and he guided the car smoothly into traffic and headed for the train station.

I'm not gonna lie - this car was just a little bit nicer than the beat-up-Crown-Vic-retired-police-car-hunk-of-junk cab I was expecting. You know, like the Packers are just a little bit better than your average team of winless high school freshmen. Luxurious leather seats, no meter ticking annoyingly away, and no unidentifiable stains on the seats or floor.

I knew of JetSuite's partnership with Dav El for ground transportation, but I knew nothing about the price. I was fine with spending $50 on a cab, but I was a little hesitant about spending a ton of money on executive ground transportation. Less than ten minutes later we pulled up to the Amtrak station. The driver got out and opened the door for us, and informed me that the ride was $30.

Thirty American dollars?!? That was significantly less expensive than a cab would have been for a much nicer ride. Even with the tip I came out ahead on that deal. We walked into the train station, picked up our tickets and found a bite to eat while we waited for the train.

The train showed up and we boarded. No TSA screening, but it wasn't quite the same as walking up the airstairs on to the jet. It was a slow day for Amtrak and we essentially had the entire train car to ourselves. That was nice, but it's definitely not the same as having your own private jet. Sigh. The train ride was relatively uneventful... until we rode back past the airport.

That's when we saw that beautiful Phenom sparkling brilliantly in the early afternoon sun. I gazed longingly at the Embraer as the train rounded a bend. I'd have to be big boy. I had to maintain my dignity. There's no use crying over spilled milk, there's no crying in baseball, and there's certainly no crying in train cars - no matter how great the plane you're looking at is.

I had plenty of time to think over the day while we were on the train. We spent about 45 minutes in the plane, and the better (worse?) part of 7 hours in the train.

In the end, I figure it broke down like this:

Anticipated cost
SuiteDeal: $536.43 ($499 + 7.5% excise tax)
Breakfast: ~$25
Lunch: ~$30
Dinner: ~$50
Cab ride: ~$50
Train tickets: ~$80
TOTAL: $771.43

Actual cost:
SuiteDeal: FREE
Breakfast: $9.40
Lunch: $15.09
Dinner: $13.66
Ground transport: $40
Train tickets: $72 (Senior discount for my dad made it 10% cheaper for his ticket)
TOTAL: $150.15

In the interest of presenting a valid review of my experience, and in the sake of full disclosure, I figured I should share the negative parts of the experience, too. I thought long and hard, and have been able to come up with exactly three things that weren't amazing about the experience. In no particular order, here they are:

1) I had to bend over to board the aircraft (but too be fair that's a stretch - all very light jets have short overall cabin heights, and the Phenom's height was very respectable)

2) The engines were noisier than I would have liked (again, an issue with all very light jets, and a very small issue)

3) The XM radio is controlled from the cockpit, so the flight crew has to change the channels for you

Again, these are all such trivial issues that I really had to get nitpicky and think long and hard to find ANY negatives. I think issues 1 & 2 are easily offset by the lavatory that's standard on the Phenom 100 - many VLJ's aren't equipped with any restroom facilities. And number 3 is laughably insignificant.

The only legitimate downside to the whole experience is that I am absolutely, completely and undeniably ruined for commercial aviation. The JetSuite experience was far beyond my expectations, and I cannot say enough good things about the company, the staff, the aircraft and the entire experience.

If you ever have the opportunity to fly with JetSuite, I'd jump on it. You can learn more about the SuiteShares, SuiteSavers, and SuiteDeals on their website and Facebook pages and their marketing department is always coming up with new ways to get you into one of their aircraft. Their Black Friday promotion was simple: $1 - yes, one dollar! - for all their SuiteDeals for the entire last week of November, and they recently flew some lucky folks from Teterboro, NJ all the way to Los Angeles for $800. You'd be hard pressed to find a single one way coach ticket from NY to LA for the next day for that price, let alone 4 first class seats.

I'd also like to acknowledge the great service from the fine folks at Signature Flight Support and Atlantic Aviation, the two FBOs that served us on our trip.

I think the whole experience can be summed up best with three words:

JetSuite: It's JustSuperb

CSI: Fairview - Stabbings

The third crime scene I'd like to address is stabbings.  The "stabbing" call could actually be a cut, puncture, stab, slash, chop, clice, thrust or scrape, all of the above or none of the above. Like shootings, they are often very dynamic and charged scenes. While bullets differ mainly in size and velocity, edged weapons come in all shapes in sizes, and there is a huge variety of wounds that can be inflicted by them.

Many of the points from the CSI: Fairview - Shootings post apply to stabbings, but there are a few additional considerations.  Take a look to refresh your memory - I'll wait - and then we can explore the differences.

Again, hopefully you'll stage until law enforcement has arrived on scene and cleared the scene to the best of their ability.  You'll still want to enter carefully, scanning for evidence and not stepping in puddles of blood whenever possible.

It's nice to think you won't have to look as carefully for shell casings, but don't fall into that trap. It amazes me how many people think it's a good idea to bring a knife to a gun fight. It's also very important to note that shootings and stabbings are often confused for each other, either by the calling party, the call taking dispatcher, the radio dispatcher, or even the patient.

I think a lot of the problem lies with the person reporting the emergency. They may not hear shots and assume it's a stabbing, or they may have heard some loud noise and just assumed that stab wound is actually a bullet hole. The fight or flight response has a way of skewing people's perceptions and recall, so that's a factor, too. Further complicating matters is that the Emergency Medical Dispatch (EMD) code is the same - 27 - for both shootings and stabbings, as they're both penetrating trauma.

Don't assume that you don't have to pay attention to your surroundings just because the call came in as a _________ and not a shooting or other obvious crime scene.

So, being mindful of evidence as you approach, you size up your scene, evaluate your surroundings, and assess your patient.  If the butcher knife/ice pick/ninja sword is still penetrating the patient's body, secure it as you would any other impaled object.

I've heard of a paramedic intern (or rookie paramedic, or a stupid paramedic) who responded to a stabbing and found a large steak knife lodged in the unconscious patient's chest. Without thinking, he quickly pulled the knife out. When he realized that he'd breached protocol by removing the impaled object, he immediately replaced it in the original wound in the patient's chest. That's right - the paramedic stabbed his own patient. Since the patient would have died no matter what, the paramedic only got a slap on the wrist.  Now, this is almost certainly an urban legend - very non-specific details coupled with very specific details never strike me as believable - but it illustrates the point well. Don't remove any impaled objects that you don't need to. The chances that you'll need to are very rare indeed.

Anyhow, that little digression aside, let's continue.

If the weapon is no longer embedded in the patient but it is on scene, try to obtain a description of it. Again, the weapon is evidence, and you should not disturb it without the knowledge and consent of the law enforcement officers on scene. While a description is great, a picture can be very helpful too. A picture of a knife may or may not indicate scale, but a picture of a knife with a ruler or other common object next to it for scale - quarter, dollar bill, trauma shears, etc - paints a much more accurate picture for the hospital staff. If your agency prohibits taking pictures, don't do anything that risks you getting fired though.

If the assailant fled with the weapon, you may be able to ask the patient what the weapon was.  The wound itself may give you an idea of how big the weapon was, but not necessarily. It will likely be impossible to tell how deep the wound is.

Remember that the patient may be altered or otherwise combative, and remember that the patient might not be an innocent victim. Watch the hands, and check for weapons.

It's important to again point out that the patient may be suffering from more than one wound, so do a complete and thorough physical exam. Remove the clothing carefully, and don't cut through any puncture holes if at all possible. Keep the clothes together, and don't dispose of them at the hospital.

My earlier points about patient statements being important evidence are still applicable, so be sure to accurately document the patient's description of the weapon, assailant and circumstances. You'll probably remember the guy attacked by a ninja sword for the rest of your life, but the guy that was stabbed by a pocket knife may not be as memorable. Both runs could land you in court, though, so be sure to document thoroughly.

So to recap: treat your patient appropriately and professionally while maintaining vigilant situational awareness, preserving the evidence and thoroughly documenting the circumstances.  It may be easier said than done, but it gets a lot easier with practice.

Again, this isn't all-inclusive, and I welcome input from other responders. Whether you're a stockbroker whose only public safety experience is getting stopped for speeding and watching Third Watch reruns or fire chief/SWAT medic/Navy SEAL/dog catcher/paperboy, the odds are that you've got good ideas and a different perspective than me, so let me hear it.

Stay safe out there...

Priceless, Part 2

After the goofiness of Saturday morning, I figured maybe Saturday night would continue the douchebaggery.

I wasn't disappointed.

Just after we finished cleaning up the kitchen after dinner, we decided it'd be good to go out for ice cream.  A lot of the time we'll have ice cream in the house, but the Lieutenant and Captain both had family in town this weekend so we decided to go out and invade a Cold Stone.

The whole house emptied out, and close to 30 of us (between the engine, truck, us and the family members) walked in together.  The bill came to almost $150 for everyone, and the Captain's brother - a retired cop - picked up the tab for all of us, which was mighty nice of him.

Good times.

We ended up closing the joint down, and got a call as we walked out.  The run came in for an elderly woman having a heart attack, with law enforcement already on scene.

So we have an uneventful response, and pull in to the patient's neighborhood.  We don't look at house numbers as we approach the cross streets, and there are no police cruisers in sight.  The street wraps around to a cul-de-sac, and we fail to see any cops anywhere.

We make a victory lap through the neighborhood, this time paying attention to the house numbers.  We locate the home, and my partner parks the rig.

The home is a well-kept bungalow with a large, brightly lit American flag flying proudly in the crisp autumn night.  The house, despite being blacked out, manages to still look warm and inviting.  It probably has something to do with the antique decorative fire plug in the yard, but maybe not.

I advise the dispatcher that we are at the reported address, but that there is no law enforcement presence.  We knock on the door, but after 30 seconds there's no answer.  I let dispatch know our situation, and we begin to look for a non-destructive way to force entry.  They advise me to standby before attempting entry and that the call came in from the State Police.  I pull out the cell phone and call their dispatch to obtain further information about the response.

The dispatcher states that a trooper had initiated a traffic stop on a vehicle for excessive speed.  Upon making contact with the violator - a 17 year old girl - and hearing her story, the trooper called for our response.  Per the dispatcher, the trooper was told that the girl was driving down the road at 95 miles per hour because her grandma was having a heart attack.  The girl provided her grandmother's address to the trooper, and that's how we got dispatched.  The typical too-many-links-in-the communication-chain situation resulted in our belief that the cops were on scene of our call.  No big deal... at least, it won't be unless the patient isn't breathing.

Now that we know the patient is inside, we knock much louder, this time at multiple doors and windows.  The lights pop on, and the sweetest little old lady in town opens the door.  She's wearing an expensive robe and well-worn pink bunny slippers.  Despite being obviously asleep a minute ago, she smiles warmly. She's my new hero.

"Good evening, boys.  Is everything okay?"

"Well, ma'am, we hope so," I begin, "are you Elizabeth Jones (not her real name)?"

She pales slightly, and the smile turns into a frown.

"Yes, I am.  You wouldn't be here if everything was okay.  Did Eunice have another stroke?"

We inform her her that Eunice - we later learn that's her neighbor of nearly 60 years - is, as far as we know, just fine.  She invites us in out of the cold, and we walk in.

We ask her if she's okay, and she assures us that she's fine.  We learn that her husband was a retired firefighter that died peacefully in his sleep a decade ago, and that she lives alone.  Aside from a touch of hypertension, she's healthy, and she is most assuredly not having a heart attack.

We thank her for her time, apologize for waking her up, and politely decline the plate of cookies she offers us.

My partner advises our dispatch that there is no patient at this address and that we're available.  I pull out my phone and call the State Police back.  I tell the dispatcher that Mrs. Jones is fine and there's no emergency at her house.  The dispatcher tells me that she'll pass that on to her trooper, and wishes me a safe night before hanging up.

I hear the dispatcher's voice over the scanner as she advises the trooper of the situation.  He copies her, advises that he has one suspect in custody, and requests a tow truck for the suspect's car.

So, twice in less than 24 hours, we had knuckleheads lie to the cops to get out of traffic tickets, generate dangerous lights and sirens fire & EMS responses, and go to jail for their efforts.

Congratulations, morons - you're a big part of what's wrong with the world today...

Priceless

It's early on a Saturday morning, and I've been in bed for about 15 minutes. I'm in that awkward not-quite-asleep daze of relaxation when the alert comes in.

For a maternity.

On the expressway.

Wonderful.

I make it to the rig as my partner fires up the engine, and we head toward the scene. After a 3 minute uneventful response through the nearly deserted 3am Fairview streets to the expressway, we pull up to a Honda Civic with it's hazard lights on sitting on the shoulder.  There's a trooper on scene already, and he doesn't look happy.

We make contact with him, and he tells us that he initiated a traffic stop on the patient's vehicle after it passed him in excess of 110 miles per hour.  Upon making contact with the patient's boyfriend (the driver), he was told that she was in labor and they were rushing to the hospital. The trooper detected signs of intoxication and notified us of the impending birth of baby Asphalt.  Or Blacktop.  Or Concrete.  Or whatever.

I conduct an initial assessment, which reveals a 21 year old woman in no apparent distress.  I cancel the incoming engine company and continue the assessment.

She states her last menstrual period was 31 weeks ago, and denies recent alcohol use.  This is interesting, since I haven't asked her about drinking.  She freely admits to smoking throughout the pregnancy, though, so she's obviously a real winner.

She states her due date is in three months - I'm no 'rithmetic expert, but that doesn't seem to add up - and she denies any prenatal care.  I ask her about contractions and - big surprise - she starts to get evasive.  She states that her water broke while she was at home asleep, which is weird because they're both dressed like they're coming from a party... Maybe cocktail dresses and tuxes double as pajamas for these folks, but I kinda doubt it.

The expressway at drunk time is one of my least favorite places to be, so I try to minimize my scene times whenever practical. This is one of those times, but she seems determined to drag this out as long as possible. After 10 minutes on scene with her stalling and evasion (and one 'contraction' that didn't seem legit at all), I tell her (as politely and firmly as possible) that the danger to all of us is excessive and unnecessary and we need to get her to the hospital.

She reluctantly climbs on the gurney and we load her into the ambulance.  As the back doors slam shut, the trooper's handcuffs ratchet closed on baby daddy's wrists. The trooper is arresting him for drunk and reckless driving. The guy is crying as he takes a seat in the cruiser.

The patient goes ballistic and tells me that they can't be arresting him.  I inform her that not only CAN he be arrested, he IS being arrested. She breaks down and admits that, while truly pregnant, she's not in labor - her water breaking was lie, and the 'contraction' was faked. I ask her if she still wants to go to the hospital, and she says no, so I have her fill out the refusal paperwork.  I open the doors to the rig, and help her step down to the ground.

The trooper comes over to see what the problem is.  I give him the rundown and he smiles knowingly.  As I pull a tissue out of my pocket for my former patient, the trooper pulls out a gift of his own.  The patient wipes her eyes as the trooper presents her with her new bracelets.  Before she could even process what was going on, he had her cuffed and informed of her charges. Obstruction, false report of an emergency and contributing to the delinquency of a minor - turns out baby daddy wasn't quite 21 yet...

Apparently lying to a trooper about being in labor isn't a good plan.  Neither is partying and having your intoxicated unborn baby's father drive you home.  Smoking while pregnant seems like the least of the problems this poor kid'll have to deal with in the future...

Pack of smokes: $5
Party dress: $150
Bail money: $1,000
Look on trooper's face as he "limits out" on the traffic stop: Priceless

Those Kinds of Things

I have a confession to make: I watched Trauma when it was on the air. 

Funniest. Show. Ever.

Seriously, it fell into the "so bad it's good" category for me. The lack of believability was spectacular, and it was, all things considered, one of the dumbest hours of TV I've ever watched. Trauma was exceptionally bad. Or good. Whatever.

But I watched it, so I guess the joke's on me.

I've been critical of the way that EMS is portrayed in pop culture for a long time. I dug Mother, Jugs & Speed, mostly because Bill Cosby is awesome and the zany shenanigans were so goofy. I really didn't care for Bringing Out the Dead - way too dark and depressing, and (at least to me) as unrealistic as Trauma. There was an indie film called Broken Vessels that did the "dark exploration of prehospital medicine" thing way better than Bringing Out the Dead and was interesting from a train wreck kind of perspective, but basically I don't think Hollywood has ever portrayed us well.

I like to think I watch quality TV shows, occasional guilty pleasures aside, and I really enjoy the complicated and dark world of Showtime's Dexter.

I think it does a great job of challenging morality and the sometimes blurry line between good and evil. 

Having said that (thanks, Larry David!), though, I had serious issues with Sunday night's episode. Read on for details (and minor spoilers!)

SPOILERS BELOW!

If you're still reading, I'm assuming that you either: a) already saw the episode, b) never plan to see it, or c) don't care much about spoilers.

The first couple of minutes of last night's episode Those Kinds of Things were completely and totally preposterous. Absurdly unintelligent. Insultingly ridiculous.

And it's just propogating the misinformation out there about EMS.

So here's the set up:

Dexter's inner dialogue tells us about how wrong things have gone as he stumbles around with a bloody knife. He calls 911 from his cell phone and tells the dispatcher that he's been stabbed. The ambulance crew (Go Team 42!) responds, doesn't stage, and runs to the now-unconscious Dexter's side with no regard for their safety, minimal equipment (who carries a jump bag on their lap?) and (convenient tie in to my CSI Fairview posts!) absolutely no attempt at evidence preservation. 

As they kneel next to him, Dexter pulls out two syringes and jabs both responders in the throat. See what I mean about the hands being dangerous? He then puts them in the back of the ambulance, interrogates them, and pretty much does the typical Dexter thing. Apparently these two knuckleheads were trafficking human organs out of their ambulance with the help of a crooked doctor, or some such nonsense.

His finishing move involves a Lifepak 10 (seriously? Those still exist?) and one paddle on each bad guy. If I'd only known you only needed one paddle/electrode to do the job, I could've saved literally seconds of my life over the years! 

He didn't charge to 200 (or even Extra Crispy), didn't yell "CLEAR!" and shot all the American Heart Association's protocols to pieces.

Aye carumba, oy vey and holy schlamoly all rolled into one. It was really, really, ridiculously bad looking. For reals.

Making things worse is the fact that Dexter's voice is on a recorded 911 call, and the ambulance crew (crooked or not) would be missed very quickly. And stabbings always warrant a police response. None of this scenario made any sense. He could have just made a normal BS complaint - flu-like symptoms or toe pain, maybe - and gone from there.

Hopefully this was a bizarre detour from the normal exceptional production value and strong writing behind this show.

[end crotchety old man-style rant]

Stay tuned for the CSI: Fairview - Stabbings post!

Kilted To Kick Cancer

That whole "being-out-of-the-loop-for-two-months" thing really threw me off. 

While the month is nearly over, I'd like to call attention to Kilted To Kick Cancer.  This is a campaign started by Motorcop and Happy Medic to promote awareness of male-specific cancers.  With morbidity and mortality rates of these cancer matching that of breast cancer, these gentlemen have been wearing kilts to spread the word.  It's a great campaign, and a great cause.

All too often, we (that is, men) play Russian roulette with our health.  The public safety field seems to be full of caring and compassionate folks who spend their entire careers worrying about the health and safety of our communities, but we frequently don't pay enough attention to our own needs.

So man up, put on your big boy kilt, and go get a cancer screening.  The life you save may very well be your own!

CSI: Fairview - Shootings

The second crime scene I'd like to address is shootings.  In a perfect world, you'll be dispatched to a shooting and then stage until law enforcement determines that it's "safe" to enter the scene. Motorcop and Happy Medic have talked about scene safety on The Crossover Show in the past, and scene safety means different things to different folks, but I digress.  Once cleared to enter the scene, you can go to work on the patient(s) and save the day.

We don't live in a perfect world, though. Shocker, I know.

I've run more than 50 shootings in my career, and they're typically pretty dynamic scenes.  I've had the unfortunate honor of being on a number of unsecure and unsafe shooting scenes, and made it out safely, but I don't recommend it to anyone sane.  Of course, most of us in Public Safety dance on the line between sanity and insanity, but I still can't really encourage you to be any part of an unsafe scene.

So, once the scene has been made (as) safe (as it'll get), you'll make your entry.  Maybe I'm just unlucky, but I can think of maybe a half dozen shootings that I've ever responded to that happened during the day.  Those of you with wicked maths skills have probably figured out that I'm in the dark most of the time - ha.  Flashlights come in really handy in those dark alleys and parks.

So, armed with your trusty flashlight, you (and probably some number of street cops with their own flashlights) walk into the scene.  You'll need to have your eyes constantly scanning for evidence.  It's not typically like a movie scene, and those nice big yellow evidence markers you're used to seeing on TV are probably gonna end up being folded 3x5 index cards or something similar.  In the initial flurry of activity, shell casings may not even be seen by the first officers on scene, let alone marked.  The last thing you want to do is kick a shell casing or step in some blood droplets.  That valuable forensic evidence you kicked away or turned into to a useless dirty smear probably won't make too many friends in the Detective Squad.

So as you scan for shell casings, blood droplets and pools, narcotics, firearms, and even assailants and suspects, make your way to the patient.  If at any point you have no choice but to destroy evidence, give the police officers the opportunity to see, and, if possible, document, the evidence before you alter the scene.

As you make patient contact, pay attention to their hands.  Even if the patient is a truly innocent victim of violence, their condition may make them prone to hurting responders inadvertently.  The patient may even be armed themselves, so keep that in mind.  A quick physical exam will help reveal both trauma and evidence, so it's a great idea to take a second and do a rapid full body exam.  This can (and probably should!) look like a pat down.  Pay attention to the waistband and pockets.  Should you find weapons, contraband or other potential evidence, make sure to notify the closest officer/deputy/trooper in order to secure the evidence and maintain the proper chain of custody. 

This whole pat down physical exam should only take 15 seconds or so.  As you go, note the normal medical findings, but also take special note of any bullet holes in the clothing and, in the case of close range shootings, the presence of gunshot residue (GSR) and powder marks.  Aside from the obvious clue to penetrating trauma in close proximity to that bullet hole, you'll want to take care to not cut through that hole or GSR when you remove the patient's clothing in the ol' strip 'n' flip.

Because gunshot wounds may or may not be obvious and the patient may not know how many times they've been shot, it's very important to remove all their outerwear.  All that clothing can be valuable evidence as well, so remove it with evidence preservation in mind.  Try to make as few cuts as possible, and if you can cut along the seams, even better.  If you can make a few straight cuts along seams, that shirt or pair of jeans will probably still look like a shirt or pair of jeans in 5 years when the evidence is presented at trial.  But a ragtag piece of fabric that doesn't look like clothing anymore just makes us all look sloppy.  It doesn't really take any longer to do it the right way, so you should really make the effort.

It can be very helpful to know the type of weapon that was used and the caliber of the bullet.  Those shell casings we talked about earlier can be a great indicator of that, but you won't make any friends by picking up the shell casing to look at it.  Under no circumstances should you take a casing to "show the hospital staff." Ask the cops -- this is their sandbox, and you're just visiting.  If shell casings aren't around, it might be pretty hard to tell what the patient was shot with by visual inspection alone.  This is common when the weapon is a revolver, in a drive-by shooting, and in some outdoor environments with lots of ground cover.  If the patient saw their assailant, they may know what they were shot with.  Even if you're unable to determine the size of the projectile, knowing if they were shot with a pistol, revolver, shotgun or rifle can be very important.

Another note about shell casings: especially if you don't know much about guns, a trip to a gun shop, shooting range or even the PD can teach you a lot about ballistic considerations.  It doesn't take much time to learn the difference between a 12 gauge shotgun shell and a .22 casing, and when you can actually see the difference in size between a .22 and a .223, you'll have a much greater appreciation for the difference that muzzle velocity makes in the impact on soft tissue.  Again, the size of the round can have a huge impact on the mechanism and severity of the patient's injury, but don't get caught up in trying to determine the information if it's not readily available.

Also, despite what you may have heard, it can sometimes be almost impossible to tell if a given wound is an entry wound or exit wound.  In truth, it doesn't even matter -- it won't make a bit of difference in how you manage the wound.

Once you've assessed the patient's injuries and initiated the appropriate treatment, you may believe that the time for evidence preservation has passed.  Many times, this is true.  There are some clear exceptions, though.  If for some reason you have the patient's clothes or other potential evidence with you, make sure that it's not disposed of. 

The patient's statements to you may be very valuable as well, especially if the patient is in extremis.  Shocking as it may seem, some shooting victims will refuse to identify their shooter to the police.  This can be out of fear of retaliation, or a desire to inflict their own retaliation, among other things.  If they give you a dying declaration that identifies their assailant, however, that could be the key piece of evidence that takes a violent criminal off the streets.  If the patient opens up to you, do your best to obtain the who, what, when, where, why and how.  The more you get from them, the better.  "Some middle aged white guy" is better than nothing, but "my ex's new boyfriend" is better.  A name, even a street name or nickname, can be better still.  If they don't know their attacker, a good physical description, along with a vehicle description and direction of travel can be very helpful.  You get the idea. 

Like I said last time, it's not EMS's responsibility to investigate the scene or catch the bad guys, but we can be valuable assets to our law enforcement brothers and sisters.  Situational awareness and proper documentation of the scene, circumstances and patient conditions can be very helpful to the investigating officer and agency.  Be aware of the presence and importance of evidence, and be careful what you do out there.  Vigilant situational awareness helps you minimize your impact on the crime scene, so work to maintain it. 

Again, this isn't meant to be all inclusive, and I welcome input from my EMS and LEO brethren.  Stay tuned for crime scene number 3...

Ugh.

All rumors to the contrary aside, I am still alive.

Social media issues at work compounded by unforeseen circumstances at home forced the long, unexplained absence.

Sorry, folks.

We'll return you to your irregularly scheduled postings shortly.

CSI: Fairview - Traffic Collisions

The first crime scene I'd like to address, and one that frequently isn't thought of as a crime scene, is the traffic collision.  When people are yelling & screaming for help and there are mangled vehicles everywhere, many of us fall into the tunnel vision-auto pilot trap.  We fail to keep our eyes open and assess for threats due to traffic, downed lines, weather. HAZMAT / fire issues etc.  We also fail to recognize that these responses are very nearly always the result of someone breaking the law.

It's important to note that evidence preservation will be much more important for a wreck with major injuries or fatalities than a typical fender bender, and common sense must be employed.  If you are first on scene of a minor fender bender that's blocking the roadway, there won't be some crazy investigation.  The cars should be removed from the roadway as quickly as practical and evidence preservation will be of minimal importance.

We march in, pull out tools, kick debris out of the way, cut the cars apart and in general destroy evidence from the moment we arrive.  On your approach to a TC, you should be assessing for all these hazards anyway, but there are few other things that all too often fall through the cracks.

As you approach the scene and select a safe and appropriate place to park your apparatus, be sure to avoid driving or parking over evidence.  This includes skidmarks, glass, debris puddles of fluid, damaged sections of roadway and anything else that wasn't there before the collision occurred.  If law enforcement is already on scene, park as directed -- the officers on scene probably won't direct you to park in an area that  destroys evidence or will impede their investigation.  If everyone is on the same page regarding blocking lanes, it'll be that much better.

As you approach the vehicle(s), in addition to continually assessing for hazards and scene safety issues, displace as little evidence as you can.  Don't kick debris out of your way, and if you do move evidence, be sure that law enforcement knows how you've altered the scene.  If it's feasible, allow law enforcement a moment to see the vehicle(s) in it's final rest position before beginning extrication.  More and more agencies are implementing policies forbidding the taking of pictures on scene, and if you don't have a policy forbidding it and you do decide to take pictures, be aware that your pictures could end up being subpoenaed by law enforcement.  If there is any doubt about when a collision occurred, touch the hood of the car and see if it's warm.  This can help you estimate when the TC happened, and that knowledge could come in handy later.  If the engine block is cold, it's probable that the wreck happened some time ago and has only recently been reported.  This is good to know, particularly in late night DUI collisions with minor injuries, as the drunk driver may have delayed reporting the accident in the hopes of sobering up before the cavalry arrives.

As you evaluate the vehicle and patient, assess for injuries and evaluate the mechanism of injury, bear in mind that the indicators we use for these purposes frequently help law enforcement investigate the scene.  That beer can jumps out as evidence, but what about the prescription bottle?

As you begin the process of extricating the patient, the scene can change quickly and dramatically, especially in a complex rescue situation.  Evidence can be altered and destroyed, and care should be taken, when practical, to minimize this.

Once the patient is extricated, law enforcement will frequently try to obtain a statement from them.  If the patient's condition allows for it, it's helpful to allow the officer to obtain the statement while still at the scene.  Bear in mind that the patient's injuries themselves may be evidence (ie, forehead trauma consistent with striking the windshield, seatbelt abrasions, etc) that will contradict a patient's statement.  This frequently happens with DUI/DWI collisions or when a driver is unlicensed.  They lie about where they were in the vehicle at the time of the collision.  If your physical findings contradict the patient's statements, it's a good idea to OBJECTIVELY document that.  Slurred speech, odor of alcoholic beverages (not the odor of alcohol itself -- it's odorless), horizontal gaze nystagmus (HGN) and other physical signs of intoxication are important for both you and law enforcement.  A blood sugar will  be important to obtain as well, as drunks can play the diabetic card and diabetics can appear to be drunk.  Pupillary response can be an indicator of both head trauma and narcotic use, so be sure to document those findings as well.

If your jurisdiction and agency protocols and procedures allow for an evidence blood draw, follow those guidelines.  If not, or the officer doesn't have the blood kit, then don't do it.  There's not a lot that's more frustrating than watching a drunk go free because of improperly obtained evidence, and you don't want your blood draw to be the weak leak in the chain of evidence.  Using improper technique or standard blood tubes is a great way for a savvy defense attorney to get a drunk off the hook.  The rules of evidence require that the chain of custody not be broken, and standard blood tubes don't typically meet the criteria for a legal blood draw.  

Also be aware that doing a favor for a cop buddy can turn around and bite you down the road if your agency or protocols forbid the blood draw.  If the case goes to trial and you get subpoenaed to testify in the case, you will probably find yourself in hot water for violating the rules.  Getting drunks off the road is great, but not at the risk of a medic losing their job.

Another issue to consider is vehicle vs pedestrian incidents.  When this happens, someone screwed up, and the potential for serious injury is very high.  Be especially alert to anything that immediately suggests fault, especially if the evidence contradicts the statements by the involved parties.  If your pedestrian patient is clutching a paper bag with booze in it or has a death grip on their cell phone, that suggests that inattention to their surroundings could have contributed to the incident.  If the pedestrian was in a crosswalk in good lighting conditions, that suggests that the driver may have been the inattentive one.  If the ped was wearing dark clothing and crossing the street at midnight in the middle of the block, they'd be hard to see.  If the EMS crew removes the patient's clothing and disposes of the clothes upon arrival at the hospital, they've destroyed evidence that could be pivotal in determining fault.

While it's not EMS's responsibility to investigate the scene or determine cause from a legal perspective, situational awareness and proper documentation of the scene, circumstances and patient conditions can be very helpful to the investigating officer and agency.  Evidence can be smaller than paint chips & glass fragments and larger than a Mack truck, so it's important to be aware of its presence and importance.  Evidence can be cars, people, clothes, vehicle contents, personal effects and just about anything else, so be careful what you do out there.  Pay attention to your surroundings, and minimize your negative impact on the crime scene.

Again, this is not meant to be all inclusive, but it's a good start.  Stay tuned for the next crime scene...

CSI: Fairview - Intro

Nope, it's not CBS's latest wannabe prime time hit -- it's how I'll (not-so) lovingly refer to many of my coworkers here in the land of dreams and schemes.

Crime Scene Ineptitude (Idiocy? Ignorance? Incompetence? Imbicility?) seemingly runs rampant among my fellow medics and firefighters.  I'd love to be able to say it doesn't, but we all could learn a lot from the cops when it comes to responding to crime scenes.  This topic can easily (and, dare I say SHOULD be...) be addressed in an 8 hour class, so while the scope easily exceeds what I can write about here, I hope to at least increase awareness...

While it's impossible to address all of the possible crimes fire & EMS would respond on, there are a few biggies that are worth addressing briefly.

As a quick overview of my own experience, I started out on this crazy planet as the son of 2 MPs.  I became a law enforcement explorer in high school, and did my EMT training on the grounds of a highly respected police academy.  Our training consisted of significantly more hours of classroom time than the EMT curriculum requires -- roughly 350 hours of didactic time -- and a large part of that training was on thinking tactically.  We did a lot of crime scene awareness exercises, and I feel I know more than the average bear about responding to crime scenes.  My paramedic program didn't acknowledge crime scene operations beyond admonishing the age-old "scene safety" advice, but a decade of practicing what I learned in EMT school has paid off handsomely.

Despite my 10 years of experience and training, though, I AM NOT a cop, and have never worked in law enforcement.  Most of this stuff makes sense if you think about it, and, if put into practice, will greatly improve the working relationship you share with allied agencies.

In the following days (weeks?) I hope to address some of these common incident types and the mistakes we make.

Stay tuned!

Don't Be a Jackass

I awoke this morning to the news that Ryan Dunn of Jackass fame lost control of his vehicle early this morning.  The traffic collision claimed the lives of both Dunn and his as-yet-unidentified passenger.  Dunn posted a picture of himself and two other men drinking just after midnight, and just under two and a half hours before the traffic collision.

Police are still investigating the collision, and alcohol and high speed are suspected factors.

While the full investigation will likely take some time, the preliminary facts are indisputable:

Mr. Dunn and his companion were in his 2007 Porsche 911 around 0230 on the morning of June 20th, 2011.  At 0238, the West Goshen Township Police Department received a report of a traffic collision near Route 322 and Pottsdown Pike.  The first arriving officer found a fully involved vehicle occupied by two deceased adults.

Mr. Dunn had been at Barnaby's of America, a West Chester, PA bar, prior to the collision.  A picture of him with two other men was posted to his Tumblr account at around 1215.

Now, with those facts in mind, the following is PURELY SPECULATIVE.  Traffic collisions at that hour are frequently the result of impairment, either from operating under the influence of alcohol or drugs or lack of sleep.  The fact that he was at a bar is significant circumstantial evidence that alcohol use (not necessarily impairment) is possible.  The degree of damage to the vehicle suggests that high speed was also a factor in this collision.  The scene of the wreck is approximately one mile from the bar.  It seems to be reasonable to speculate that Mr. Dunn's death, and that of the other occupant of the vehicle, resulted from driving under the influence.

If that proves to be the case, this incident is a highly tragic and entirely preventable end to two young lives. To that end, please consider the following video:

Smooth Operator

Let me tell you about the coolest guy I work with -- he's a legend in his own mind.  A self-proclaimed hero.

The rest of us know him as a giant bag of tools.

So Mr. Smooth has tried to foster the image of himself as a renaissance man -- he's one of those d-bags that knows more about anything than anyone else.  Not only is he a jack-of-all-trades, he's mastered them all.
 He's in his late 30's and recites the Dazed & Confused line "That's what I love about these high school girls man, I get older, they stay the same age" as a mantra and a way of life.  His estranged wife is 8 months pregnant with his second daughter, and his current girlfriend just graduated from high school last week.

I really don't like this guy.

So Mr. McBride, as I'll call him, also has the charming habit of being creepy and lecherous 24/7.  He'd hit on a nun that collapsed during Christmas Mass without a hint of shame.

There've been rumors about McBride chatting up prostitutes on duty for some time, but most of us dismissed the rumors, thinking that he wouldn't be dumb enough to do that.

It seems we were all wrong.

While on duty yesterday, he stopped and talked to a working girl while getting lunch.  An FPD Vice detective walked up and told both of them to take a hike.  McBride kinda blew him off, but the girl was smart and took the hint.  The detective then identified himself as a detective, and informed McBride that Vice was preparing to sweep the area and round up a bunch of pros and johns.  McBride finally wised up and left the area in his ambulance.

He was later sent to a medical aid call for an unknown man down.  He arrived to find a beaten prostitute (not the same girl from lunch) who didn't want transport to the hospital. He decided it would be a good idea to give her his number, and offered to treat her injuries himself when he got off duty.

And that's how Vice found him this morning -- shacked up with the girl at the local No-tell Motel. They both got arrested, and his career is likely completely done.  It sounds like the girl is a 16 year old runaway, and this waste of oxygen exploited this broken child for his own selfish gratification.

What a complete and total embarrassment to the entire public safety community.

Blinded By the Light...

Wrapped up like a douche. Dressed up like a dude. Wrecked up like Medusa. Knocked up like a douchebag.

Okay, so misheard lyrics don't have much to do with anything here, but since I blatantly stole the song's title for this post, there ya go.

Anyway, we get sent to a cardiac arrest in the world's tiniest apartment.  We arrive at scene and climb the three flights of stairs (of course) to access the patient's residence.  I walk in to find two beat cops working the patient up in the smallest kitchen in the history of humanity.  Seriously, this thing is so narrow we can't get an 18" backboard in to the patient.  The cop controlling the patient's airway is squatting and grimacing like a catcher that should have left home plate 3 or 4 innings ago, but he mans up and volunteers to stay there while we move the patient from the patient to the outside breezeway, which is the only place we can work without claustrophobia and/or furniture and walls getting in our way.

The cop doing compressions gets out of the way to help us make access and take over treatment. I straddle the patient to take over compressions while we evaluate the quickest and easiest way to move our patient.  Due to the close quarters and our inability to get the backboard to the patient, we decide to just drag the patient outside.  With the plan made, I feel like things should finally start to move a little more smoothly.

That's when the kitchen light burns out and we are plunged into darkness. 

Awesome. 

I decide to stand up and stop compressions for a moment to pull out a flashlight. The cop behind me had the same idea at the same time, though, and, believing that I was still straddling the patient and doing compressions, pulled out his 6 cell Maglite. He snapped it toward his partner like he was deploying an ASP (watch this video if you're not sure what that means) just as I stood up.

I heard the thud as the light crashed into my skull. My vision dimmed, the stars came out, and I almost fell over. BAD times.

So the cop apologizes profusely, I attempt to clear my head, and we finish running the call. 

Our patient, an elderly frequent flier with an extensive medical history, died in the ICU the next morning without ever regaining consciousness. If he had one of those Hollywood style out of body experiences while we worked the arrest, hopefully he got a chuckle at me getting clobbered by the Maglite as he walked toward his own light.

A couple of Excedrin later and I felt like myself again. Oh, and as a huge bonus, the cop brought me a hard hat and a quart of cookie dough ice cream. I'm sure we'll be laughing about the incident for a long time. He even drew me (on a napkin, no less) a cruder version of this:

 Good times.

Rites of Initiation, Part 1

After reading Motorcop's post on Supreme Court Double Dog Dares, I was inspired to write this...

As George Bernard Shaw once said, "youth is wasted on the young."  While Mr. Shaw probably wasn't talking about new public servants, I think the idea carries over to our new guys, many of whom are likely to start puberty within the next 6 months.

Everybody knows the new guy.  We all call them something different - rookie, rook, boot, probie, new guy, FNG (F'n new guy), greenhorn, etc - but they're all talking about the same guy.  He's probably young and thinks he knows everything.  He probably takes himself WAY too seriously.  And your newest pair of boots is probably older than him.

While many of our "new guys" are actually not guys at all, some of our new men and women have a highly charming combination of entitlement, arrogance and self-importance.

To be fair, most of our probationary employees are good employees, but there are always folks that aren't yet living up to their full potential.  This post, however, isn't about them specifically.  Instead, it's about the rites of initiation we can put them through.

Now, don't mistake me here.  There have been many high-profile incidents in the media over the last few years that make us all look terrible.  Hazing and all other kinds of bullying are serious problems, and there's no place for it.  Hazing and bullying can cause all kinds of physical, psychological or mental harm to the victim, and expose the tormentors and their agencies/employers to serious civil and criminal liabilities.  If you're hazing someone, stop reading this blog and figure out where you screwed up in life.  Many of the hazers out there were hazed themselves and feel the need to perpetuate this vicious cycle, and this is decidedly not okay.  If you're jeopardizing anyone's health and safety, wasting department resources, delaying emergency response or in any other way acting unprofessionally, you're doing it wrong.

I'm talking about team building exercises that help the rookie learn to take themselves less seriously and quicken their transition into public safety.  I'm talking about station pranks.

Shenanigans.

To paraphrase, shenanigans are cheeky and fun.  If your shenanigans are cruel and tragic, you're probably Farva, and you're probably hazing someone.

Proper shenanigans help the rookie relax a little and, ideally, help them learn.  One of the easiest (and most common) things to do is to send them on a fool's errand.

Done right, this involves the rookie wandering all over the station, often for quite some time, looking for something.  Aside from entertaining the rest of the house, it teaches the rookie to ask questions and clarify orders.  Some of the typical tasks include finding:

#7 Fallopian tubes
Strobe rotator grease
Ladder stretchers
Sky hooks
Electrode chargers
Helicopter landing gear
Neck tourniquets
Tubes of elbow grease
Water hammers

They can also be sent to rotate the air in the tires of the backup rig, shake all the IV bags to preserve freshness, replace the squad's spark plugs or even sent to fill out the ID-10T (idiot) form.

While rookies are fun to tease, the whole point here is to bring them into the family.  If you're making them feel like an outsider, you're screwin' up.  So make sure that the rookie isn't singled out.  The shenanigans should extend to the other members of the crew, too.  You've also gotta make sure that your timing is appropriate, and that the victim's got a good sense of humor.  Also, if you aren't able to take it, you better not dish it.

A can't-miss crowd pleaser is to switch the victim's mattress and box spring and remake the bed like nothing has happened.  The great thing about this one is that it won't typically be discovered until bed time.

Another good one is to buy a universal remote and program it to work on the station's TV.  If you select your victim carefully and only use your remote sparingly, you can torture him for months.  If you can pass the remote around to other crews, he won't know who to suspect, and if it only happens every week or so he'll slowly go crazy as the channels randomly change on him.

If your rig is equipped with a field programmable keyless entry (most Fords), pick a spare one up off eBay.  Program it to work on the vehicle, and if you do it right you can convince the new guy that the doors are voice activated and programmed by saying a specific (and embarrassingly goofy) phrase.  When he speaks the phrase, you lock or unlock the doors.  When it stops working, have him fill out the proper equipment repair forms.  Works even better if the Chief is in on it, and best if the 'programming phrase' is insulting to the Chief -- but only if he's in on it...