This is one potential question on the NCLEX, the national licensure exam for RNs. Asking this to a CNA is like asking your dog to do calculus. With an abacus. Blindfolded. It's as wrong as two boys f**king. For any RN, it's a lay-up. An easy shot. Follow up questions: Why is this rhythm important? What should the (actual) nurse do next? Answers at the bottom.
For whatever reason, Angus is under the severely-misled misimpression that a CNA with a one-month classroom and clinical certificate (total, all-in) is functionally identical to an RN with two to four years of upper-division college education and a nationally recognized license.
He states the difference between a CNA and an RN is "Not much."
A CNA is a 60 hour course, and less than 3 weeks' supervised clinical training. In CA.
Florida CNAs need even less than that. (Color me shocked.)
An RN, by contrast, is a two- to four year degree program leading to national licensure, including more clinical hands-on hours in any month than CNAs require for their entire certificate. (Florida RN licensure may be less rigorous, IDK, but that's why an RN from CA, NY, or IL can work in all 50 states, and nurses from the Gulf Coast belt can generally not get hired anywhere else without extensive testing and additional classes unless they go to similarly low-educated states. Mississippi nurses right out of school, for example, can generally not go out-of-state to anywhere else. That's not for nothing.)
Apparently we really have to go into why one of these things is not like the other one.
Starting with CNA's having a state-specific certificate, not a professional license recognized in 50 states and seven territories.
This is the difference between a vet tech, and an actual vet.
One of those cleans animal cages, and the other one diagnoses animal illness.
That's why a CNA (an expired-certificate CNA to boot) passing herself off as an RN is committing criminal malpractice.
A CNA has exactly zero training, experience, or competence in assessing patients, absolutely none in pharmacology, nor in pathophysiology, gerontology, obstetrics, pre- and post-op surgical care, pediatrics, psychology, critical care, or about a million other things large and small that even a new grad RN walks out the door with from school before they can pass their boards.
A CNA literally lacks the knowledge of about a dozen 800-page nursing textbooks, whereas to get a CNA certificate, if you don't put your shoes and socks on in that order, you'll likely pass the class. The number of CNAs anywhere who could take and pass the NCLEX without years of study is going to be 0.000%, nationwide, since ever, even one with 25 years of floor experience behind them.
A CNA literally doesn't know what she/he doesn't know, any more than the guy who sweeps out the hangars at Boeing is a qualified aeronautical engineer. (As recent unqualified DIE hires at Boeing have demonstrated, in case anyone was watching.)
It's that big a difference, and anyone - family or not - telling someone otherwise with a straight face is talking out their other end.
And by "early on", apparently Angus is referring to 150 years ago, when even doctors had less actual medical knowledge than a modern EMT possesses. Yeah, things have changed a wee bit in nursing since Florence Nightingale got the ball rolling in the Crimea. Which is why CNA is a few weeks of night school, and not a college degree plus 3-12 months of directly-supervised clinical hands-on experience that an RN license requires. (CA requires 500 hours, minimum. My program was closer to 1300 hours.)
Putting it gently, Angus kind of stepped in it with both feet.
A CNA takes vital signs (with a machine that does 90% of the work), helps change dirty diapers and linens, and walks patients to the bathroom. That about exhausts their entire clinical skill set, and many of them are hard-pressed to be barely competent at any of that. Like I-didn't-realize-that-a-pulse-of-180-should-be-immediately-flagged-to-the-nurse/doctor barely competent. I've only seen that one - or one like it - about a thousand times in 25 years.
That skill set was covered my first week of nursing school, and they expanded on that to quite a degree over several years. Almost like one was a dead-end entry-level cert, and the other was a bona fide medical profession.
I don't know why anyone would lead someone to believe it was otherwise, but anyone so informed has been rather egregiously misled.
In Angus' experience wheelhouse, on the skillset continuum, it's the difference between a tank loader 5 minutes out of school at Ft. Benning (it still makes me shudder that it's not at Ft. Knox any more), and a SFC with 16 years in Armor who's the Tank Commander. (In point of fact, that loader got more - and better - training at his 19K MOS in 8 weeks at Ft. Benning than most CNAs get in school. EVER.)
*(Answer: C. V-tach. It's important because if it's pulseless V-tach, the patient is in cardiac arrest, and the nurse should get the defibrillator and zap that patient pronto while calling "CODE BLUE" loud enough for everyone within earshot to hear and respond to. Total amount of time CNAs get educated and trained to know and do this: Never. Period.
Whereas for an RN, any RN, it should be automatic. Anyone who sincerely thinks the difference between a CNA and an RN is "not much" should let their grade-school-aged kids take out their appendix or gallbladder with kitchen utensils, and get back to us on how well that worked out. That's what expecting a CNA to be an RN is like.)
*** ADDENDUM ***:
If you came here, read this, and then ran over to dogpile Angus at his blog, please stop. (If anyone this applies to didn't read follow-ups there, that speaks for itself.)
1) Like most blogs (including this one) comments are moderated, meaning rude and obnoxious rejoinders disappear into the ether. Just like here.
2) Take the time to note Angus' multiplereplies and amplifications on the original topic (and a couple of spicy ripostes for people doing it wrong. It's clear that what came out in his first post wasn't precisely what he meant to say, i.e. that CNAs doing CNA tasks do them as well as RNs. (We have no argument whatsoever with that contention, though we do wish it had been phrased better originally.) And that some jobs require far more licensure than the tasks that make up the job entail. We absolutely agree with him on that point as well, and we have no doubt some idiot managers over-mandate licensure levels a given job at hand doesn't require, in a phenomenon not limited to the medical arts.
3) That doesn't mean that the wingnut deliberately perpetrating a professional fraud in the OP deserves a pass (she deserves to get hammered into the ground, in fact) but it does illustrate that whoever classified that job as one requiring an RN license grossly over-stated the necessary qualifications to excel at it. Why anyone running a business would be as stupid as to do that in the first place is beyond explanation, but then so is demanding an RN license, and then performing no due diligence to ensure that anyone considered for the position actually possessed one. Stupid is as stupid does.
I got the clarification of what he intended by his second post on the topic. There have been at least two more since that, for a total of four, not counting the pointed reminders that going to his blog (or anybody else's, in nearly every case) to storm in and crap on the carpet will never see the light of day. The list of blogs on the internet where even being right, if you're a right dick about it, will get your missives discarded, is long, and distinguished. This should not be news to anyone.
FFS, I agree with Angus on many important things (guns, the military, and most current events, to name but three) more than even he thinks, even if we're not carbon copies of each other. What a boring internet that would be. And if you're going to disagree with anyone online who's worth the trouble, do it within the bounds of decorum. You'll get more flies with sugar than with vinegar.
If that's too much to ask of anyone, I don't want to know you.
Coming weeks will determine whether the entire Democommunist Party and its adherents are simply a societal emetic, or instead an actual civilizational laxative.
Either way, the purging is going to be a sight to behold.
Stock up on beverages and popcorn.
The only thing to remember about 2028 is that it's coming, and there's nothing you can do about that. Plan ahead now, so you've little to worry about come the day.
B thinks his situation is the exception to the rule, because time/distance.
Sorry, B. But almost certainly, no.
Ditto for the rest of you. I don't care where you live (unless it's Alaska, 200 miles from town, and you and your float/ski Super Cub are 9-1-1).
---
Suture Self approach: You elected to self-identify as an Ambulance/Driver.
Points To Ponder:
So, if things go to total shit while you're driving someone to the ER, do you stop, pull over, and hope the ambulance - which you'll now have to call anyways - can try to find you somewhere between home and the hospital? What have you got in the car that you didn't have at home for that eventuality? Starting with space, and a well-lit area?
Or do you step on it, trusting to your cat-like reflexes and total lack of red lights and sirens to get them to the ER yourself, and hope that 14 minutes without a heartbeat or oxygen, or sufficient blood flow, can be overcome by medical arts and luck? And that you won't crash on the way, and injure or kill more people in a vehicle neither designed nor intended to transport critical patients at high speeds, with a totally untrained and emotionally compromised driver at the wheel?
What if there's a Big Accident halfway there that you can't get around or through, lacking flashing red lights and a siren?
What if the person you're bringing crumps in the parking lot of the ER, at night, and now you have to go get the ER staff to play Hide-and-Seek, in the dark, with your unconscious (or dead) relative?
What if you went to the wrong ER, because they're not the place equipped to handle the problem? What if they're closed to certain patients, because their CT scanner is down, or they have no cath lab team for a heart attack, or they're so overcrowded there's literally nowhere to treat the patient but the parking lot?
The ambulance would have known that before they got to your house; you don't.
The reason you call an ambulance is that the ambulance brings the ER to you. Paramedics were literally invented 50 years ago to prevent the exact scenario you're describing.
---
I had some poor (well-meaning) jackass once decide to bring his elderly wife, with a history of cardiac problems, to the ER for chest pain, from only five minutes from the hospital. In town. With the FD's paramedics two minutes away from his house.
She went into full arrest two minutes out, and arrived DOA, and a lovely shade of gray.
And received no treatment for another couple of minutes on top of that for the time it took us to get a gurney and a team, pull her dead ass out of the car and onto the gurney as a sack of jello with sticks, start CPR in the driveway outside the waiting room, and get her inside to a treatment area.
We managed to restore a pulse after several minutes. I don't know her long-term outcome, or if she had any resultant brain damage.
I do know if he'd called 911, she would have received vastly better care, from beginning to arrival. And he wouldn't have been kicking himself for risking killing his wife because of panic.
All of the care she needed would have happened before she got to us in the back of an ambulance, i.e. instantaneously.
Every minute you go without CPR decreases your survival chances by about 7%.
And that's best-case.
(i.e., except for cold-water immersion drownings, after 15 minutes with no heartbeat, we're probably just saving the body for organ donation, and making the family feel better. Hard truth. Do CPR as long as you want. Reality is still a bitch.)
And you can't do CPR and drive a car.
---
Serious bleeding?
Traumatic Full Arrest, because the victim bled out, which you can't monitor, nor do anything about while driving a car, can be managed and headed off en route by paramedics just by starting an IV and administering fluids (which you can't do either of from behind the wheel), as well as by applying the tourniquet you probably don't have, and positioning the patient better in a vehicle designed for a stretcher with a critical patient on it.
OTOH, the survival rate for TFA runs into single digits.
And that's if you're smart enough to go to a trauma hospital (which - NewsFlash! - isn't every ER).
---
Anaphylactic shock, with closure of the airway?
What, you have no meds for treating that on hand? You can't intubate en route? Bummer.
---
And on and on.
There are rare exceptions to the rule, and there's always sheer dumb luck, but as a general rule, the impulse to scoop-and-go on your own with no medical capability en route is a foolish one, with statistics to match, and you're throwing dice with Death with someone near and dear to you as the chip pile, every time you do it.
Anybody that survived riding with you could have waited for paramedics at home, where you don't have your hands full of steering wheel, and can do things that can actually help if they get worse.
You fly planes, B.
In your terms, you're the guy telling the CFI/CATP with 20,000 hours you know better, and hoping you get back to the field before you run out of altitude, airspeed, and ideas.
Some few times, it might work.
Mostly, not.
The quote about bold pilots comes to mind.
If arrival time of medical aid is an issue, you're far better off getting medical training yourself and having a basic kit, than you are trying to be Mario Andretti.
Even if you live in BFEgypt.
The only transport that should ever be contemplated is to move them to a more advantageous location for either a handoff (say, at the dirt road where a maze of unmarked country roads meets paved highway), or getting them out of a forest or canyon to someplace where emergency vehicles or a helicopter can make a rendezvous/find an LZ.
Even then, all the drawbacks I noted still apply.
You should probably have at minimum two people to transport, so somebody is monitoring the patient at all times, with enough kit to intervene, within your training and abilities. If you haven't got that, the odds of making things worse rather than better just multiply.
And the time to play what-if, just like with flying, isn't after all the yellow and red lights on your panel start coming on.
You grok flight plans to the max, amirite?
So make a Medical Action Plan.
Talk with somebody local with serious medical training, and work out now what to do ahead of time for your exact area/situation, instead of trying it on-the-fly after your adrenaline has pegged at 11.
Somebody's patient, somewhere, may have blown out a varicose vein at work, managed to spurt out two units (a liter) of blood while driving to the hospital, had it immediately repaired by the ED MD on duty, and then, apparently stable, have then actually gone into mild shock, passing out, and requiring fluid resuscitation with half a gallon of normal saline, and required a hospital admission, for "just a little bleeding".
If that were my patient, I - of course - couldn't talk about it because of HIPPA laws. But there's always the possibility it happened somewhere.
Which is why keeping at a minimum some QuikClot, a roll of Coban, an ACE or Israeli bandage wrap for a pressure dressing, and a CAT-T tourniquet or equivalent, in a small and handy vehicle first aid kit isn't just a random option.
You may not be interested in trauma, combat medicine, or bleeding control, but that doesn't mean trauma isn't interested in you. Failure to plan is planning to fail.
This was "just a little ruptured vein". That wouldn't stop. This patient didn't get to the hospital. But they made it to the morgue. Leaks - ANY leaks - in your meatsuit can be terminal.
Unless you want to roll the dice on passing out in your car at freeway speeds, injuring yourself and possibly other people, and ending up in shock in Main Trauma all busted to hell, after the equivalent of a pinhole in a minor superficial vein turned into Demolition Derby. All because "you thought you could make it to the ER okay on your own", right up until things got hazy, and your car went all spinny and flippy and perhaps explodey.
Don't want to deal with the hassle of having that kind of stuff near to hand, anywhere, anytime?
Preserving HIPPA and general confidentiality, suffice it to note that Some Unnamed Agency in SoCal was doing high-speed low-drag range training, during which, despite all good intentions to the contrary, bullet fragments went uprange at a high rate of speed instead of down range. And into people.
Bad ju-ju.
Did training end?
O no it did not! It simply transitioned from Weapons training to Casualty treatment and transportation training.
Bad news? Multiple GSW casualties.
Good news? All, thank a merciful deity, walking wounded, minor injuries, and discharged home same day.
Adopting The Other Ryan's trusty AAR format, we proceed with the particulars.
The Good
Pretty much everything.
Immediate training halt. All weapons safed/secured for patients and medical personnel. Multiple victims, swarmed by multiple TCCC-trained doods, treated and properly field-bandaged within half a minute.
OIC not only knew who/where it was, but made immediate telephone contact with nearest trauma ER, and spoke with on-duty MICN. Given somewhat extended transport time, and relatively minor nature of wounds, all victims transported Code 3 by black and whites to said trauma center, and probably well in excess of the speed of anything but a Lifeflight helicopter (which would have been ridiculous levels of overkill in this instance). All victims seen by MD within less than 30 minutes of initial incident. Which borders on best-case time, as the training range in question is 20+ minutes' travel time away on a good day at normal speed.)
Better still, had it been necessary, agency OIC was prepared to send escort unit to meet EMS and guide them to victims, had their direct contact number on speed dial, and knew the designated Lifeflight/EMS helo LZ, had the injuries been more serious. Quickest route out was well-briefed, and all units and patients arrived at ER in convoy.
The Bad
Not much. Multiple trained medics, but no designated medic per se. Fog of war also led to confusion on number of casualties. One turned out to be two, which turned out to be three. Oops. Adrenaline and small fragments will do that; minor initial wounds are easy to miss when you're young, healthy, and amped up.
Were I consulted, I'd suggest permanent or ad hoc Battle/Training Buddy Checks: everyone is paired up at initial briefing, and once there's an incident, each person checks himself, then his buddy. Designated medic(s) check each other, then triage, assess, and treat all ID'ed as wounded, and report level of injury. That's about the only thing they didn't do that they should have done, or something like.
The Ugly
Nothing. We should all be so lucky. And if you prepare in advance for just this type of thing like their OIC did, you too can be similarly "lucky".
Luck is the residue of diligent preparation.
BLUF:
If you shoot (including hunting*) regularly, at least one entire annual practice session should be a full casualty rehearsal, so that when it's real, you don't cock it up. Because if you do, you'll beat yourself up for years afterwards with coulda/woulda/shouldas, and it's too late to be wise then, and just jacks up your stress, blood pressure, and ulcers.
If you shoot in a group, it should be a group thing. Including updating medical info kept either by the group, or on each individual's person: blood type, last tetanus vax, medical history, allergies, surgeries, meds, doctors, and who to call (or not), and how to do that. And full hands-on practice victim treatment, including packaging for transport/transfer. (Which includes safety and security of all operable weapons - guns, knives, grenades, etc.!! - on both patients and all responders.)
And "MEDICAL" should be one of the briefed contigencies gone over at the beginning of any training/shoot day, even if it's just to say "The plan is the laminated card on top of the group first aid kit; the nearest ERs and EMS numbers are on the back of the same card."
If you shoot solo, you should use it to go through your IFAK/Oh Shit GSW/trauma kit, and update location info, emergency contact and transport/evac plans (P-A-C-E:Primary,Alternate, Contingency, Emergency) for the nearest EMS and ER locations. If you don't have that many, you're doing it wrong.
Train like you fight, so you fight like you trained. "Winging it" is not a plan.
*(That would include leaving a route plan/hike plan with a relative, friend, ranger, or under the visor on your vehicle - or all of the above - in case you go down in BFEgypt, and can't hobble back to the vehicle, so folks will know where to start the search.)
{Nota Bene: I'm not telling you that you should even have a pill kit. Nor what to put in your pill kit. I will tell you what I've put in mine. YOYO: You're on your own, in every sense - medical, legal, moral, etc., after that. Big Boy Rules apply. I'm not a doctor, and even if I was, I'm not your doctor. You should consult yours in reference to assembling any such item as described herein. Read and follow all label directions. You should understand medication action, proper dosages, indications, contraindications, and cautions of any and every medicine you carry, take, or might hand out. If you don't do that, I will testify in open court that you are an unmitigated moron, and should not be entrusted with sharp objects or even shoelaces. Test me, and see if I'm kidding. That constitutes your boilerplate safety briefing for this module.}
Step One: Obtain one (or more) standard MOLLE 12-round 12 gauge shotgun shell pouch(es), in whatever color of the rainbow they come in, and from whatever of 200 manufacturers tickles your happy switch. IDGAF about either point, and it doesn't matter for purposes of this briefing.
Step Two: Go to the Travel Aisle of your local pharmacy retailer. Obtain at least two bottles each of Tylenol and Advil. Brighter students will figure out why. Stay with the class, please.
Step Three: Obtain a six-pack of small bead vials at Hobby Lobby, WallyWorld, Michael's Crafts, etc.
Step Four: Open all the 10-pill bottles of Tylenol and Motrin. Double pack each one. (FTR, I could get 14 Extra Strength Tylenols into one tube, and 18 Motrins into the other.
Step Five: Screw the caps onto those two bottles. Dump the extra pills back into the house supply, unless you have someplace else to put or use them. Put the two full bottles into two slots in the MOLLE pouch. They're almost exactly the size of a standard 2 3/4" 12. ga. shell. How cool is that?
Step Six: Peel the entire labels off the remaining two empty tubes. I put an entire 24-pill bottle of Aleve into one, and all 48 of a bottle of 81mg chewable baby aspirin into the other one.
Step Seven: Photocopy the labels from the bottles of origin of those medications, including name, dose, maker, lot number, expiration date, indications, and dosages. (The warnings etc. are Tom Clancy novel length.) Get some clear UV resistant packing tape, and label those bottles, sealing them outside the bottle, inside the tape.
Step Eight: Take the small bead vials (which are slightly smaller than a shell: 3/4" x 2 1/4"), and do the same procedure in turn with Immodium AD, Sudafed PE, Benadryl, and Pepcid AC. Obtain all in hard pill form,(not gelcaps, notever, which will self-destruct in the bottle by the time you wake up the next day.)
You've now filled up eight of your twelve slots.
The last four I selected were an antacid (Rolaids), SPF 15 lip balm, and Original and Less Drowsy Dramamine, the latter two of which already come in travel-size tubes.
Original curbs motion sickness. Less Drowsy is meclizine, which curbs the vomiting that results. Both are handy to have.
Benadryl is an antihistamine. Sudafed PE is a decongestant. Immodium AD is a world-class anti-diarrheal. Pepcid is an acid blocker, but the way it works is as an H² histamine blocker. The histamine response is why you swell up with allergic reactions, including anaphylaxis. I'm not telling you to use it for that. I'm telling you I carry it, because every ED physician I've ever worked for, uses 40 mg of it for exactly that, alongside 50 mg of the Benadryl. YMMV.
You now have a small pouch of OTCs that will stand you in good stead against most of the things you can treat yourself for, in multiple situations. Which clips and buckles onto the outside of all manner of pouches, bags, belts, etc.
The Rolaids being in a paper foil roll, I put them in a small ziplock bag (found in most jewelry craft aisles), making it completely water resistant, as the other bottle and items are already. (They won't survive prolonged immersion while wading the Amazon, but a quick dunk, or a steady downpour on the exposed pouch, won't affect them much.
You could do another pouch, with your own RX meds, antibiotics, etc, plus additional OTC items. Including water purification tabs. If you go by the hobby paint aisles at Hobby Lobby, etc., you can also find small polyethylene dropper bottles that seal absolutely tight, and hold about 1/2 to 1 ounce of fluid. (IOW, they'll pass a TSA inspection.)
You can (and should) then put rubbing alcohol, hydrogen peroxide, Bactine, povidone-iodine, household bleach, etc. from much larger bottles into those little versions, and label them, and they'll fit into such a pouch as well, or your main FAK, without them leaking. Thus making you able to carry a personal-use quantity of all manner of modern medical potions, without toting 6 gallons of liquid, plus the packaging for same, and in handy dropper bottles for direct applications.
(NOTE:Hydrogen peroxide, bleach,and povidone-iodine bottles should be either painted completely on the outside with black paint, or dipped into a dark shade of Plasti-Dip to the bottom of the cap threads, then allowed to dry, before filling, and labelling. This because ambient light rapidly inactivates all of the above.)
Label everything scrupulously.Check contents at least annually.Rotate stock as appropriate.
You've now got a world-class expeditionary medicine kit, in a space slightly larger than your newest cell phone pouch.
Warning: You may want to go at this in bits, because the components are rather pricey, done all at once. YMMV.
What you've done is tell me about your first aid kit for Apollo 11. (And, don't get me wrong, you've nailed that, as far as it goes.)
What you've forgotten is, you forgot to invent NASA.
Or build a rocket.
"Other than that, Mrs. Lincoln, how was the play?"
The wheels all come off right here at Point Four:
Stay connected with guerilla hospital and any available higher medical care
Um, excuse me, what "Guerrilla Hospital"??
The one you never planned for? Nor built? Nor stocked? Nor staffed?
Look, if this is just for mental masturbation, ROWYBS.
If available higher medical care means "you're going to be turned in to the authorities, and get tortured for information just as soon as you're well enough to tolerate it, and then be executed for sedition", what you're planning for is "shoot the wounded". We've already dismissed that clever plan long since.
So instead of telling us about the glorious flag pole on the skyscraper, humor us by telling us about the foundation, and the 100 floors from that to that flag pole, first. Then you can tell us about how the stars on the flag will be embroidered.
We're kind of sticklers for building things that way, as a recipe for some chance of success.
Just saying.
Hospital?
Where are you going to get your trusted doctors and nurses? (You ain't got those? You ain't got a "hospital.")
Where will you get your supplies, particularly medicines, in quantities of which you have no wild idea? (No medicines, in quantities approaching "metric fuckton"? No medicines, no hospital, even if you had the entire medical personnel available of the United States.)
The other supplies, from food to linens to sanitation to mortuary to consumable supplies (bandages, etc.) that you'll need every single day forever? Like rust, infection never sleeps.
Go to the local big-city hospital. Now, tell me how you'll be hiding that. Show all work.
Now, tell me the supply chain to get all that stuff, and keep it coming. From Wherever to You. Again, show all work.
This is like telling me how to operate the automatic body welder to make a Ferrari, without having a car factory. Or steel. Or tires. Or gasoline. You get the idea.
So, did you really want to talk about the weather, or just make chit-chat?
You wanna get into the real details? Cool. We've gone into it a timeorthree regarding bare-bones starting points. We've barely touched the tip of the iceberg, but you'd better start off by recognizing that iceberg before you hit it, and we welcome bigger and wider discussions.
Which you'd better have, at least with yourselves, if you want to do something besides kill your own people.
(We leave the greater question of "Partisan Medics? How about you start with some Partisans first?" for another discussion, another time.)
From Comments on an unrelated post last week, I was referred to, and requested to comment on, a specific medical advice post at The Firearms Blog:
Which we'll get to momentarily.
But first, let's review a few things, to set the table for the discussion that follows.
I. Tactical Combat Casualty Care
TCCC was originally developed jointly by SF Medical and NSW (Army Green Beret and Navy SEAL medics, for civilian pogues), by both their team medics and medical staff, shortly after Gulf War I and before Gulf War II and A-stan operations, and was rolled out as a military SOF medical course. The original concept was to identify the most frequent causes of combat deaths that could be reduced by timely field treatment by field medical personnel, with minimal additional gear. Massive hemorrhage, airway occlusion, sucking chest wounds, tension pneumothorax, IV access/fluid resuscitation, and hypothermia/shock prevention were identified as the biggest payoffs in treatment for the least outlay in training and medical resources. The information, once disseminated among SF, was deemed far too good to restrict to just the high-speed low-drag types, and well within the scope of ordinary medics, and even average troops, and was subsequently adopted military-wide, and then by civilian elements, starting with law enforcement tactical teams, and from there, on to ordinary paramedics, EMTs, and trauma specialists throughout the civilian world. There are currently 42 voting members on the Committee on TCCC, who decide upon and frequently revise the TCCC guidelines, and they represent deployed specialists and doctors from all service branches. It has been regularly updated, and rigorously field-proven in practice in two decades of warfare in SWAsia in Iraq and Afghanistan. Its adoption and promulgation on a widespread basis resulted in a phenomenal and unprecedented reduction in killed-in-action deaths, casualties who died of wounds, and preventable combat deaths. You could look it up. In short, this is evidence-based trauma practice from the pointiest tip of the sh*tty end of the stick, not just a couple of guys just spitballing what-ifs and pulling stuff out of their ass.
Covering all of TCCC is beyond the scope of this post, but we've done so in the past in abbreviated form,
along with some other perennially needful things, and you should be familiar with it if you're in the military, own guns, or simply might get jacked up by some miscreant or random injury. In short, if you have a pulse, the nuts and bolts of TCCC should concern you deeply and personally.
For your edification, if you haven't already done so, you can (and should) download the entire current TCCC course free from the following link:
Then read it, assemble the toys, watch the videos, and practice the skills, until they become second nature.
The military course for every Larry Lunchmeat (TCCC-ASM) in the dot-Mil is a total of 7 hours.
The Combat Lifesaver course (TCCC-CLS) is 40 hours, geared for previously non-medical personnel.
The course for actual medical personnel course (TCCC-MP) is 16 hours.
None of those should kick anybody's ass to master, but it's your ass, and your time, so either learn it, or suture self.
II. Your IFAK Blow-Out Kit
The TCCC items that should be in your Individual First Aid Kit - IFAK (or elsewhere in your gear) would be:
* a modern tourniquet (CAT-T or SOF-T recommended) - ideally as many as you have limbs, unless you figure you won't really need all of yours. At least one of them should be in the actual IFAK. The others can be anywhere in your gear. But if you think you need less, you're simply wrong, unless one or more of your limbs are already prosthetic. End of discussion.
* an occlusive chest seal (or actually, two, as many penetrating wounds tend to leave entry and exit wounds; or even more, as sometimes, you have more than one wound, or may be caring for more than one person)
* a chest decompression needle - or really, two to four, since it may take two pokes, and you have two lungs. (which item(s) is/are exactly the point at issue today)
* [for those for whom it's within their scope of practice and/or expertise, a cricothyrotomy kit, IV start kit, and appropriate IV supplies and antibiotics (that will be "NOT YOU" for 95% of readers here, so we ain't gonna cover any of that here)]
If you haven't got an IFAK that contains at least 6 of those 10 items already, you're just wrong.
And now, a few words about why this is germane today.
III. Tension Pneumothorax
First, basic lung anatomy:
Your lungs reside inside the pleural cavity (your chest), and they work as a bag-within-a-bag on each side (so our lungs don't rub up against your chest wall every time you breathe).
There are multiple non-traumatic causes for a pneumothorax, but we're only concerned today with the traumatic ones: penetrating or blunt, e.g. by gunshot wound(s) (GSW), explosive fragmentation, stabbing, one or more rib fractures, or blunt force (beating, motor vehicle accident, fall, explosive blast trauma, etc.). When something traumatically punches a hole (or holes) in your meat suit above the diaphragm, air can leak out of the inner sac (the lung) and enter the pleural cavity (the bags that the lungs sit in). This air is trapped, and cannot escape, and as more air gets inside the pleural cavity than inside the lung, the lung collapses.
1. Besides the original trauma, this hurts. A lot.
2. It cuts down on your ability to transfer oxygen in and CO2 out. This gets worse by the breath, due to the ongoing hole.
3. This makes you breathe faster (tachypnea). Normal adult respiratory rate is between 12-20 breaths a minute. Anything over 20, by definition, is tachypnea.
4. Which makes your heart beat faster (tachycardia). Normal cardiac rate is 60-100 beats per minute. Anything over 100, by definition, is tachycardia.
5. This makes you feel short of breath (dyspnea), and somewhere between uneasy and full-on panicky. The worse you are, the worse this gets. This, in the immortal observation of Cliff Clavin, is called a "vicious circle".
6. As the punctured lung collapses, it pulls your trachea (windpipe) to the good side, pressing on the pericardial sac (where your heart lives). Which makes it have to work harder, which makes it beat faster, while oxygen transfer isn't occurring in 50% or more (your lungs are different sizes) of your respiratory tract, which makes it beat faster, and get behind, which backs blood up into your heart, which makes it beat faster, which makes blood back up upstream, especially coming down from your brain, which makes your jugular veins bigger on both sides. Which makes you more panicky, and more short of breath, and you can see the patient's trachea go from midline, and move over to the good side (tracheal shift). Meanwhile, your heart is not working properly, leading to low blood pressure (hypotension), and low oxygen exchange body-wide (hypoxia), and you're going into shock. See how one hole makes everything go to shit in a hurry?
Here it is in pictures, and a basic video:
Turn the volume off; there's no narration.
That should cover it, and anything simpler would require crayons.
I will adopt the format used by The Other Ryan, from his sadly departed blog, Total Survivalist Libertarian Rantfest, to wit:
A. The Good
That giant three-and-a-half-inch, 14 gauge needle is colloquially known as a “chest dart”, but is more appropriately a tool used to perform a needle thoracostomy to decompress overpressure from a tension pneumothorax (we will refer to this in shorthand as tPTX). First off, if you could not immediately define a tPTX per the last part of that previous sentence, that may be an indication that you have no business carrying that equipment.
Absolutely SPOT. ON. If there's anything in your kit you don't know WTF or HTF to use, either unf**k yourself, or get it out of your kit. There is no third option.
And then, after this certified brilliant observation, he goes into the guard rails.
B. The Bad
"A tPTX takes a long time to develop—like 30-40 plus minutes (even up to hours). Using signs like “tracheal deviation” and “jugular vein distention” means you missed the problem a long time ago. By the time you start having vital sign changes and cardiac problems, the condition is pretty progressed, and is also what makes it “tension”. The tension is what is causing the vital sign changes since unacceptable pressure is being applied to the heart and vascular structures."
Sorry, Slick, but no, it doesn't take a long time. It takes as long as it takes. Bigger holes make it happen faster. File this under Physics, and Duh! It can happen in as little as a few minutes after the injury, in fact. BTDT. Teenager with one punch from a 9mm, walked in under his own power, already in extremis after maybe 5-10 minutes, affected side had a partially collapsed lung. Chest tubed immediately. Oxygen sats immediately jumped from the high 80s to the high 90s. Don't have a trauma physician, Rx meds, wall suction, and a chest tube kit the size of a daypack? Might be a good idea to have a large-bore chest decompression needle then, wouldn't it?
"There are a few vital signs that may indicate a tPTX. Hypotension, hypoxia, subcutaneous emphysema, and tachycardia. For hypotension, you need to measure the blood pressure which means a blood pressure cuff and hopefully a stethoscope. For hypoxia, you really need a pulse oximeter (though cyanosis could be argued if you can rule out other causes). Tachycardia is easy to measure (and the pulse oximeter will do this for you as well).
Alongside that needle, do you also carry a stethoscope, blood pressure cuff, and pulse oximeter, in your IFAK?"
If you're the designated medic, you damned well better carry those items, and know how to use them. If, instead, we're going to use the most lazy and the stupid as the average person, the argument to dump gear becomes endless, and ends with the advice to simply suck your thump and hug your teddy, because anything else is out of your lane.
But c'mon, Doc, let's stop being stupid. I can diagnose tachycardia with one finger on a pulse, and a cheap Timex, in about 6 seconds. Even under the fireworks show at Disneyland, let alone in combat. I can use a calibrated eyeball and that same watch to diagnose tachypnea, same method: count for 6 seconds, multiply by 10. This is retard-simple. And while a pulse oximeter is fabulous for hypoxia, the most sensitive organ in the entire human body is the brain. If the patient is becoming more anxious, is diaphoretic (sweaty), and getting panicky, it's probably hypoxia and hypotension. Blue lips and extremities are worse, but even more simple, except at night. And if I can't find a pulse at the wrist, systolic pressure is below 80. If I can't find one at the groin/pelvic junction, it's less than 70. If I can't find one at the carotids, it's time to start CPR. I can tell all of that in about 2 seconds, with no BP cuff, and we both know none of this is news to you. One can piss and moan about ultimate accuracy, but if your standard of care is a fully equipped ER or nothing, why have a medical kit at all? That's a "shoot the wounded, and drive on" standard of care. So stop acting like this is Chinese calculus.
The indication for needle decompression in the field, far from CT, chest X-ray, or any other medical machinery, which is the whole point of TCCC, is if the patient is hemodynamically unstable. IOW, if they're breathing too fast, their heart rate is elevated above normal, their oxygen saturation is down, their blood pressure is dropping, or they have jugular venous distension (JVD) and/or tracheal shift. That's both WHEN and WHY you do needle decompression.
Telling me that needle decompression is bad because some people do it too often, too poorly, and/or too soon, means they don't understand that whole "clinical indications for therapy" part of the lesson, and/or haven't mastered the basic skill. That's a bad instructor/stupid medic problem, not a bad emergency technique problem.
C. The Ugly
"I would argue that someone that has the appropriate experience and training to CORRECTLY diagnose and decompress a tension pneumothorax, happens to be there at the exact time you need it, is willing to do the procedure knowing that they know will likely NOT be covered by insurance (or Good Samaritan laws), and also doesn’t have their own equipment is a Venn diagram of “not going to happen”.
Venn diagram I poorly drew showing the above scenario…
Or maybe you are running around the downtown of a large urban area (while wearing your plate carrier and carrying your IFAK) and a mass casualty occurs. Assuming you haven’t been detained by the authorities for looking out of place (unless there was an airsoft gear convention going on), you hop in and start helping. Nearby someone yells out that “I’ve got a tension pneumo here; anyone have a dart?”. Your cape unfurls, you rip open that IFAK, and chuck over that needle.
Tongue and cheek, yes, but seriously… Think through what actual scenarios you are likely to encounter and the probability of having a patient that will develop a tension pneumothorax and having another Good Samaritan on hand that can fix the problem."
Okay, that's the Captain Recockulous Strawman Version. Now, how about if I play?
i. Dumbass at the shooting range muzzle sweeps the line, and dumps a round into the guy two lanes over from you. After observing some other guy helpfully remove the pistol from Dumbass' hand and punch the shit out of him by way of getting his attention, you notice the guy on the ground has frothy bubbles of blood forming around that shiny new hole in his chest, and he's having some trouble catching his breath. But it's okay, you're out of cell service, it's only a five-minute run to the range shack phone landline, and the range is only 40 minutes from civilization. Think you might need a chest needle there, Butch?
ii. You're driving any one of a hundred lonely highways in BFE west of the Mississippi, and you're the first one to come upon the scene of an automobile accident, and you find the driver of the older car minus airbags somewhat the worse for wear, with a lot of chest pain, blue lips, sore ribs on one side from that steering wheel he slammed into when he hit the ditch, and his trachea is pointing to one side. Hmmm, good thing you left your tools at home because someone told you you'd never need them, right?
iii. Hiking with your friends, Jimmy takes a tumble down a slope, but fortunately, a large boulder to the chest arrests his further ass-over-heels progress after only 50-80 yards of tumbling. When you get down to him, he's panting for breath, he can barely talk, and he's got a lot of pain in the ribs on that side. What can the matter be?
Traumatic TPT doesn't require the Marines clearing Fallujah of dug-in Taliban to happen. Pretending otherwise is idiotic, or one has led a very sheltered life in trauma care.
And someone who acts according to the standard of a "reasonable person", within their level of training, is going to be completely covered under Good Samaritan laws in 50 states and seven US territories, just like with CPR or basic first aid. That doesn't mean you can't be sued, it means they can't win. In fact, failure to act may be prosecuted as criminal negligence if it was an accident you had a hand in accomplishing (like an auto collision), because at that point, you have an affirmative duty and legal obligation to render appropriate aid and summon help. Time and place are a factor, as is your level of training, and equipment available. The standard moves, depending on whether you're across the street from the fire station, or 50 miles out in the woods, two days' hike from the BFEgypt Community Hospital and Veterinary Clinic. So it depends on how much of a good guy (or douche) you are, at that point, and what's available for use.
"IT’S BETTER TO HAVE IT AND NOT NEED IT THAN NEED IT AND NOT HAVE IT…
I’d love a portable trauma suite fully staffed with trauma specialists, but the reality is…
In wilderness medicine, we discuss the concept of “Ideal vs Reality”. Ideally, I would like to have instant access to all of the specialized equipment I could and be able to deploy instantly as needed. The reality is that I can only carry a limited amount of stuff without looking like a crazy person (depending on the context) and drawing inappropriate attention. The reality is that I am likely to encounter only a small subset of known (and treatable) medical problems in normal life.
100% of the people on the planet will experience cardiac arrest at least once. That doesn’t mean I carry an AED around with me everywhere.
I can think of many different things that would make my first aid kit long before a decompression needle. No one that has ever dealt with a traumatic medical emergency has ever said, “You know, I just had too much gauze available…”
Part of providing medical assistance is having good judgment. Good judgment includes understanding the injuries that are most likely to happen and having the ability to treat those injuries. Good judgment is also staying in your lane (within your training and experience).
IT DOESN’T TAKE ANY SPACE IN MY IFAK
You could fill an entire IFAK container with equipment that “doesn’t take any space”. Don’t let equipment serve the role of magic talismans that replace training and skills. The most important piece of equipment is your brain. Fill THAT with the ability to determine if a problem is serious or not serious and if the problem is getting better or worse.
In your IFAK, you should carry, at a minimum, tools to help you deal with IMMEDIATE life-threatening injuries. Injuries that will kill you right now. Tourniquets (a real tourniquet that applies mechanical advantage and is backed by science, not a fancy rubber band). Compressed gauze. Chest seals. Be wary of any kit that does not include those items."
Let's stop bullshitting here, Doc: chest decompression needles are the size of ink pens, and of similar weight. We're not talking about packing a CT scanner in your pack, or leaving behind the tourniquets and all the bandage gauze. Four of them take up minimal space, and weigh maybe 4 ounces. This is stupid easy and simple, for field reversal a simple but treatable life-threatening condition, which is the whole point of all of TCCC. And if you don't do it, they're probably just going to die. I vaguely recall in school hearing that that's bad, but I'm open to counter-discussion on that.
Tension pneumothorax is both life-threatening left untreated, and reversible with minimal equipment and training. And there's nothing else than can substitute for that chest decompression needle if you need it RFN. Many of us carry three pounds of loaded handgun, holster, and spare mag or so, FFS, every time we leave the house, even though needing it is literally a one-in-a-million situation. You want to pull out your crystal ball and tell me when I won't need that, too?
We can go back and forth, and I can knock over all the straw men (and that's about 90% of the blogpost) you've built for why you're right, and all the king's horses, TCCC, the committees that developed it, and thousands of medics and trauma docs, military and civilian, who think carrying a chest needle is a good idea are all wrong. But forget anything I say. Let's just look at go-to medical thinking, from someone far above both our pay grades: the author(s) of an authoritative professional medical text:
A tension pneumothorax is a severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures, and compromising cardiopulmonary function. Early recognition of this condition is life-saving both outside the hospital and in modern ICU. Knowledge of necessary emergency thoracic decompression procedures are essential for all healthcare professionals. Traumatic and tension pneumothoraces are life-threatening and require immediate treatment.
Patients with trauma tend to have an associated pneumothorax or tension pneumothorax 20% of the time. In cases of severe chest trauma, there is an associated pneumothorax 50% of the time. The incidence of traumatic pneumothorax depends on the size and mechanism of the injury. A review of military deaths from thoracic trauma suggests that up to 5% of combat casualties with thoracic trauma have tension pneumothorax at the time of death.
...hypoxemia, acidosis, and decreased cardiac output [from tension pneumothorax] can lead to cardiac arrest and, ultimately, death if the tension pneumothorax is not managed in a timely fashion.
On examination, it is essential to assess for signs of respiratory distress, including increased respiratory rate, dyspnea, and retractions. On lung auscultation, decreased or absent breath sounds on the ipsilateral side, reduced tactile fremitus, hyper-resonant percussion sounds, and possible asymmetrical lung expansion are suggestive of pneumothorax. Symptoms of tension pneumothorax are more severe. With tension pneumothorax, patients will have signs of hemodynamic instability with hypotension and tachycardia. Cyanosis and jugular venous distension can also be present. In severe cases or if the diagnosis was missed, patients can develop acute respiratory failure, and possibly cardiac arrest. In some instances, subcutaneous emphysema can also be seen. The diagnosis of tension pneumothorax must be made immediately through clinical assessment as waiting for imaging, if not readily available, may delay management and increase mortality.
Initial assessment to determine whether the patient is stable or unstable dictates further evaluation. Emergent needle decompression or chest tube thoracotomy must be performed immediately if the diagnosis [of tension pneumothorax] is highly suspected."
Gee, chief, that's gonna be kind of hard if you left all 2 ounces of those two chest needles back home, because you thought you'd never need them, i'n'it?
"Tension and traumatic pneumothoraces are usually managed in the emergency department or the intensive care unit. Management strategies depend on the hemodynamic stability of the patient. In any patient presenting with chest trauma, airway, breathing, and circulation should be assessed. Penetrating chest wounds must be covered with an airtight occlusive bandage and a clean plastic sheeting.
If the patient is hemodynamically unstable and clinical suspicion is high for pneumothorax, then immediate needle decompression MUST be performed without delay. Needle decompression is done at the second intercostal space in the midclavicular line above the rib with an angio-catheter."
They sound pretty sure of themselves, don't they? But what do doctors and medical school professors know about this? Oh, besides all that medical school, and stuff...
Tom R. (the author of the offending post at The Firearm Blog) may be a helluva field medic. But his advice on this subject is tainted by advocacy with a dearth of authority or common sense behind it, and a surplus of logical fallacy and just plain silliness.
Should untrained Jaspers try needle decompression? Hell no!
If you're an idiot, or simply too lazy to learn the skills, by all means, leave out the chest needles. You don't need them, for a certainty. If the audience at The Firearms Blog is a bunch of lazy idiots, then the post is solid gold sound advice. I don't know them, so I cannot say.
If you're not an idiot, and you're going to pack the gear, you'd better damned well know the pathophysiology of this cold, understand the correct procedure (which we have not gone into in depth here, but which takes less than 3½ minutes to learn), have practiced and demonstrated same correctly under competent training and preceptors, and be able to explain in excruciating detail why you did or didn't do it multiple times in a court of law afterwards.
Stabbing someone in the chest is a lot like shooting people, in that respect. You're going to be talking about it afterwards, and not in a comfortable "There-I-was" way. Bet. On. That.
But the medical literature - nearly all of it - is 180° out from Tom R.'s dubious advice. You're packing your own kit, and neither he nor I are holding your hand when you do that. You're going to have to use your own head (brains optional but highly recommended), and trust your gut. But as Murphy's Laws Of Combat informed you, "Anything you do, including nothing, can get you or someone else killed".
But if you need to do it, in either the case of shooting someone, or needle decompression, explaining that you left the gear home because someone on the internet told you that you'd never need it isn't going to help much, and somebody is liable to suffer death or serious injury because of your lack of foresight.
If medical stuff is too hard for you, don't do it. You won't hurt my feelings. But if it's not, learn the things that can actually make a constructive difference, carry the gear to do them, practice the skills, regularly, and be prepared, intellectually and emotionally, to suck it up and do them if the need arises. Chest trauma is rare, but certainly not beyond the realm of possibility, even in everyday peacetime situations. And tension pneumothorax in the presence of chest trauma is pretty common, and the actual medical literature is clear: prevention of death is a lot easier on the patient if you don't wait until the last second, and they're in cardiac arrest, because you dithered. Suggesting that standard is flatly asinine, and contrary to every precept of trauma medicine. I'm going to go with that advice, and leave the advice found in this editorial turdburger right where I found it. Particularly when we're talking about carrying something the size and weight of ink pens.
If that's too much extra gear to carry, maybe skip the whole first aid kit, and just carry a rabbit's foot, right?
The author at TFB may have any number of good and well-thought out posts on medical advice for Joe Average. But the example referred to me is NOT one of those, and for the reasons set forth above, we consider it really, really bad advice. And if you look at his closing comments, it seems he knew from the outset he was jumping hard on his wedding tackle with cleats on, and expecting exactly the response I've given. One can only ask, "Then why do it?" For reasons passing understanding, some people are masochists, we suppose.
The whole post reviewed, on reflection, sounds exactly like the cinematic chin-wagging from gold-plated Ranger battalion geniuses who told Grimes in Blackhawk Down that he wasn't going to need water, NOD, or trauma plates(@01:32ff).
So, how'd that "wisdom" work out when tested?
Learn and live.
If anything in this left a mark on anyone, we commend to their usage a certain ointment.
"As I type this my wife has been in a local hospital emergency room waiting for a bed for the past 12 hours. She has Covid and is struggling to breath. She has been treated like a leper an not even offered an food. Her ER Doc walked out and slammed the door after she asked to be given a vitamin C IV. He said he wouldn’t treat her with something not proven and she was free to leave."
My reply, which Cdr. Zero may or may not elect to publish there (his choice. And the graphic aids are just for you, Gentle Readers):
My sympathies on your wife's plight. Really.
Just curious: When you take your car to the mechanic, do you tell him how to fix that, too? Or not? If not, how many years of education did your mechanic get, after his college degree?
Have you ever hired a lawyer? Who handled the legal work? You, or him/her?
Just wondering. Let me know if the penny drops.
FWIW, the time to bulk up on Vitamin C was probably long before coming down with COVID, and shockingly, there aren't too many doctors amenable to letting their patients run their own treatment regimen.
It's got a lot to do with losing their own medical license for letting patients practice the medicine. States are kind of sticky about letting passengers fly the airliner, for similar reasons.
So the bigger question is, why did you go to the emergency room in the first place?
My second is, how much is orange juice selling for at the local market?
My third is, where d'ya suppose she got COVID, and how regularly do folks thereabouts wear masks, and how often does she use ordinary hand sanitizer?
And regarding getting fed, did you see a menu at the ER drive-thru window? Or not?
I ask that last one, because as a rule, if you need food, it's probably not an emergency; and if it's an emergency, you probably don't need food. Unless she's been there at least overnight, and/or her blood sugar is less than 70mg/dL, as a rule. 12 hours is largely meaningless, because if there's no food to offer (which is most days, or in my case, nights) there's no point in making such an offer. But if you're admitted and there all day and overnight, we'll generally put in a breakfast order for a tray the next morning. I've yet to see anyone starve to death my entire career for missing a meal or two, but I suppose it might have happened, somewhere.
If being treated "like a leper" is being put inside a sealed isolation room, that's standard of care for COVID for, oh, about 18 months. We're not really big on hand-holding and wet sloppy kisses with infectious diseases, and speaking personally, a COVID patient (I had two more last night) involves getting gowned and gloved up before I enter the Giant Ziplok Of Isolation, and I'm required to wear an N95 at all times in my department. Some people add a face shield or powered respirator. If any of this is news to you, you haven't been watching any since about February 2020.
If you meant they marooned her on an island for life and poked her overboard with sticks, then you have my sincere apologies for the misunderstanding.
But even then, lepers should expect to be treated better than COVID patients: leprosy, unlike COVID, can be cured.
I'm sincerely sorry your wife is sick enough to need a hospital admission. Ain't nothing good about this bug, and even mild cases suck. But waiting to drive the bus until you get to that point isn't really a great plan, as you're both finding out about now.
Best wishes on your wife's full recovery and return home to her world, rather than spending time in the hospital. I don't recommend it to anyone unless they have no choice, because most people have no wild idea why it isn't run like a billionaire's ski resort or a fast food drive thru, especially for the last year and a half, and are shocked and dismayed that unlike House or Scrubs, or any number of fantasy treatments, things don't all get resolved in 42 minutes, plus commercial breaks, and it becomes very frustrating and disorienting to not be the bright center around which the universe revolves. Illness annoys people, because it rubs their noses in the fact that everything they thought about being in control of their life was pure fantasy. And that's a jarring shock every time it happens.
And particularly among a burgeoning pandemic, short on staff and long on patients, we don't generally have a lot of time to break it down in detail for everyone, every night.
The short story would be for folks to ponder why, going back centuries, it's called being a "patient". All of us in the health care biz are generally working pretty hard lately, but try as we might, we can't be everywhere at once, and we can't make things happen that simply aren't possible. And if people aren't swarming around you in droves, cheer up: it means you're not the guy whose heart has stopped, while we try and bring you back from the dead. So if that's not you or yours, it's a pretty good sign that things aren't really so bad.
And I'm telling you this because you're a good enough guy to be concerned about your wife. (You'd be shocked how many people aren't even that decent.) But what you don't know, not being around nor familiar with the strange new world she's visiting, involuntarily, is that usually the best way to help us do our job, is to let us do our job. Even when and if it makes you feel impotent and out of control.
And if you don't trust us to do that, you probably should leave, and go find someplace where you do trust the people there to do that. As a rule, it doesn't hurt our feelings, especially if you figure that out before you ever walk in. We only get ticked when we waste 5 or 10 hours on someone, who then bails out anyways, wasting the time we could have spent on someone who wanted to be there enough to stay.
_____
I frequently make mention, in my workplace travels, of a salutary tidbit of medical history, from James Burke's excellent The Day The Universe Changedconcerning a seminal point about the era when medicine departed from witchdoctory, and became science.
One of the brilliant improvements in the life of the average Frenchman under Napoleon (and there were many such) was that after deposing the king and nobility, there was suddenly a lot of wealth to spend on the peasantry. Consequently, Napoleon set up dozens of free hospitals throughout Paris. And for a real change, they each specialized in one thing. IOW, one hospital treated just gun shot wounds (Napoleon's conquests provided a lot of those too); another might only do broken legs; yet another might do nothing but treat eye injuries, or skin infections, or sick babies.
As Burke points out, medicine before this time was myth and hokum, and if any physician found something that worked, he kept it to himself, lest the other quacks find his secrets out, and steal his best-paying customers.
Under Napoleon's hospital system just the opposite. In the Gunshot Wound Hospital, for example, they might treat 20 gunshot wounds to the legs of as many patients. Five would be treated with boiling tar applied to the wound. Five others might receive a poultice of dog crap and urine daily. Five more would be wrapped, and left to heal or putrefy on their own device. The last five would have the wounds washed daily, and the dressings changed with fresh clean ones. Unsurprisingly, all of the first 15 would get gangrene, and lose their legs to amputation, and the last five - or perhaps only 4 out of 5 - would heal nicely and make a full recovery. But now, the doctors would discuss and publish the results, and tell all their fellow doctors, and the next 20 gunshot wounds would all get the treatment that worked, and the others would be discarded forever. Withcdoctory meets statistics, and transmogrifies into actual science. Voila!
There were only two inviolate rules under this system:
*Everything was free to the patient.
*Anyone who didn't comply absolutely with the doctor's treatment regimen had his sleeping pallet lifted up, carried outside, deposited at the curbside, and given the benediction "God be with you monsieur!" Because the uppity presumption that you, Peasant Scum, knew more about medicine than Le Doctor, brilliant graduate of the medical university, quite reasonably and rationally meant that your ass got kicked the fuck out, with a smile and significant alacrity. You got exactly what you wanted: to run your own case. "Bonne chance, Mssr. Cerveau!"
Fuck off, Bumpkin. We're doing science. And you're fucking up the data.
It's a custom begging to be re-introduced, with a vengeance.
And it's also why people in any science, who lie, or fake data, are the cardinal sinners in the whole edifice, because they're not just screwing the pooch for you, they're dynamiting the entire foundation the whole machine runs on: honest data. Truth.
It's why liars get harsh penalties in courts, and why bearing false witness got its very own Commandment.
You're not just being selfish, or evil, you're crossing the streams.
And fucking it up for EVERYONE.
Which is why people doing that, for Globull Warmist religious reasons, or COVID Is A Hoax, or the Not-A-Vaxxes Are Safe and Effective, or anything else, should be staked out in the sun all week, then beaten on the back with a dry swim fin, then skinned alive, and lowered an inch at a time into a vat of rubbing alcohol. For openers.
And why people trying to run their own case should be turned loose to do so. At the curb.
Not counting the news outlets or websites along the full range of accuracy and veracity, I follow multiple actual individuals' handwritten blogs. (Bot news aggregators don't thrill me.) Looking them over, many are current serving or former military and a couple are some variation of high-speed low-drag elite forces ninjas. Or just funny as all. Because life without humor is just despair. So in other words, the same folks I trusted in the military not to wet the bed, sh*t themselves, or otherwise run around like headless Nancys, are the same folks I trust on the interwebz, for demonstrating pretty much the same trustworthiness and circumspectly responsible behavior. Color me shocked.
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