The tickle of curiosity. The gasp of discovery. Fingers running across a keyboard

Sunday, July 20, 2014

TEMS Medics: Information for Writers with Deputy Jay Korza

Fiona - 
ThrillWriting is happy to host Deputy Jay Korza who is an author and works as a first responder with fourteen years of experience as a deputy as well as military experience under his belt

Jay can you give us a glimpse into your 
professional background 
and an idea about what you like to write?

Jay - 

Sure. Background: I started in EMS when I was 17, going through my first EMT cert class at the local community college. Then I went into the Navy at 18 and became a Hospital Corpsman. Corpsman are the medics in the Navy and for the Marine Corps. The Marines don't have any medical personnel, they are all supplied by the Navy. I worked in Emergency medicine while I was enlisted and afterwards as well.


Fiona
Were you mainly on the boat or out in the field with the marines?



Jay - 
I was shore based at a hospital, The Naval Medical Center San Diego. I was later in the reserves after active duty and was trained as an 8404 Corpsman. They're the ones who go out with the Marines. I never deployed though. I tried while I was active and couldn't.

They wanted to send me to a small boat, less than 500 crew, after my first enlistment was up, so I didn't reenlist. I should have. I didn't realize how much I would miss it.



When I left, I did a few small jobs for about six months until I started managing a private medical practice. I did that for a little over a year and then was a paramedic for a federal prison. I did that for a year and then moved to Massachusetts with my girlfriend, and I worked on ambulances out there. I also started a non-profit organization teaching first aid and CPR to the community.

You asked what I like to write. I like to go with the idea of writing what you know. My first book was a science fiction space opera that dealt with special forces, Marines, and one of the main characters was a Corpsman. I put a lot of medical and tactical stuff in the book.

It's hard to find Jay in this picture.

Fiona - 
I love that! And that's what we're here to talk about today - you have functioned as a TEMS - can you explain what that job would entail?


Jay - 
A TEMS medic is responsible for the medical operational needs of their team. TEMS could be used to describe military medics, but they are more often referred to as combat medics, and they deserve that "combat" rating as opposed to just being tactical.

TEMS - Tactical Emergency Medical Service

TEMS are responsible for the medical care of suspects, bystanders, and victims in and around a tactical scene.

Fiona - 
So do all SWAT teams go in with a TEMS medic attached or some kind of medic?

Jay - 
It is becoming the norm, but it is not universal at this point. There are "teams" out there that aren't really SWAT teams, and they don't fit the national standard definition of one. In line with that, their "TEMS" also aren't really TEMS, just a few EMTs thrown on a mission. Don't get me wrong, these are great guys doing what they can with what they've been given, but it isn't a real TEMS program.





Jay - 
But for those teams that do employ TEMS on a regular basis, there are two basic structures.

The first type, like my team, the medics are fully a part of the team. They come to our training sessions where they do all of the tactical training with us, and they deploy on every single mission. We won't deploy without a minimum of two medics.

The second type of TEMS element is where the team works closely with the local EMS guys, and when there is a call, they have the local medics respond. But the medics aren't actually on the team.

Fiona - 
What are the most prevalent issues faced during a tactical medical emergency?

Jay - 
The most prevalent issues are your own guys jacking themselves up during training. 
We deal with more sports injuries than we do suspect injuries. That is fairly common with all of the teams.

Fiona - 
Jacking themselves up during training would result in?

Jay - 
Jacking themselves up = twisted ankles, heat injuries, back injuries, burns,

Fiona -
So would the EMT have to wait for an "all clear" to respond while a TEMS could run into the fray? Is that the difference?

Jay - Not necessarily. Depending on the team structure, the TEMS may be up in the armor right in the hot zone (as is with my team), or they may be back at staging waiting to be called up for a specific issue, and that issue may be when things are in full swing or after the action has ended.

Ever wonder what a Taser wound looks like?

Fiona -
Lots of ice - though now I read that research says ice is bad for injury inflammation...

Jay - 
We train harder than our missions will be so that we're ready for whatever happens. And as a result, we tend to get injured in training. Like I said, mostly what would be considered sports injuries. Though we have had a couple of medical issues pop up that were unexpected.




Practicing TEMS on dog manikins in case one of our working K9s gets hurt

Fiona -
You have read a lot of books which include emergency medical intervention. Can you take us through one situation where you see the author consistently misunderstand and write something incorrectly?

Jay - 
One major inconsistency is the concept of not moving a patient because they aren't stable. This is not accurate.

Fiona - 
So what really should happen?

(By the way, Readers, if you want to read an OUTSTANDING article Jay wrote about flat-lining and defibrillation go here: (LINK) And you will write that scene accurately.)

Jay - 
This is a concept that is, I can only guess, derived from in-hospital care. Where you might have a patient that is very unstable and moving them could cause a recent surgical site to reopen. The patient might have internal injuries that need to self-repair before transfer, or their vital signs are so poor that they are in such a state of shock that moving them would be bad. 

The type of move we're talking about in the hospital situation is moving to another facility that is more suited to the patient's needs. You have a burn patient that needs a burn center, but their injuries need to stabilize before you can make that kind of transport to another hospital.

But in TEMS or field medicine, your patient is messed up and needs a hospital. It doesn't matter what their condition is, you will NEVER not move them because they are too unstable.

Fiona - 
So what do you do on site prior to moving them v. stabilizing en route v. letting the hospital deal with it?



GRAPHIC IMAGES WARNING - If graphic images have a negative effect on you, please scroll down past the next three photographs.

Jay - 
On site, the only thing we do before transport is fix life-threatening injuries to the best of our ability. And let me clarify, that's for a really messed up patient, medical or trauma. There are a lot of things we can do on scene and en route for a seriously injured patient, but if they need a surgeon then we need to move. 

So, take for instance a patient I had a few years ago, he was struck by a car when he ran a stop sign on his bicycle. His head and neck went into the windshield and then his body went over the car and his head/neck came out of the windshield. He was unstable with deteriorating vital signs and internal injuries to his head and chest. I did a cricothyrotomy on him (cut into his throat and put a tube in there), and then we put him in the ambulance and did everything else en route.



Practicing Cricothyrotomy on a pig's throat.




Performing the Cricothyrotomy in the Field 




Suturing Up a Wound 



Fiona - 
YIPES!

Jay - 
We may do other things on scene while we are fixing the major things, but a lot of those things aren't for stabilization, they are ancillary. If we have the time and manpower, we'll do them simultaneously.

Like IVs, everyone thinks IVs are important. They aren't all that important. They can be helpful, but in general, probably less than 1% of people have been saved because an IV was placed.
And it wasn't the IV that saved them, it was the venous access that the IV gave us in order to give the patient medication to reverse their condition.

A major change in IV therapy is that we used to dump lots of fluid into trauma patients because we thought it helped them by increasing their blood pressure. What we have found out is that we are actually making things worse by trying to get their blood pressure to a "normal" level. By doing this, we cause more bleeding because their body can't clot with the increased pressure. So now we go with permissive hypotenstion, we only give them enough fluid to get their blood pressure up to a systolic of 90 (the top number).

So we aren't taking days at the scene of the injury. We have our responders grab and go. 

Fiona - 
So no - "Push an IV STAT!"

Is it unusual that you were able to do this surgical procedure? Or do EMTs train for that as well?

Jay - 
The cric is a paramedic level skill. As TEMS, we can't operate outside of our scope of practice which is determined by the National Registry of EMS. Then, each state can make be more restrictive on the skills they allow their paramedics or EMTs to perform.

Fiona - 

Can you do the things that you learned to do on a battle field or do different medical protocol issues mean your constricted as to what you can and cannot do? 

And VERY HYPOTHETICALLY would a character choose to override law and do what he knew how to do to save a life? If yes, how much trouble would the responder get into (under the law?) 

Jay - 
Can I do the stuff I learned in the military? Yes and no. If I do, and it is outside the scope of my paramedic skills, I could lose my certification and possibly be civilly liable.

However, most states have a good Samaritan law that allows people to act to the level of their training. So if I were at the mall off duty, and not acting under the color of my authority, I could conceivably do more as a good Samaritan than I could as a civilian paramedic. However, realistically, the advanced skills I gained in the military are generally used in a hospital setting. I'm not going to perform minor surgery in the mall.

Fiona - 
What an interesting distinction - but if my kid took a bullet and we are hiding from the bad guys - you could help her with a hanger, a bottle of perfume, and a fine silk scarf, right? Meanwhile, SWAT goes in and takes down the terrorists.

Jay - 
When I moved to Massachussettes, there was a civilian paramedic in the news because he performed an emergency C-section in the field. This is WAY outside of our scope of practice. However, he had been a surgical tech Corpsman in the Navy and had done surgeries under the guidance of surgeons and of course his job was to assist in surgeries as well. If you're a good Corpsman, your docs will let you do A LOT of stuff you're not allowed to do. Anyway, the mom was full term and involved in a motor vehicle accident. She was dead on scene but the baby was still alive inside. He knew he could do the procedure, mom was dead anyway so he really couldn't mess up, and the baby would never survive the transport to the hospital while still inside. He waited too long to do it, and the baby didn't make it. He hesitated, worried about the civil outcome. He lost his cert because he did the procedure. Even if the baby had survived, he still probably would have lost his cert because he acted outside of his scope of practice.

Fiona - 
Oh, dear. That shouldn't be.

Jay - 
The other MAJOR wrong thing with medical stuff in stories (movies or books) is putting medication/needles directly into the heart. This is soooooo outdated and useless.

Fiona - 
So no Pulp Fiction adrenaline in the heart?

Jay - 
They used to think that if the heart wasn't circulating blood that you had to inject the medication directly into the heart to get it to work.

So during a code event, they would push high dose epinephrine into the heart. This doesn't do anything for several reasons. If your heart isn't moving (naturally or artificially through CPR) then the blood isn't moving. Without blood moving, medication can't go anywhere. Not to mention, without blood moving, you have no blood pressure. Without blood pressure you can't exchange gasses at the cellular level (basic physics). If you can't exchange gasses you can't metabolize medication. So without a high enough pressure, you can't do anything with the medication that is injected into your body. 

Also, you are putting a hole, albeit a small one, in the heart and that can agitate the pacemaker cells in the heart and cause other issues. And you can create a pericardial tamponade which is fluid between the heart and its protective sac, because of the hole you just put through the sac. 

NO MEDS IN THE HEART! Simply put the meds in any vein or IV access. 

No one puts needles through the neck either. 

And adrenaline is the exact same thing as epinephrine. One name is of Greek origin and the other is of Latin. Same thing. I've read in stories that one is synthetic and the other is the natural form - nope.

Fiona - 
Most excellent.

You were saying you use a lot of this technical information in your book which is very exciting - and I have you queued up as my weekend read.


Amazon Link $2.99

Can you tell us a bit about your plots? No spoilers though.

Jay - 
Plot for Extinction: An ancient race created a species of warriors to conquer other planets/systems for them. A millennium after the conquering, the current Emperor wanted to end the tyranny, but even he couldn't do it. He would be overthrown. So he devised a plan to lead an expansion colony himself to an unexplored part of the galaxy, and then cut himself off from the Empire, letting it wither without him. Then, he would come back and rebuild things the right way. His plan didn't work.

A thousand years later, humans are exploring the galaxy and come across one of the Emperor's first colony sites in our region of space. The scientists accidentally set off a distress signal to the old empire and the warriors find out that the old Emperor had lied to them, and now they are coming to claim our portion of space. 
Two special forces teams will embark on separate missions to stop the threat.


Amazon Link $2.99


Fiona - 
Very fun! I have a lot of readers here on ThrillWriting who love to read and write sci-fi. You also wrote a zombie theme?

Jay -
My second book is called "This Is Not What I Wished For..." It takes place where the zombie genre is unheard of. A boy on his fourteenth birthday has his family wiped out by what he believes to be demons. He sees his neighbors and family eaten and killed in front of him and then turn into these demons. He flees and ultimately joins with other survivors and leads them to the epicenter of the outbreak, a hospital that is really a covert government lab that accidentally allowed this foreign contagion to escape their labs.

I've only read two zombie books, World War Z and How to Survive a Zombie Apocalypse. But I love the genre and wanted to add to it. There are fighting, tactical and medical scenes. It is mostly about the children's journey - their bonding and coming of age together in this new world.

But it isn't a gore or scare fest. I wanted it to be emotional. And there is a rather large twist at the end.


Amazon Link $2.99

Fiona - 
Very interesting - I just read my first zombie books - and I loved the tactical parts of the books. 

We are at that part of the interview when I ask you the traditional ThrillWriting question: Will you please tell us the story behind your favorite scar, and if you've managed to make it this far without a scar story - or if it's just too darned embarrassing to share - then a harrowing event you survived.

Jay - 
All of my scars are non-work related. However, my most harrowing work story is when I was on patrol about ten years ago. I was behind a Circle K doing my paperwork for the evening.

A guy went into the Circle K and asked the clerk if there was a cop there. You see, that store let us use their office for doing reports and stuff. The store is in a bad part of town, and they liked our presence there. 

I usually hid behind the store when I was doing paperwork because I wanted to finish it, not talk with people.

So the clerk says that he hasn't seen one come in lately, but there might be one out back. Thanks dude.

So the guy comes around the corner and sees my car, and I see him. There is something definitely off about him. I get out of my car, so he can't approach me while I'm in a position of disadvantage.

He starts to say something to me then stops, thinks, and says, "Hey, there's something in my car I need you to see."

Immediately I picture a family chopped up in hefty bags. This guy was not right - and even someone without my experience would've been able to see that. 
So I ask him, "How about you tell me what you want me to see?"

Fiona - 
Good call

Jay - 
This goes back and forth for a little bit. I call for backup.
No one was closer than ten minutes away, Even code three (lights and sirens), which they weren't even using yet.

We end up walking around to the front of the store, and he is asking me if I'm part of the Mexican Mafia, and if he can trust me.

He talks about walking his son out to the desert, but it wasn't really his son. Then his son died. So I'm thinking he had a psychotic break and killed his son, who he thought wasn't his son, and that's what was in the car waiting for me. 

Still no back up, though I've asked them to step it up at this point.

Ultimately, he decides he's done with me and is going to leave. I can't allow that. Regardless of what's in the car, he is obviously on drugs and/or mentally incapacitated, and I can't allow him to drive and endanger the public or go kill someone after he leaves me.

Fiona - 
So what did you do?

Jay - 
I step in his way to stop him. He swings and misses. I impact push him. He moves towards a large truck parked on the side of the Circle K. For perspective, I was parked in the rear on the west side, the front is on the east side with some parking, and there is parking on the south side, that's where his truck is.

He backs towards his truck with his fists up ready to fight. I don't mind getting into a fight, but I'm also aware that no matter how confident I am in my abilities, that doesn't mean the other guy isn't good also. So I'm not ready to get into a clinch with this guy.

Fiona - 
Or he's on PCP - so your skills does't matter a fig.

Jay - 
As he backs away, he looks over his shoulder and there is a passenger in the truck, a kid about 19 or 20. The kid smiles, and I testified in court that the smile was the most chilling thing I have ever seen. It was demonic; it was pleasure and excitement. This kid was waiting for me. They were working together to lead a cop back to the truck to kill him.


Fiona - 
HOLY MOLY!

WHERE IS BACK UP? How did you get out of there?

Jay - 
The kid gets out of the truck, and I thought he was going to join the fray, and I was ready to go to my gun. No cop should ever be okay with fighting two people at the same time. It doesn't matter if they have weapons or not, that is a lethal force situation.

The kid completely changes his expression. Maybe it was because my hand went to my gun; I don't know. But he turned and took off running. Just gone. We never found him or identified him.

I then switched to pepper spray and unloaded on the guy. It didn't do anything.

He kept backing towards his vehicle, and he got in to the drivers seat and closed the door. I smashed the window and kept spraying him. He backed out about three feet then put it into drive and tried to run me over. I dodged and went back to my gun. But then he backed out of the parking lot and took off. I got his plate out over the radio, and he actually went home. 

Other units went to his house and the guy got dog bit, more pepper spray, and a bunch of other stuff.

There was a shotgun, and pistol and lots of ammo in the truck.


Fiona - 
That's a hell of a harrowing story.

Jay - 
He got five years for that, would have got more but the prosecution forgot to file a motion that allows for a greater sentence given the offense was against law enforcement.

Fiona - 
I'm glad he's off the streets! 

Jay, thank you so much for spending the time with us and teaching us so much.

And a big thank you to you writers too for stopping by. If you have any questions or comments please post them below - they are moderated to protect from SPAM so I'll get them up ASAP. Also, if you find this blog to be helpful, please take a moment to help spread the word. I've put some social media buttons below. Happy plotting.

Cheers,
Fiona