Showing posts with label EMT. Show all posts
Showing posts with label EMT. Show all posts

Sunday, September 14, 2014

Crime Scene Plotting Gems: Info for Writers w/ USA Today Bestseller Jamie Lee Scott



USA Today bestselling author, Jamie Lee Scott joins me today.

Jamie, as you know, I love to learn how to write it right. And, like me, you like to get down and dirty with the learning process. I know that for your novella you went out on a ride along in Thibodaux, Louisiana thanks to our fellow author Police Chief Scott Silverii. And we were in classes together at the Writers' Police Academy, recently.

Before we get started sharing some of the crime scene plotting gems that you picked up, can you tell us about yournovella?
USA Today Bestselling Author, Jamie Lee Scott

Jamie Lee - 

Uncertain Beginnings -
When Sergeant Wyatt Burke goes to the house of one of his officers -  after the man doesn't check back in for duty after his dinner break - he finds him face down on the floor at the foot of his stairs inside his house. What first looks like an unfortunate accident, soon becomes a murder investigation, and takes Sergeant Burke into darker shade of blue.

Though my novella, Uncertain Beginnings, is the first in my "uniformed" police procedural series, I've written six private detective agency novels prior to this series, and I've used the information I've learned from law enforcement and crime scene investigators to write both the P.I. novels and the police procedurals.

Fiona - 
And of course we know that when you said a darker shade of blue, blue refers to cop culture. Would you say your novella is a police procedural?

Jamie Lee - 
Yes, a police procedural. I incorporated what I learned riding with Scott's cops and CSI to catch the killer in my novella. In this case, it's what you can't see that may be the evidence that solves the case.

The seed that started this series was a 12 hour night shift with the Thibodaux police. I watched, followed and listened. It helped to get the details of how cops interacted with the public and how the public interacted with them.

Fiona - 
And today we are going to be sharing gems from your CSI class.

One thing that doesn't show up in many books is that there is a series of hand offs in a criminal death (or an unexpected death).
1) The police have to give the okay that the area is safe before the
     EMT can go help someone.
2) The EMTs go in and help the injured person or declare the
    person deceased and give them a time of death. The official
    time of death is when the EMT makes the declaration and has
    nothing to do with the actual time that the person died.
3) The EMTs hand the scene over to the medical examiner or their
    representative. The ME takes pictures and conducts specific tests
    on the body that will help them to make a determination about
    whether an autopsy is required.
4) The ME hands the scene over to the detective - but the body is in
    the custody of the ME

But that's not always true.

Jamie Lee -
In my CSI class at WPA, I learned that not all states have an ME who comes to the crime scene.

The CSI unit works in tandem with the detectives to be sure the scene is processed properly and that the evidence isn't contaminated.

Many CSI investigators aren't police, they are hired companies. The CSI is a trained layperson. In this case a layperson means that they have not taken a police officer's oath.

When the detective determines there's been a crime, they call in the CSI unit, who then comes in with their gear, completely suited up. They expect anyone on the scene to be suited too. This includes booties, gloves, hair nets, white suits (Tyvek).

Fiona - 
When they enter the crime scene can you go through the CSI unit's priorities?

Jamie - 
The scene is first photographed, long distance, to get an overall picture of the scene, then middle distance, gives objects relationship to one another, then close ups.

English: A crime scene. .
 (Photo credit: Wikipedia)
Nothing is touched until ALL photographs are taken, and CSI is satisfied.

After the initial photos, and possibly video is taken:
* Numbered tents are placed
   for possible evidence
* Items are again
   photographed. At this
   time the evidence may be
   collected. There are
   different types of 
   collection containers. 
The containers are usually paper, 
   but may be hard plastic, in the
   case of a container for a knife.

Patti Phillips, photographer "Grab the CSI Kit"

Fiona - 
What are some details that you found surprising about the packaging?

                                                               Patti Phillips, photographer "Grab the CSI Kit"

Jamie Lee - 
All wet evidence is dried before packaging, and rarely is plastic
   bag used unless there is zero % chance of mold.
* DNA is packaged in paper.
* When the evidence is sealed, it is taped. 
* The information is written across the tape, so that if there is
   tampering, it will be evident. 
* All evidence bags have handwritten Incident Report #, 
   Date sealed, Time, Initialed, #items, and new opening each
   time the package is opened.
* The information is written on the package every time it's opened,
   and the new info is again written across the tape.
*  Only CSI can touch the contents. Lawyers can look at it, but not
   touch, but then no one wants to touch if they don't have to.
* Each time the evidence bag is opened, it must be opened from a
   different side, so the original seals are never disturbed. 
* Once all of the openings are breached, that package will be put in
    a new container, to start over with the original seal.This helps
    with chain of custody.
All evidence is kept indefinitely until released by the courts.
* There are warehouses of evidence from cases that have been
   cleared by the courts, but the statute of limitations hasn't cleared,
   so the evidence is kept.

Fiona - 
Tell us about any evidence collection that was new to you - surprising. 

Jamie Lee - 
When hands are covered for evidence, they are covered with paper bags, to avoid sweating, as that will ruin any evidence.

Fiona - 
On a dead person or on the way to the hospital?

Jamie Lee - 
Any person who was at the scene and may be a witness or a suspect.

Fiona - 
Alive then - who knew!

Jamie Lee - 
We can talk about "swabbing the log"

Fiona - 
Yes, let's do that. what is it?

Jamie Lee - 
When looking for DNA evidence, you need skin.

English: Overflowing toilet
English: Overflowing toilet (Photo credit: Wikipedia)
If you have nothing, you can wait for your suspect to take a poop. Then you "swab the log" because there will likely be some skin shed in the process of eliminating the fecal matter.

The matter itself is worthless, but the skin cells that may have been deposited at the time of defecation can give detectives the DNA they need.

Fiona - 
Argh. So how do you stop them from flushing? And how do you swab a log?  - So awesomely gross!

Jamie - 
I'm not sure how they get the fecal matter in the first place. But if they aren't letting the suspect out of their sight, they may have them go in a facility that they've clogged, or somehow if there are "skid marks" that may hold some matter. 

Swabbing the log would consist of the same protocol as swabbing the inside of a cheek. Only I'd think they'd try very hard to swab the entire surface, as to not miss a chance at getting skin cells.

Fiona - 
And this is why I write about CSI but don't actually do CSI.
Other gems?

Jamie Lee - 
Interesting: GSR, gun shot residue will show on anyone in the room when the gun was fired.

GSR is also extremely fragile and must be processed within four hours.

The most important thing is that ANYTHING can be evidence.

Fiona - 
Give me a "for instance".

Jamie Lee - 
A person who put in a job application on Monday may come back and rob the place on Tuesday. Now you have the robber's address.

My biggest surprise was learning that they use Mylar and a form of electricity to pick up prints.

Fiona -
Wait - how do you do that with a stun gun?
Jamie Lee - 
* They place the Mylar over the fingerprint, then make the
   electrical charge with a stun gun, which lifts the print into
   the Mylar,
* The static charge on the dust particles cause the Mylar film to be
   sucked into the surface.
* T
hen the air bubbles are rolled out with a fingerprint roller, and
   the print can be examined with a light. A flashlight will work. It's
   just to make sure you got the print before you affix it to a more
   secure surface. And it absolutely can't be in contact with plastic
   because it will remove the static charge.

Fiona - 
Affixed with superglue?

Jamie - 
It is photographed immediately.

That photo is an electronically-lifted print

I know your readers enjoy video quick studies. Here's one I found on Electrostatic Footprint Lifting with Dr. Shaler. In this film he:
* Shows the film
* Shows the electrostatic lifter
* Step by step procedure including using a brayer to get rid of air
* Electrostatic print can be lifted from paper, carpet, almost any
   surface. But the print can not be made with water. It must be
   made with dust.

Fiona - 
Very fun stuff! Thanks so much Jamie Lee for stopping by ThrillWriting to share. Before you go, we always like to hear your favorite scar story.

Jamie Lee - 
I have a scar on my face, under my nose on the left side, and everyone always thinks it's a pencil mark, if they see it at all. I was in a car accident when I was 5 years old. 

My dad was driving our Riviera on a raining night, we were coming home from my grandfather's art gallery on Cannery Row in Monterey, CA, and he tried to pass a motor home. The motor home sped up, and my dad lost control of the car and hit a tree head on, I went through the windshield. Yes, I had a seat belt on, but in those days it was only a lap belt. 

The cut was on the left, and my body was black and blue on my right. I have no recall of the accident, or several days after, nor do I have any memory of my life before the accident. I'm probably one of the few kids who has no memory of kindergarten. 

Fiona -
Thank you Jamie 

Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.

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.

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 - 

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 - 

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.


Saturday, December 3, 2011

EMTs and Gunshot Wound Information for Thriller Writers


When I learned CPR, it was on a dummy like the one strapped to the gurney in my EMS photo on the right. It was okay training. In the back of my mind, I think that what I learned on the dummy might not translate so well when and if I were actually doing those chest compression and singing, “Ah ah ah ah Staying alive. Staying alive…” that ironically provides the perfect tempo for CPR.

English: A paramedic preparing a intra-venous ...Image via Wikipedia

It was a real treat to have the second year paramedic students role-play for us. Mainly it was relieving to know they practice on each other. If I were lying out on a road somewhere and the first responders were practicing on me as a human - instead of me as a disembodied plastic torso - for the first time…well, I’d be grateful, no doubt, that someone was willing to show up - but I’d be hopeful that their hands had been on real people.

Real people indeed. A girl stumbled into the room in a daze, gasping for breath, collapsing on the cold tile floor in the ambulance bay where we perched to watch and learn. An ambulance pulled up and the work began.

Paramedic work, like all field medicine, requires a little MacGyver-esque ingenuity. For example, the victim had two open wounds. These were not referred to as gunshot wounds. The paramedics I spoke with are not allowed to diagnose - though I have had paramedics write and tell me they can so check the locality of your book's setting.

In order to apply pressure and seal the wounds, front and back, they used the pads from a defibrillator. Very effective. They discovered that the victim had a deviation between her right and left lungs. Her wound must have caused a tear in the lung causing it to collapse. That’s life or death. But Kent Sears and his crew went methodically forward. They used an intravenous needle taped (any foreign object that has entered the body either by design or accident, and is sticking out, needs to be taped) to the victim’s chest balancing the lungs.

When the lungs collapsed the victim passed out. Splat. They needed to get an
IV line in. How do you do that if the vein has collapsed? They used an Intraosseous or IO machine. It looks like a hand held drill. They screwed on a drilling attachment that had a spoon like bit. They have this enter into the flat portion of the fibula (in the leg), or if this is unavailable they can use the humeral bone (at the shoulder). This process is very quick and is usually done on someone who is unconscious. If it is done on someone who is aware, they give a quick burst of Lidocaine before they introduce the fluids.

WARNING Trigger alert  Video Quick Study

Pain ratings for the IO

Entry drill 3
Pain with drip (no Lidocaine) 8
Pain with drip (Lidocaine) 1
Pain pulling out apparatus 1-2

How do the first responders know what to ask? They use a mnemonic.

O - onset - when did this start?
P - provocation - how did this start? Ex. With a heart attack victim

      where you doing something strenuous?
Q - quality - Is it sharp? Is it dull? Does it throb? And so forth.
R - Radiation - where do you feel the pain?
S - Severity - This is the famous 1-10 scale. 10 being your head is

      about to explode.
T - Time- are there any changes over time.


S - signs and symptoms
A- allergies
M -medications. What medications are you taking?
P - pertinent - What pertinent medical information do we need to

      know? Ex Are you pregnant?
L - last - When is the last time you ate or drank? Important for

E - events - What events lead up to the medical issues?

Here’s some interesting shot related information:
Once the bullet enters the body it can bounce around and go anywhere. The physics of the ammunition entering the body at any spot can cause hydrostatic shock. Basically a shock wave that runs through the body and can injure the brain. This is why gunshot victims wear a
c-collar and are on a backboards.

The victim’s health comes first. The
EMTs are trained to cut away from the cloth where the bullet was introduced. They try their best to preserve evidence. Of course, all that goes out the window when a life is on the line.

The EMTs appreciate people who can help. The will often give hysterical family members something to do. Sort the old “go boil water, Dad!” scenario. They need to be careful though. They’ve had it happen that someone is hanging around looking like they want to be helpful, but they are really just there to make sure that the job got done and the victim dies- especially with gangs.

There is something called a Tactical Medic. This is someone who was trained as an EMT and trains with the sheriff or police though they do not do police work per se. And this job might be an interesting one about which to write. Especially in a situation that goes very, very wrong.

I hope you find this information helpful. Please let me know if you have any questions.
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