Final Word: George Floyd (Foreword)

The Foreword isn’t about George Floyd. The Foreword is about me.

I was a working medical professional for about a decade. Not to glorify myself with my actual job title, I was what you could call an ambulance driver.

Among medical professionals, ambulance drivers receive about the least formal training. To have less medical training than an ambulance driver and still be called a professional, you also have to be a certified Wildland Firefighter or something.

The training to be an ambulance driver is intensive, but it only lasts about half a year. Obviously you can’t make a physician or a surgeon in just six months. The part they can teach you in that limited time is the best part: Assessment.

For filling out certain medical paperwork, there’s a formula called SOAP. It means: Subjective, Objective, Assessment, and Plan.

Subjective is whatever the patient is complaining about, that you can’t see. “My stomach hurts.” “I feel dizzy.” These things are referred to as symptoms.

Objective is things you can see in one way or another. There’s a rash on the scalp. The breathing is noisy. Blood sugar is down to 35 mg/dL. These things are called signs.

Assessment is what you think is going on. Diabetic ketoacidosis. Siezure. Generalized anxiety.

Plan is what you did about it, or what you intend to do. Administer aspirin. Administer electric shock. Splint a fracture. Transport to ER.

A physician working in a full-service hospital has all the tools for assessment, including things like blood work and CAT scans. Obviously you can’t take those tools out in the field. But you have your physical senses, and a few tools: heart monitor, pulse oximeter, blood glucometer, stethoscope, blood pressure cuff, penlight. With that limited kit an ambulance driver can rapidly and accurately assess dozens of common medical conditions and internal injuries.

Ambulances typically roll with a crew of two: the driver and the Paramedic. Paramedics have about two years’ minimum of intensive training. In terms of assessment, it’s not much of an advantage. Paramedics have exactly one assessment skill that drivers don’t: they are licensed to assess a heart monitor readout. Which is a very nifty skill, but rarely applied.

Thus, paramedics are only marginally ahead of drivers when it comes to Assessment. But when it comes to the Plan, the paramedic is God. A driver has a license to splint and bandage trauma patients, do basic life support and defibrillation with a couple of crude tools to help manage the airway, and administer a handful of the most innocuous drugs. Paramedics can bring the dead to life. If there’s air in the chest, a paramedic can poke a hole and let it out. They can poke a hole in the neck to let air in. They can poke a hole in the circulatory system, add fluids to a bleeding patient, add sugar to a diabetic emergency. They can chemically paralyze and intubate, administer opiates and sedatives, insert a urinary catheter, etc.

An ambulance driver isn’t licensed to do those things, but he knows how they’re done and he’s generally the one carrying the gear. On scene, the driver acts as a physician’s assistant or surgery nurse, anticipating the next step and having tools ready when they’re wanted. The driver has another traditional role: when the paramedic has his head down working on the patient, the driver keeps his own head up.

It’s called the Prehospital Setting, and nobody knows where it’s going to be. It might be in the works of some industrial machine, it might be at someone’s elegant wedding feast, it might be in the bottom of a muddy ditch trying to smash the window of an overturned pickup truck that was on fire when you got here. Scene safety is paramount. Is this machine locked out/tagged out? Is the attacker still here at the feast? Is this truck going to roll over on me? And you have to keep an ongoing eye on all these things. That cross-eyed bridesmaid with the serving fork could pop out of the shrubbery anytime. The ditch bank could start to erode.

It’s common to have sketchy people or weapons on scene. In the semi-rural service area where I worked, there was a lot of what you might call downscale living, and people who live like that rely on emergency services for their health care. Many live in squalor; some are drunks and/or meth-heads; a few are flat-out criminals. When sketchy people are around, you have to try to be tactical to keep everybody in view and maintain a line of retreat. You don’t just assess the patient. In a low-key, circumspect way, you continuously assess everybody.

Imagine you’re at a party with some friends, some friends-of-friends, and some other acquaintances. As you move around and interact with people, you use your social skills to assess people and decide how to treat them. This one seems manipulative, this one is friendly but annoying, her laugh is atrocious, that one’s attractive, he seems grumpy, etc. Now imagine everyone at the party is a sketchy stranger. This one’s huddled in the corner mumbling, this one seems to be spoiling for a fight, this one has sallow skin and twitching hands, this one is wearing sunglasses and trying to look intimidating. You’d pick up on the dangerous vibe and amp up your awareness. You’d notice more details about everything and everybody. People who live in neighborhoods with detectable levels of street crime develop the habit of heightened awareness when out-of-doors.

Ambulance personnel do the same thing, not so much as a matter of instinct or habit, but as of training and experience. Heightened awareness coupled with medical training means you can assess a lot at a glance. You see the skin, the posture, the eyes, hear the voice or the breathing…you can often make an accurate assessment before you even have time to introduce yourself and set down your bags. If the patient has heart failure, you can see his swollen feet and confirm it by listening to him breathe. There are quite a few specific conditions you can spot from across the room.

In my capacity as an ambulance driver, I have worked with the police. I have treated people who were in custody at the time. Not all cops are good, but the cops I worked with were good, and I never knew them to mistreat anyone. Police have medical training too, some of which I know about. I also know a thing or two about fighting and the legalities of deadly force.

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I assessed the video of George Floyd’s death. I saw the cellphone video of him actually dying, and I also saw the bodycam video of the initial stop and confrontation.

In a nutshell: George Floyd’s death was wrongful. I predict Derek Chauvin will be justly convicted of murder in the second degree. I also predict Chauvin will be unjustly sentenced; a light sentence or early commutation would be just. They’ll give him life. There is no justice in any of this.

There’s a lot of commentary to the contrary, from both right and left, so I’ll take that line by line in Part One.