Forum Replies Created
April 9, 2020 at 8:39 am #145537
April 9, 2020 at 8:33 am #145535
@wheelsee, thanks for sharing man. I can give two perspectives, EMS (as medical director) and from the ED (Dept. Chairman-but I work full time ;):
1. EMS: our county implemented department wide PPE on all calls weeks ago. With the high rate of asymptomatic shedders as well as atypical symptoms, we decided early to maximize PPE: N-95, gown, eye pro, gloves, etc. on all calls. To date, we’ve had results and knock on wood despite high rates of known exposures…our folks are staying healthy. We also limiting aerosolizing procedures and increases screening to maximize our risk mitigation. We have a full surge protocol in place if we get to NYC level craziness.
2. ED: man, this has been crazy, as my group staffs 5 ER’s for the health system. We crafted an intubation good for critical patients, cohort area of new negative pressure rooms in the department, separate triage area and advanced screening. To date, our volumes are down, but acuity is up. Positive pressure ventilation and high PEEP seem to be key in managing this thing…ARDS.net has been a great resource as well. PEEP, prone, and time.
Our mortalities are highly associated with age (>65) and significant comorbidities.
For intubation, we’ve shifted to 100% videoscope under our “hood” to reduce risk of aerosolization. We wanted to switch over to only MDI’s for breathing treatments…but just don’t have enough.
PPE: moving target based on supply. Eye pro, gloves, gown and surgical mask on all suspected patients. N-95 or PAPR for aerosolized procedure. I personally wear N-95 all shift under a surgical mask. In my mind…every patient has it, only way to reduce my risk is to treat everyone as if they are carrying it. The hospital has been awesome and provides us all with scrubs every shift. So I show up in shorts, change, work, drop off, and head home without bringing home “contaminated” scrubs.
At home, I have a separate entrance to the house where I fully decon. Shoes (dedicates work) never come in. I fully change and throw stuff in laundry. Wipe down keys, phone, etc. Full shower before joining the family in common area. Nothing is perfect, but better than most.
Happy to share protocols we’ve drafted if it helps. Just trying to stay ahead of this thing in our AO, which to date seems to be working. Stay safe!
March 25, 2020 at 12:48 pm #144717
Update from Idaho:
Been silent for a bit on the forum only because I’ve been up to my head in this shit. In the middle of a seven day stretch and buried with preparedness meetings and Incident Command stuff. I’ll try to keep it brief:
1. We’ve seen the same “curve” here as NY and other places, we’re early still and project this weekend will be the shit show (I’ll be working all weekend).
2. Multiple positives with a few deaths. The deaths so far are older with significant comorbidities, but it’s fast and devastating. This viral infection is very much NOT like influenza, that’s my firsthand experience.
3. Normalcy bias has reduced the social distancing and shelter in place mentality. There really is something to reducing risk of exposure, especially with the way this virus survives in places and on things. Getting past the entitled mentality has been impossible and it will only promote spread.
4. Supplies are in short demand. PPE for medical professionals and first responders is stretch to its thinnest. We continue to explore sources and it seems more is on the way, but until it’s in hand, I don’t trust anyone.
5. Schools are shut down, local non-essential businesses are on lockdown.
6. Stores struggle to restock the buttcoin of the apocalypse. Amazing the run on toilet paper. Availability of perishables has not been affected…yet.
That’s what I’ve got, stay frosty. I’m off for a nap, then back to the suck.
March 21, 2020 at 10:03 pm #144293
Cases spiking, at least with increased testing. Knew it was here. We’ve shut down operations at our heaviest hit hospital in Sun Valley:
Only the ER remains open, my group has been asked to help with staffing.
Washington state is now starting to look like Italy:
Our staff remains healthy, however we’ve now only just seen our first cases of admitted patients with COVID-19. We’re early in our curve so to speak.
Boise has shut down all schools and nonessential city buildings/services. Shelter in place requested…but not mandated.
Unprecedented times…I’m off to start my 6 day stretch in the ER. Pounding probiotics, Vit C, E, D, selenium, etc. The stats are in my favor…but shit, you never know. Into the breach once more…stay frosty folks.
March 16, 2020 at 6:29 pm #143717
My AO is locking down. Moved our flight home to tomorrow, hopefully can still make it back. Not running from the virus…but back into the sick. Needed in the trenches. Family will be safer at home with what I have there for them. Stay frosty, National interstate travel ban is likely imminent.
March 13, 2020 at 11:44 am #143376
Case-fatality proportion among cases aged ≥60 years was:
60-69 years: 3.6%
70-79 years: 8%
≥80 years: 14.8%
Comorbidity Fatality Rate
10.5% for those with cardiovascular disease,
7% for diabetes
6% each for chronic respiratory disease, hypertension, and cancer.
Case fatality for patients who developed respiratory failure, septic shock, or multiple organ dysfunction was 49%
Limited information is available about the clinical presentation, clinical course, and risk factors for severe COVID-19 in children.
2.1% were aged <20 years
0%<10 years of age
March 13, 2020 at 10:49 am #143372
Begin, sorry…typing on a cell phone. Please excuse the typos.
March 13, 2020 at 10:41 am #143370
In the spirit of the thread: Information/Intelligence…I’ll share updates from my AO and current experience as boots on the ground in the ER and preparations going into EMS (Ada County Medical Director):
1. NO documented COVID-19 cases in Idaho as of last night. Doesn’t mean it’s not there, just no positives.
2. CDC, State Dept of Health and Hospitals are coordinating with each other on surge planning, resource utilization.
3. Supply chain is a HUGE issue. PPE is on a 20 day timeline to run out secondary to everyone buying up N-95’s.
4. Staffing is going to be a HUGE issue. But as it evolves and we begging to stretch the workforce, we’ll adjust and adapt. Wrist case scenario…no one shows up to work.
5. Nothing has changed on the epidemiology of the virus: highly infections, two phases of illness. Droplet spread (N-95 overkill), surgical mask and 6-10 feet of separation enough. Killed easily with regular cleaners and disinfectants, but lingers on uncleaned surfaces 5-6 days.
6. Effects on economy are undeniable. My 401k got its teeth kicked in. Good thing I’m no where near retirement.
7. Humans as a herd species are stupid. Put them into a contained space and introduce panic…BOOM.
8. Wash your hands, take your vitamins, get sleep. Statistically, you’ll be fine.
9. I appreciate a good skeptic, misinformation is legit. What people are reading and then interpreting are vastly different. I’ve seen it. People will always see and hear what they want to.
10. This is as real as it’s come for my generation. Glad I’ve trained and prepped. Having the right mentality goes further than ever now. Stay frosty. If anyone wants to chat directly, PM me. Or get my cell. Happy to share thoughts, plans, etc. Stay frosty…
March 10, 2020 at 10:42 pm #143037
Big hospital meeting today, Covid was addressed, here are some points I gleaned:
1. Idaho, Wyoming and Montana have 0 confirmed cases, however we are surrounded by states that have declared states of emergency, take it FWIW.
2. NO DEATHS under the age of 10. Under the age of 20, <1%. However, mortality among positive tested individuals is 2-3% at age 50 and doubles with each decade, 60= 4-6%, etc. however, in South Korea, asymptomatic testing shows its actually 0.5-1% even in 60+.
3. No treatment
4. Disease has 2 phases, phase 1 is upper respiratory and MOST get better. 20% go on to develop phase 2 at 5-7 days which is the lower respiratory stuff. 1-3% mortality.
5. Current data shows it is NOT spread by air, but by droplet. Problem is it can survive on surfaces for up to 5 days.
6. Easily killed with basic cleaners, Lysol, etc.
More to come as it it’s available. Our system is in full react phase. Actively keeping these folks separated and masked on arrival, etc.
March 9, 2020 at 9:26 pm #142900
Idaho has been fun, especially with the cases in Seattle. Costco is rationing toilet paper. I’ve been through tons of hurricanes, all the big Cat 5’s and never once was there a run on TP. Now beer and bread…don’t mess with Cajuns!
From a medical standpoint, Idaho has 0 confirmed cases. Our hospital has implemented triage protocols, PPE, etc. Common sense stuff. Contingency plans and surge plans are ready to go if needed.
Personally, I’m more concerned about economic impact, local supply chain with the hysteria. The virus isn’t a joke nor something to take lightly. But common sense shit like hand washing, sleep and risk mitigation just like with flu will keep exposure down. Unfortunately, I’m on the front lines…
January 4, 2020 at 11:34 am #135191
This is a GREAT post filled with some of the best takeaway information available!!! Thanks for sharing. I’ve shared the link with all of my Idaho guys. Why chance you’re life when it really matters??? All the greatest gear won’t mean shit if your go to war rifle fails out of the gait. Thanks again!!!
December 28, 2019 at 1:03 pm #134121
I utilize a Vortex Razor HD scope. Have had it for years and it has held up on multiple field excursions. It also has a changeable eyepiece with mildot crosshairs. I utilize it for hunting and shooting matches, my wife utilizes it for birding and wildlife excursions (Yellowstone, Tetons, etc). In conjunction with the carbon fiber manfroto tripod….it’s as good as I could ask for in weight, portability, clarity and durability.
December 24, 2019 at 4:38 pm #133502
Happy holidays!!! Stay safe out there!!!
December 11, 2019 at 9:20 am #131912
I’ll throw what I’ve been running for the last few years out. As with anything, it’s whats worked for me after multiple evolutions:
1. Battle belt: shellback
2. Mag pouches: HSGI rifle/pistol x2
3. TQ: NAR hard case
4. IFAK: pull-fak on belt
5. Holster: custom kydex for Glock 19
I also run a leatherman MUT multitool on my battle belt. Highly recommend having one somewhere and easily accessible.
6. PC: Warrior Assault Systems Recon
7. Plates: Shot stop GT
8. Radio: Motorola DTR/Horizon Marine, depending on mission
9. Helmet: Crye Airframe with Liberator II earpro attached, helmet light: surefire HLA-1 IR/strobe/white light
10. NVG: PVS-14, see JRH
11. Thermal: FLIR Breach, also see JRH
12. Daypack/assault pack: I have a couple, mission specific: Camelback HAWG, Crossfire, and Eberlestock F5.
Again, this is what has worked for me. It is definitely a journey. Hope this is what you were looking for Max. Didn’t have time to embed links.
- This reply was modified 8 months, 1 week ago by idahocajun.
December 5, 2019 at 9:19 am #131116
About to head into the OR to get my shoulder fixed. I won’t be able to do anything with arms..but plan on doing modified stuff as soon as I’m able. Thanks for doing this!
December 1, 2019 at 10:14 pm #130566
I decided to buy once, cry once and got the FLIR breach from JRH last year. It is the absolute BOMB.
November 6, 2019 at 1:37 am #126440
I’ll give my experience and two cents for what it’s worth. My go to war rifle is a Colt 6960 and my wife’s a 6920. I run the Leupold Mark 6 1-6x with the 5.56 CMR reticle. Found some ammo that flies that reticle perfect, now I’m solid out to 600 yards consistently. My wife runs the vortex strike Eagle 1-8x. She’s solid out to 500 consistently with that, only draw back is it’s a SFP scope. I’m assuming your AO is similar to mine in Idaho. Personally, the 3-9x doesn’t make much sense unless you’re going to shoot consistently from a bench or a bipod. I’d sell it and get a solid 1 to 4 or something similar. Again, just my opinion on the matter, This is what worked for me. Good luck.
- This reply was modified 9 months, 1 week ago by idahocajun.
October 22, 2019 at 3:28 pm #124711
October 15, 2019 at 1:21 am #123710
October 15, 2019 at 12:57 am #123700
Absolutely in again!!!
October 13, 2019 at 4:26 pm #123478
Ordered today! Looking forward to field testing it in Idaho.
August 9, 2019 at 7:55 pm #113716
July 5, 2019 at 11:38 pm #82091
I have no connection to that part of Idaho, but some of the boys from east Idaho were at CLC in October. I can hook you up with contacts if interested, they’d be a likely good source of information. Hope all is well man!
June 25, 2019 at 12:50 pm #91961
Wound care, what a broad topic. I could grab drinks and spend a ton of time discussing the intricacies of this: where is the wound, how deep, how contaminated, animal vs human bite, preexisting medical issues (diabetes), medications (blood thinners), etc. Or I could give you my basic gist:
1. Immediate care of wound: clean it, clean it good! Tap water just as effective as “sterile saline”. Don’t use stuff on deep wounds like peroxide as it actually can create a problem with healing.
2. Repair: I prefer sutures or stereo strips, allows the wound to “breath”. Glue and occlusive dressings have their place, but trade off is they can lock in shit leading to infection, dehiscence, etc. I also NEVER use a topical antibacterial ointment on bite wounds, dog or human. Don’t treat the actual type of bacteria you worry about and cause major healing issues.
3. Wound care: keep dry for 12-24 hours, then clean with soap and water lightly. After 1-2 days, dressing changes 2-3 times a day with whatever works.
4. Special considerations: someone’s don’t require any kind of repair. It’s actually more beneficial to allow them to heal from the inside out, what we call secondary intention.
5. Long term care: keep it simple right? Keep it clean. Dress/cover it for the appropriate conditions.
I’m happy to discuss this in more detail, as this is something we deal with pretty regularly in the emergency department. But again, it’s a pretty deep rabbit hole With lots of considerations.
June 13, 2019 at 12:26 am #82089
Sorry for the delay, I’ve been offline and off the forum for a bit. I’m in the Boise area, would love to cuss/discuss more. PM me and let’s set up something over coffee.
March 19, 2019 at 12:48 pm #113074
How timely with the release of this article:
This all goes back to my post on bias and agendas. Here’s a mother who lost her child being ridiculed and shamed by a “movement.” Now don’t get me wrong, the other side of this is just as guilty. What I’m attempting to draw attention to is the bias. In order to make educated decisions, you have to weigh through all of this shite from both perspectives. In my limited experience, you can’t do that by calling someone stupid or alienating them for their beliefs. Understanding where they are coming from and having a rational discussion is key…the ONLY way compromise happens. Otherwise nothing ever gets accomplished…
March 18, 2019 at 12:31 pm #113072
That was “the paper” that folks have been touting for years. The guy has since retracted it, lost his license, etc. He admitted to forging the data. At one point, Jenny McCarthy was the face for the anti vaccination movement. Turns out her son did NOT have autism, but another genetic disorder. She has since disappeared from that campaign. All goes back to my point on bias. People truly see the truth as what they want it to be. In my experience the only thing that can be done is present as much of the facts as possible and allow folks to make informed decisions for themselves.
March 18, 2019 at 1:13 am #113069
I think your point on disease cause and effect is spot on! There is rarely a single cause for disease like cancer, heart disease, diabetes, etc. It’s a combination of environmental factors coupled with genetic predisposition. Now, do vaccines cause autism, the answer is no! There is no direct cause and effect. However there is one study from the National Institute of Health linking a 3x higher incidence of autism with infant Hep B vaccine during a specific time periods:
Now, to your point, are vaccines safe? No more than anything else we put into our bodies. Antibiotics are not 100% safe. I’ve seen allergic reactions, kidney damage, liver damage, etc all related to antibiotic use. What it truly comes down to is cost/benefit. Is the treatment risk greater than the risk of the untreated disease? I deal with this decision daily.
To your point on vaccines. Herd immunity is a legitimate thing and in some regards the only way a vaccine reaches maximal effect. Being vaccinated is not a 100% guarantee against any disease, but can lessen the impact, etc. It comes down to informed consent, but also the public health impacts have to be taken into consideration. It’s a fine line, protecting individual rights but also protecting public health.
Just my thoughts, not worth much.
March 17, 2019 at 7:28 pm #82086
Also in the TV, always looking to make contacts and expand.
March 14, 2019 at 12:42 am #108253
My father in law runs the Crye JPC and loves it. I run the Warrior Assualt Systems recon rig. I personally love the quick snaps versus Velcro. I have been eyeballing the first spear rigs for a while, just haven’t pulled the trigger based on the price point.