Author: powshredder

my sar medical bag

my sar medical bag

I was having a discussion with some folks about this topic so I thought “hey Eric, you should sit on your ass and write about it, bro.”

I really think buying medical equipment that you’ve never trained on is a bit silly: it’s akin to buying random tools at the home improvement store thinking “well you never know, I might just need this rivet gun one day.” Everything I carry is something I’ve used in the field or at home, and was part of my training from either basic first aid, my WFR, or my WEMT. When some dude is bleeding in front of you is not the time to stare at the piece of gear you got from Amazon and try to figure it out: take a class.

Also, our sar team has its own medical bags which I often use instead. We have a “first out” bag which carries basic airway, bleeding, and assessment gear. We have O2 tanks we can bring in, litters, vacuum splints, etc. But there’s only a couple of bags and if we’re on a search or otherwise not in a simple “the single injured person is at coordinates xxx.yyy, sss.tttt”, I don’t like running around in the field with my own personal wimpy backpacking first aid kit (my team’s minimum for me personally). Also, I use this for my family and keep it in my truck for whatever randomness the world provides.

I have allergies so I use unscented deodorant. TheMoreYouKnow.jpg

For starters, you can see it’s pretty small. The bag itself is sort of a piece of crap but it works and if something breaks on it I won’t be sad.

It’s not the size that counts. -_-

I put the stethoscope on top because I didn’t like how it was getting bent inside the pack. If I’m going to use it I’ll throw it down my shirt while I get other stuff ready so I’m not freezing someone to death with a 0 degree piece of plastic on their skin.

Not bad for a little bag, right?

So here’s my list of what’s in there, trying to group things:

Assessment, since you can’t fix problems you don’t know about and handing off patients to paramedics/hospitals with a “I dunno” response makes you rightfully look like an idiot.

  • BP cuff. I keep a pediatric at home and if I needed I can toss this on a kid’s thigh and get X/palp with a pedal artery.
  • Pulse oximeter. Handy not only at altitude up here, but also gives you a pulse nice and easy so you can move a bit quicker.
  • Thermometer. Temple and forehead, I won’t lie: this is mainly for home use with sick kids. It also doesn’t work under 50 degrees F.
  • Stethoscope. Getting good lung sounds is pretty important for diagnosing HAPE, pneumothoraces, etc.  Plus you can say “auscultate” which is pretty tight.
  • Pupil light. More often than not I use it to read something or stare down a patient’s throat.
  • Emergency Spanish for Fire/EMS. Small booklet, but good luck doing anything if you can’t talk to someone.

Bleeding. For the most part, by the time a sar team gets to you a massive arterial hemorrhage isn’t going to be treatable. Most sar responses are well outside the golden hour, but that doesn’t mean all hope is lost. Also, I have this kit with me in my truck and have been to enough motor vehicle accidents to know that I can actually be there fast enough sometimes, even if just in a good samaritan role.

  • Tourniquet. Spooky and dangerous, these are actually back in vogue and for my training was the preferred mechanism of stopping an uncontrolled bleed. Refer to your training for usage and ischemia management.
  • Gauze. One roll because if you need more than one roll you need like a million, or a tourniquet.
  • Triangle bandages (x3). So these can double-duty as crummy gauze.
  • Bandaids. Sometimes it’s just that easy.
  • Povidone iodine pads. In my WFR training (where you may not have sterilized water) these little bastards can be squeezed into a water bottle killing off germs and making a diluted wound irrigation fluid that won’t harm skin.
  • Medical tape. Good for taping gauze/stuff down on wounds. Also good for deadlifting days to put on your shins so the bar doesn’t cut you up when lifting heavy. #SubtleBrag

Airway. This is actually fairly legit (in my opinion) to carry because for sar you tend to have long carry outs and if homeslice loses consciousness things can go bad quick.

  • I used to carry a whole mini-fleet of OPAs but a single NPA with a lube pack is way lighter, smaller, and more versatile. Yanking an NPA out takes a second and if someone is U on AVPU I’d rather have an NPA in than an OPA. Pulmonary aspiration of vomitus is a big deal with scary high death rates.
  • Valve mask. More applicable to motor vehicle accidents and random urban life than sar.

Medications. This is all about your protocols, your prescriptions, your scope of practice, and how much liability you want to handle. Again, some of this stuff is for me and my family’s use: do your own math and consult your training.

  • Aspirin, chewable 81mg. If a patient is having a heart attack you might just save their life or add a decade (or more) to their clock.
  • Diphenhydramine. Allergic reactions are common and life threatening ones aren’t the rare rainbow-unicorns from twenty years ago.
  • Electrolyte tabs. It’s pretty normal to find people exhausted and cramped up. An hour’s rest, some electrolytes, and fluids can make the difference between walking someone out and carrying them.
  • 500 MG amoxicillin (x6). Not for sar, but if on an extended trip into the boonies this buys me two days of bacterial combat to get them (or me) handed off to higher care.
  • Prednisone. Again nor for sar, but I’ve had my own life saved by this stuff so I keep it on me.

Doo-dads. Rounding out the edges, things that are handy.

  • My protocols, written down, staring at me in the face. It’s so easy to get carried away in the moment.
  • Pencil, rite-in-the-rain EMS vitals sheet. Use some of that medical tape to secure your notes to an unresponsive patient’s leg.
  • Gloves, cloth mask. BSI, PPE, scene safe! I put gloves everywhere so there’s no excuse not to wear them. Open the top pouch: gloves. Open the waist belt pouches on my frame pack: gloves. What’s up my butt? Gloves! Gloves everywhere, baby. Combined with a sharpie you can make cool balloon animals for kids with gloves too.
  • Tweezers.
  • Trauma shears. Nothing says “I care” like cutting someone’s $300 GoreTex pants off of them.
  • Vet-wrap for stability. The colorful stuff that you see on a horse’s ankle is called “vet wrap“. Dirt cheap, multicolored, and self-adhesive. You won’t be sad if you never get it back.
  • Triangle bandages. They come with safety pins and can double duty as gauze or making slings/wraps.
  • Burn gel. I’m not into most goofy creams and ointments but burn gel really does work and people really do burn themselves.
  • Antibiotic ointment (speaking of goofy creams). I know most hospitals like to work on non-gooey wounds so this isn’t really a sar thing. But if you’ve got a dirty environment and a couple of days until definitive care I can’t see this as a bad idea.

So there you go, that’s what I keep with me most of the time. Starting back at the top I recommend that you go out and get your training: WFA, WFR, EMT, RN, MD, DO, witchdoctor, alternative Eastern healer, whatever. Just learn how to treat others and yourself and equip yourself with tools for jobs you know how to do. Otherwise you’re that dude with an inch of dust on your rivet gun and no idea when or how to use it.

Oh, and a word about batteries. For my sar radio I have a six AAA spare battery pack in my pack, made up of lithium batteries which are really your only option in the cold. My pulse ox has two lithiums in it at, put the thermometer is so limited I keep the batteries out and just pop them in if I’ll use them, which is normally at home with a sick kid.


chains and winter driving in mammoth

Winter driving is a skill and not just in the driver’s seat. Knowing when you should drive, when you should wait, and what to toss in the car. Unfortunately for people visiting Mammoth (or any snowy mountain area) this just isn’t something they need to deal with all the time so those skills can be a bit rusty.

Step one: understand California chain control rules.

There are three levels of chain control, and you can see these by checking the highway status from Caltrans. Here’s the 395 (major Eastern Sierra highway) and the 203 (connects the 395 to Mammoth’s Main Lodge). Mid-storm, you’ll want to keep checking this every ~30 minutes because the chain control restrictions and road closures shift with the conditions.

Typically managed by Caltrans with CHP around for troublemakers, you generally can’t talk your way out of chain control. Either you meet the requirement or you turn around.
  • R1 – Unless you have snow tires (with M+S stamped on the sidewall), you need to have chains or cables on one of your axles.
  • R2 – Unless you have AWD/4WD with snow tires, you need to have chains or cables on one of your axles.
  • R3 – Never really seen, and honestly you should turn back if you see this. Typically roads are closed past R2. I wouldn’t personally go out in R3 unless I  had sufficient equipment to bail on my vehicle and head out on foot, or wait out the entirety of the storm in my vehicle (fuel, heat, food, water, etc).

Cables count as chains, and modern cables work great. Practice putting them on at home and if you don’t have 4WD/AWD make sure you put them on the axle that the motor actually spins. If you have a 2WD car or truck make sure you know whether it’s front wheel or rear wheel drive and that’s where your chains/cables go. If you have 4WD/AWD there are religious arguments about whether you should chain up the front or the back: I’d recommend starting with the front.

Also, not all snow tires are created equal and not all AWD/4WD vehicles feel the same. I’ve had our AWD Subaru with Blizzaks completely spinning out unable to get up a climb. My twice-as-heavy FJ80 with KO2 tires jaunted up the same climb minutes later without the slightest hesitation. So just because you see a vehicle doing something doesn’t mean yours can, and the other way around.

Drive safe. Note that the snow berm on the right is higher than my truck.

Step two: drive slow.

I have a heavy 4WD, high clearance truck, with aggressive snow tires. If it’s really gross out I’ll rarely drive over 20MPH. Highway, neighborhood, whatever: drive slow. If you have chains or cables on they probably have speed limits too. Plus, packed down snow (after a storm) is generally worse than deep snow for slide outs, and the next night after it went through a melt/freeze cycle can be really slick. Drive slow.

There’s an expression in snowmobiling and winter driving: inertia (speed) is your friend going uphill, it’s your enemy going downhill. And definitely when going downhill there’s a difference between a slideout being an ego-bruising hour of shoveling versus t-boning another vehicle with kids in the back.

ABS (antilock breaking systems) work terribly in snow and ice, and your braking distance will be really magnified. One of the most common accidents is someone “braking” at a red light or stop sign only for the brakes to start ABS-jittering and the vehicle to happily roll straight into the intersection. Again, drive slow and watch the downhill momentum.

Step three: if it’s a storm or you see R2 conditions on the 395, take it seriously.

Bring a shovel (collapsible ones work), keep your winter gloves and jacket handy, and make sure you have a full gas tank. If you get near a half a tank, pull over at the next opportunity. Getting stuck for a couple of hours with your heater working fine is a little annoying, getting stuck with no heater can become an emergency in minutes.

If you do get emergency-stuck and it’s really dumping outside, make sure you keep the vehicle’s exhaust pipe in the back relatively shoveled out, the front grill relatively clear, and at least the occupied doors able to open if need be. There are deaths every year of carbon monoxide poisoning because the snow essentially traps enough exhaust gas under the vehicle which is where the air intake for the heaters pull from.

My buddy’s truck high centered: tires spinning, compressed snow under the axles is now what’s supporting the weight of the vehicle. Have fun chiseling compacted ice out. Plus, it will just happen again as soon as he moves forward or back.

Step four: be visible.

White cars are cool but like an all-white snowsuit they are terrible for visibility. If it’s really reduced visibility, consider putting something on the back of your car to make it visible. And keep your lights on! If you’re having problems navigating the road, toss the hazards on. No one will get mad at you for signaling that you’re having a tough go of it and that you want to increase your vehicle’s visibility.

Step five: sometimes you need to wait it out.

The 16/17 winter here in the Eastern Sierra was epic by all accounts. We had the highest monthly snowfall ever recorded in the United States and even with our shovels, 4×4 rigs, traction devices, and related fancy gear, there were plenty of days where I looked out the window and just shook my head. We had to wait for the plows and blowers, we had to wait for the visibility to improve. Getting stuck really sucks when the conditions are so bad that people can’t even come help you.

The drive up the 395 is normally a total cakewalk requiring nothing other than typical safety. But mid winter in a storm things change fast. The thing you could have gotten away with six hours earlier can get now get you killed. Be safe, drive slow, and when in doubt just wait it out.

mammoth’s fort co-working space at main lodge

Back in October there was a pretty screaming deal on access to The Fort if you already had a season pass, so I snagged the no-longer-available option. The price structure has changed a bit but here I am with access until June. Typically I work from my home office: three phones, three monitors, two headsets, charging stations galore, a comfy chair, and a stand-up/-sit-down desk. I don’t really need a co-working space in Mammoth personally but the concept of being able to work from Main Lodge (one of the two Fort locations) just seemed too good to pass up.

There’s a small 6’x8′ room behind me, but otherwise this is The Fort at Main Lodge.

The Main Lodge location is, frankly, perfect. As you can see in the photo you are quite literally spitting distance from Chair 6. Walking, it takes less than a minute from your desk to the chair. There’s wifi, lockers, places to stash skis/boards, a decently sized coat rack, and a sweet app that lets you unlock the door from your phone.

It’s relatively quiet inside and it’s at the end of a hallway that isn’t trafficked by most skiers/boarders so you can even kinda-sorta make phone calls from there, more on that below.

It’s also warm and dry which might not seem like much but folks coming in with snow gear on tend to create a lot of humidity as the moisture evaporates so it was nice to not be a dank sauna.

Four knocks against it I would make:

  1. Size. It’s small, and although empty in the photo above imagine three more folks in there (a total of five, counting me and the person at the far end) and you can see how it can get cramped quick. There are 8 lockers present, only a couple of which weren’t locked already, and I’m not sure how you could truthfully manage to have 8 people in there. Photos often show someone sitting in a chair with an iPad but modern work generally involves a laptop, a drink, a notepad, and your phone. My advice: get there early and don’t expect to show up mid-afternoon and have much to work with.
  2. The chairs are terrible. Although they look neat, I’ll bet you cold hard cash that no one reading this right now would want to sit in them for more than 30 minutes. They look good and trendy, but comfy office chairs exist for a reason.
  3. Zero kitchen. Mammoth exists to make money, and there’s nothing wrong with that. But most every workplace has a kitchen because it is just way too cost prohibitive to eat out for all your meals. That’s especially true at a ski resort where two hard boiled eggs and a cup of coffee ran me $9 yesterday. Additionally, some folks have dietary issues. Pretty much any workplace including, I’m sure, for the folks who work at Main Lodge for Mammoth, has an employee fridge and a kitchen of some extent. Perhaps just a microwave, toaster oven, and drip coffee machine. The Fort at Main Lodge has zero in that regard.
  4. Only one “sound proof” area for calls. Co-working spaces suffer from this problem in general: where do you make phone calls? You can be that obnoxious jerk who rattles off in a public area, forcing everyone else to put headphones on. Or you can be considerate and walk somewhere quiet. Some people aren’t on the phone a lot but it’s rare I think for most people to not need to be on a call at least once a day. There is the outside hallway but it’s only luck if you get privacy there.
Lockers! You can put your laptop and doo-dads in there while you buzz around on the slopes.

The Fort started up last year with two locations: main lodge and “downtown”. The downtown location is by far larger and better equipped. Main Lodge’s location is not just its advantage but it’s really its only advantage with a pile of disadvantages heaped on.

Real estate being what it is, it shouldn’t be a surprise that space at a ski resort’s lodge is a top commodity with contention all around for multiple purposes. And considering that The Fort only opened a year ago, I think they’ve done a terrific job with where they’re at.


The Fort’s integration with the ski resort is the blessing and the curse. Without that integration, there’s no way you’re going to be in such a great location, have the financial capital, the built-in maintenance and janitorial services, or the ability to do things like offer packages that combine a Cali4nia Pass.

Conversely, that integration favors the inclusive design of ski resort economics. You should be eating at ski resort restaurants, buying or renting your gear from the resort, staying at ski resort lodging, and otherwise staying inside the ski resort ecosystem.

For me personally I’ll look at the pricing next year to see if it makes sense. I’m not their target market of course, having a home office already in Mammoth. But I would hope that they continue to improve and that similar to most other work spaces (including co-working spaces across the country) thought is given to things like food and multi-hour comfort.

In short, employees at Mammoth Mountain don’t sit in one of those chairs or spend $5 for a cup of drip coffee, because that’s not the standard of a professional American workplace. Whether that’s what the Fort is trying to do, be a modern professional workplace more so than part of the resort’s economic ecosystem, is a balancing act I think they’ll be working with for some time. I’m looking forward to seeing how things progress.

i still hate heights

Any official operation we do as members of search and rescue is run by the Sheriff up here, and as such I can’t really talk about specifics. Also when I’m touching a patient both out of HIPAA and general decency I can’t talk about the person(s) involved very much. You can read up on the official story  with officially release details, and the Sheriff released this video for public consumption. I’m down there on the bottom.

So this story really isn’t about the rescue as much as it’s about what it’s like for this particular guy to get a call on my phone and find myself in a world that I’m still coming to grips with.

For starters, the part you don’t see in the video is where my buddy and I got lowered out of that helicopter, by a little wire, with all our packs and gear, onto those rocks, a half hour before that.

So let’s backup a bit to the point where I found myself at a lonely municipal airport, geared up: harness, mountaineering boots, helmet, goggles, radio, full pack. The helicopter crews start to rip the gear off slowly but surely: all the excess weight must go. Seats, spares, everything. Hauling my teammate and I up into the mountains takes a lot of power and to carry us the rest must go.

I’m surrounded by paramedics, the CHP flight team, other SAR members, and law enforcement. Radios crackle with updates, and I’m noticing that this all seems totally normal to them.

A little voice gets into my head:

It’s time you come clean and tell these people that you have no business here.

I try to shake it off, just figuring it’s the jitters. The pilot does his last fuel calculation and we load in. Sitting on bare metal, clipped to a bolt on the flooring, and holding onto the back of the pilot’s seat (the only seat left), the blades start slowly whirring.

My buddy and I in the back, red helmets, taking off.

The voice comes back, trying to bargain with me:

You’re on the team and technically you’re trained for this but this is the real deal. The is the stuff you see on Youtube. You’re not that guy. You’ve managed to get here, but you’re not supposed to be. You better tell them they have the wrong guy.

A classic case of imposter syndrome, I was feeling it in earnest. Putting myself on the couch, was it actually imposter syndrome or was it my deathly fear of heights scrambling for leverage? I even got worried that my feet would fall asleep being crunched up on the chopper floor. Wouldn’t that be hilarious: rescuer tumbles out of helicopter because his foot fell asleep.

I first decided to get into search and rescue, bluntly, because my daughter’s life was saved by a team like that. Maybe knowing that I’ll never be in the incredible PJ squad has me always feeling like I’ll never really be “enough”, and that it’s a cast of heroes that do the real work and my place is more centered around getting them coffee than being on the the pointy edge of the spear.

This was the first fire truck I ever ran a call on. Laurel Hill, Norwich, CT.

The first time I ever responded to a 911 call I was 18 years old running code 3 to a motor vehicle accident (“mva, car vs motorcycle” in dispatch parlance). I distinctly remember the feeling of “Oh shit, there’s no one else coming, it’s just us.”

I think for the average Joe Citizen when you call 911 you imagine this Hollywood-esque crew of Dwayne Johnsons rushing towards you, equipped with everything and flawless. But when you’re the one getting the 911 call it’s a very different story. You’re aware of your shortcomings. You’re trying to remember everything from your training. You’re trying to be aware of the things that won’t let you stay focused. You’re trying not to get hurt yourself but really you know you took this job because you wanted to help people and a bit of risk is part of the package.

My team and I, doing our thing, in the middle of nowhere.

The voice kept talking to me, but I went back to that realization I had as a teenager: this is your job and people are relying on you. If you don’t want to do this, quit later, but for now do your f’n job kid. You trained, you have a solid team that will back you up. They’re relying on you. The patient is relying on you. He’s hurt, he needs your help.

The crew chief hooked me onto the hoist wire and unclipped my tether. The spitwadded toilet paper in my ears did its best to muffle the rotor noise. I don’t remember going over the edge, but I do remember looking up at the underside of the AStar helicopter, dangling from its hoist wire: RESCUE was written in large, bold letters underneath it.

Touching down on the ground, I unhooked the wire. Meeting up with my other teammates we got started on our jobs. I don’t know if I’ll ever feel like I belong in this work, serving with these amazing people. But I sure as hell will try to keep up with them, not let them down, and take care of my patients. The voice in my head can quiet down and take a number.


aiare avalanche 1

Today was the third and final day of my “avy 1” course, taught by Sierra Mountain Guides. This marks the second wilderness-y course I’ve taken where the school portion was in an RV park’s common area, the first being my WFR.

While it’s still fresh in my head, here’s my thoughts on the course. Most of this is the AIARE curriculum mind you, none of my negatives are at the feet of Sierra Mountain Guides. In fact, they’re a super top notch organization. My instructors were experienced, personable, and solid at teaching.

Avy 1 is a whole bunch of people poking around in the backcountry. Part of my class.

There were maybe ~24 students in the class with four instructors, and folks traveled from San Diego, Orange County, and Los Angeles for the course. Only a few of us were locals. Additionally, the snow this season has been utter garbage so it was hard for our instructors to really show us dangerous snow conditions because frankly there is almost none in the Eastern Sierra right now.

What went well and what I think the big takeaway is that I learned the framework of how to properly prepare a safe backcountry trip. I learned how important your companions are, how much you need to gel with them, and how much risk you can dodge by terrain selection. If you eyeball the fatal avalanche data, you can note that slides under 30 degrees are rare. And 30 degrees is actually pretty steep, if you look at something like “the wall“. So if you stick to intermediate-esque backcountry runs (with nothing bigger around or above that can run-out into you) you’ve effectively eliminated your avalanche risk: poof-walla.

There’s obviously more to learn in 3 full days time than the above paragraph, but hopefully it shows that there are smart terrain choices you can make that slash your risk considerably.

Digging and studying snow pits.

Possibly the least interesting part of the course for me was the snow-science itself. On SAR I’ve learned that everyone has some stuff they’re really into and other stuff they’re just not as excited by. Maybe you like rigging, maybe you like medicine, maybe you like snowmobiles: you probably aren’t interested equally in all three but in SAR you have to be trained on a dozen different disciplines whether you’re into them or not.

It was very cool to learn about the layers that exist in the snowpack and how they relate to avalanches. But ultimately there is no magic fortune cookie at the bottom of a snow pit that will tell you whether something is safe. You just get more data:

  • Data from the terrain (angle, aspect to the sun, etc).
  • Data from the avalanche advisory bulletin that covers that area. Ours is the Eastern Sierra Avalanche Center.
  • Data from poking your poles / probe into the snow.
  • Data from looking at the snow. Was there an avalanche 100 yards away from where you are now? Is there a big ass cornice staring at you? Etc.

In reality you need to know the faceting and depth hoar processes as building blocks to understanding what they do in a snowpack which of course means you need to know how to identify them in the first place. If you’re venturing into avalanche terrain, and even just knowing what avalanche terrain even is, you really should get trained up.

Thinking a little harder, another thing about this course versus most of my medical ones is that in medicine it’s about people’s lives. It’s important and you cannot screw it up. With avalanches it’s almost always about allowing people to recreate and have fun, which just doesn’t have the reality check that exists in rescue medicine.

I guess I’ll see you in the backcountry, but I’m sticking to the coward slopes. They’re safer on the way down and easier on the way up.

doing the generator install

In total our power was out for about three days last year. A squirrel chewed through a line (or so it was reported), a truck backed into a power pole, and the last one I never heard the scoop on but it lasted a while.

These are just generally inconvenient but mid-winter it can be a different bag of potatoes. We could keep from dying I suppose by hopping in one of the cars: even if we couldn’t drive due to snow conditions we could keep the vents and exhaust shoveled out and just sit there in a nice warm cab. But that sounds absolutely horrible so I set out to get something more baller.

The noisy and heavy part: the generator. 

I opted for the Champion 3800, which is really more like 3500 watts at our altitude. It was $500, has an awesome reputation, and burns either gasoline or propane with the flip of a switch.

Propane is more expensive and harder to come by, but it never goes bad. The tank can get cold, and it produces less power than gasoline, but it starts up easier and it’s pretty hard to spill propane on your hands. The exhaust doesn’t stink that much. We have a 30LB tank hanging around.

Gasoline is cheaper, puts out more power, and is easier to come by. We have about 20 gallons, with fuel stabilizer mixed in. Come summer time the gas goes into the cars, and a new batch is put in the tanks with stabilizer again.

So ignore the unpatched drywall and focus on the spanking new electronics.

The previous owners had run multiple circuits to single breakers and installed a sub panel (huge hole there) because they ran out of space on the 1975 original panel that came with the house. There were all kinds of blank marker arrows and drawings, the thing was a mess and it drove me nuts. As would be said on the waterfront, it was chickenshit work.

I got a badass QO panel with space to grow, got a whole-house surge protector (white labeled box with little green light there), and wired the generator in with a generator transfer switch.

You could, if you’re a horrible person who likes killing others and setting your own house on fire, plug your generator directly into the outlet where your clothes dryer plugs in. The problem here is you are sending current out into your house and back into the power lines. Chances are if you’re running a generator it’s because the power is out and guess what electrical crews need to work with? That’s right, the electricity you’re sending out even though they think they turned all the power off.

A lineman for SoCal Edison was electrocuted last year by this very thing.

The generator plugs in here, so no need to have a cable snaking through a door or window.

So instead we use an awesome generator transfer switch. Beyond the safety, it’s wired directly into your main circuit breakers so you pick (in advance) what you want powered. For us it’s the pellet stove (heat), the fridge (food), the hot water heater, the lights in the kitchen and living room, and the television/PS4. Even our broadband gear will work if the outage isn’t impacting some other part of the network.

It was fun to walk around and read the current requirements from the various things we wanted to run at the same time. Interestingly enough, you need to balance the load between the two phases of electricity or some such. I’m not sure of the details but basically (on my unit) you want A+B == E+F, more or less. It shouldn’t be totally lopsided.

The super awesome generator transfer switch.

We tested it, and everything works great. Normally the circuits we care about are in “line” mode, so they’re powered by the regular power lines. If we flip them to “gen”, the generator will handle them. They can’t be in both, so no worries about sending current back out or having mismatched sine waves (for those super geeks reading this).

Plus, the circuits you’re not running on the generator are just sitting there waiting for normal line power so when the lights come on down the hall you know everything’s up again.

Cheap and can be used for any 12v battery.

The only other item you may want to consider is a battery charger. I picked up a small unit for $20 and every few months that the generator hasn’t run I toss it onto the generator’s small 12v motorcycle-ish battery. There’s a pull cord to start but those are no fun.

So the next time the power’s out in Mammoth swing on by. We’ll have hot showers, cold drinks, warm air, and Call of Duty multiplayer.


A few days I had my first patients that I couldn’t save.

Imagine a few of these crumpled up next to each other.

On Monday I was driving home from San Diego on Highway 72 and traffic came to a stop in a place it normally doesn’t. I was behind a big rig but couldn’t see much, so I grabbed my phone and checked my messages. After a few moments I heard someone say “accident”. I peered out, didn’t see any flashing lights, and got that EMS feeling.

Most of the time, things aren’t an emergency. Even “emergencies” usually unfold slowly and you have a minutes if not hours to correct things. Actual no-kidding emergencies where the stuff hits the fan are, fortunately, rare. The EMS feeling is my stomach dropping an inch or two, thinking “oh shit, is this for real?”

I pulled off to the side and saw multiple vehicles ahead. Some on the shoulders, some flipped over on their backs, some so smashed to pieces I couldn’t tell what they were or in what position.

Try to determine if it’s “safe” to touch someone in the white truck. Broken glass, sharp metal, and blood.

Someone started yelling at me to stay back. Instantly my training kicked in: scene size up. Is it safe for me? How many patients? How many rescuers? I looked at the guy yelling at me to not go in: he was a civilian, there were no red and blue lights anywhere, and if there was anyone in there that I could help, fuck you, I’m rolling in.

Is it safe for me? Hard to tell. I had my exam gloves which offers me razor thin protection, but it was a debris field of gasoline and gear old, car parts, walking wounded mulling about like zombies from a horror flick. How the hell do you determine what “safe” is in something like that? One step at a time, I told myself.

How many rescuers? One, counting me.

How many patients? Again, hard to tell. If they’re walking, I’m not interested in them at the moment. Take me to the worst and most terrible: I was pointed towards two vehicles that looked like soda cans crushed for recycling.

I didn’t even know how to access them. In one vehicle, if I crouched down, I could see a body part hanging down with bones sticking out. The “safe” part kicked in and I realized that I wasn’t a firefighter anymore with extrication tools, a team, and turnout gear. I pounded on the vehicle and listened: nothing.

I moved to the second vehicle. Air bags had been deployed: lots of them. Curtain air bags, steering wheel air bag, side air bags, the works. The un-moving person was in their seat belt.

I yelled that I was here to help. No response. I reached into the mangled metal cage and squeezed tight for a carotid pulse. Did I feel one, or was that my own adrenaline? For a moment I felt the faintest movement, deep inside the neck. I probed around more. I check a lot of pulses and the carotid is by far the easiest and most pronounced: even on a baby you can find it within a second.

As a I kept probing all I felt was warm soft skin.

A few minutes later, I couldn’t really tell you how many, a CHP car raced in. I explained who I was, my level of training, and what I was up to. He nodded and thanked me for stopping and asked me to keep working the scene. There wasn’t much to do as all signs pointed towards death. The kind of death you don’t come back from. The physics required to bend metal and send cars flying airborne is simply more than ample to cause massive hemorrhaging in nearly every part of the human body. Brain and heart, in particular.

Ten minutes after the police arrived a fire rescue team rolled in. I gave my assessment and findings, and got out of their way. I read the news this morning and saw that both drivers were pronounced dead at the scene.

I spent the rest of my drive home calling my wife, and then two of my friends: one cop and one fellow sar. The next day I went snowboarding by myself for a while. I’m still not “okay” with seeing and feeling so much death and carnage. But everyone, including you and me, will die. If you’re an EMT you’ll see it more often than a librarian.

Be good to each other out there. Leave lots of follow distance when driving. If you care about someone let them know. And don’t think the safety features in your car have made Newtonian physics obsolete.

The location and date have been changed.


follow up q&a to my wemt/emt+w post

A friend of mine asked me some questions about my last post (finished my WEMT) and I thought the answers might be helpful for others out there.

What was your favourite part of the course?

Having people in it who had some serious experience. Two guys were heli-ski operators, one guy was a mine rescue technician, several were guides, one guy got shot in the chest point blank, and the instructor is a paramedic who has patients she can’t transport for up to 48 hours because of weather and general Alaskan-remoteness.

In a normal world I’m the most outdoorsy-medical guy around, so it was really humbling and level setting to be around others who experience near daily horror stories and handle them with grace.

What was your least favourite?

I think from an annoyance prospective it was dealing with state and local protocols which are basically always a little out of date with current research. You learn and get tested on some things that aren’t in the best interest of your patients because it takes years for medicine to change (great example: back boards and traction splints, medieval torture devices that are still on most rescue inventories).

At a personal level it was going through scenarios that I had never considered. Like a pediatric with multiple gunshot wounds or a woman who just had a miscarriage, sitting on a toilet, and you being the person who’s going to manage that scene and bring calm. I think everyone has situations that hit them hard in the emotional department, and you never really know what they’ll be until you’re in it or perhaps after the fact.

What surprised you the most?

How quickly a talented person can burn through a primary assessment, establish an airway, stop major bleeds, and prep for transport. It’s like less than a minute (tops) if you’re good, complete with all the gore/mayhem/ppe/bsi/safety.

Going back to the last one, it was also the scenarios that I hadn’t considered. Using a plastic model to practice sticking your hands into a vagina to push a baby’s face off a prolapsed cord and keep the airway patent. Or how to deal with excited/agitated delirium. They’re not scenarios I really signed up to handle, but if you’re functioning as an EMT in an urban setting you can’t pick and choose your patients.

Also, how easy it is to get a bp via a pedal pulse and a cuff on the thigh on a neonate now that I know what I’m doing.

Have you done the NREMT yet, and was it different than what you learned in class?

I’m an Alaskan EMT-1, and have applied for my NREMT course but haven’t taken the test yet. If you’re taking a state’s written and practicals I would really focus on that (which is different than wilderness protocols, which is different than NREMT) because you need to pass it to move on and remembering multiple protocols is rough. It’s a bit dumb because I had to memorize Alaskan procedures I’ll never do in California, but conflicting and head-scratching protocols seem to be the name of the game with medicine in general. Most things are right, but some protocols are bad and just haven’t been fixed yet.

But in general Alaskan and NREMT protocols overlap probably 90%. Dyspnea is dyspnea, a biphasic AED is a biphasic AED, and COPD is COPD. The differences are more subtle like: emphysema patient with a 2LPM nasal cannula complaining of difficulty breathing. Do you crank up the flow a bit or swap her out for a NRM at 15LPM? Either way you’re increasing their O2 but  what’s the specific blow-by-blow protocol? Did you need to use pulse oximetry and if so how? Stuff like that.

My sample tests I’ve taken for NREMT are going well; there’s a few items that are new but nothing mindblowing.

Are you planning on working as an EMT, or did you just do the class for the knowledge?

I think like sailing you suck unless you do it so I’m going to try to work at the local hospital maybe 20 hours a month covering other people’s shifts. My neighbors are trauma surgeons at the local hospital so if I’m lucky I can work with them, or try to hang in the ER in general.

I studied vital sign ranges before the class but from taking literally over 100 blood pressures from various people I actually learned way more about the ranges and concreted in the numbers. Ages and sex matters it seems but I learned that a skinny 14 year old girl probably just has a really low BP and that for little pediatrics I’m high as a kite if I think I can get them to sit still. So the practical application seems to be part of the knowledge to me, if that makes sense.

Do you plan to register in California by county?

So after I get through NREMT I’m going to hit up the hospital in town and just say “Hey, I’m a NREMT EMT-B, what else should I do and what other training would be helpful?” I think there’s ancillary stuff they’ll want too like phlebotomy, probably some blood borne pathogen training, etc. It’s a super rural county so I’m expecting some hoops but probably not a million.

What extra study materials would you recommend?

I was based out of the “Brady Book”, it was the major text we used in conjunction with our wilderness stuff. I bought the workbook along with it and burned through those chapters doing the work before the class. It was probably 100 hours of my life I’ll never get back but the pathophysiology really helped and I liked learning why a pulse oximeter sucks for CO poisoning, as an example.

My learning style is that I need to understand the whole circle and then I can branch out so I felt like (for me) I really need to go ham on the textbook and know underlying health-nerd stuff that there just isn’t enough time in a lecture to cover.

Also, really knowing a lot of the abbreviations and medical terms help. Writing tx is way faster than treatment, ditto pt for patient, hx for history, etc. Sometimes people toss out things like npo and it sucks to have to stop and say, “Huh?”. Yeah, they should speak in normal English but around hospitals they don’t and it’s pretty available info.

In class I made flashcards of things I didn’t understand.

Are there any extra non-study materials you’d recommend?

I made good use of 3×5 flashcards (in addition to pre-made NREMT ones), highlighters, a notebook, and rite-in-the-rain for outdoor stuff. For field scenarios and on actual sar callouts I have WMA’s field guide. It’s 4″x6″ (same size as my rite-in-the-rain book), and both fit in my radio chest harness pocket. On real ops I thumb through it for whatever the suspected injury is to remind myself what the hell I’m doing. There’s also some dope stuff in the back on litter tie-ins, chopper stuff, and medical terms. For whatever field team I’m in I’ll read it out loud (before we get to the patient) and we can discuss what to look for, who’s doing what, what gear we’ll need, what complications we might see, etc.

I just have the boring rite-in-the-rain 4″x6″ because I end up jotting down notes from witnesses, cops, other teams, etc. I’ll write a SOAP and try to format it well enough. In sar land I hand it off to the chopper/ambulance and ask them to give it to the receiving facility as well.

Anything else?

Just because I took so many damn blood pressures I’ll add that quickly being able to ballpark the systolic on a patient, rapidly getting there, then rapidly getting down to the diastolic then rapidly deflating completely is the difference between pro bp readings and torturing a patient by keeping what is essentially a tourniquet on their arm whilst futzing around trying to find their brachial artery for a minute solid.


three weeks later, i’m an emt

I’ve previously written up my views on WFR vs WEMT (aka EMT+W), and now I’ve got both of those cards tucked in my wallet.

For two weeks I lived, ate, and breathed emergency medicine up in Skagway, Alaska. I met some amazing people and as an aside I definitely want to write up an entire in-depth post/book/article about not so much the course but the trajectories of those involved. Think about it for a minute: who exactly are the cast of characters already armed with their WFR who are going to spend weeks of their lives up in Skagway learning a super persnickety version of medicine? But first, here are some pictures (some others on my Instagram account too).

My class. Bent down in the middle is a former CHP trooper, and current paramedic in a fairly remote part of Alaska. When she spoke, everyone shut up and listened.
On my one day off I hiked with a classmate up to some lakes near the far end of the Juneau Icefield
The incredibly new and awesome fire department building, where I spent most of my waking hours for two weeks.
Being in the “south east”, as Skagway is referred to we were actually in a temperate rain forest. As such it rained *constantly*. With the exception of pavement and well worn trails everything else was covered by copious amounts of plant life. The roofs of buildings had green moss, and I dare you to find a single square foot of raw dirt in the area.
Skagway’s main business is the constant stream of cruise ships dropping off passengers. These folks buy ice cream cones, jewelry, t-shirts, and have a few beers. As such the majority of the town residents cater to these people. This shot was taken the day after “Last Ship Day”, and shows the ghost town that Skagway becomes after the final cruise ship of fall.
Wilderness EMTs pass all the regular “in town” EMT training, but then we also have to perform the skills with less gear in jacked up environments and handle longer transport times plus coordinate our transport decisions. This photo was from a campfire after one of our nighttime simulation trainings, somewhere in the Alaskan woods.
When not in the woods, we trained in the firehouse using the gear from Skagway’s ambulance, sar, and fire teams.
My bunk and living space for a few weeks.
The kitchen that myself and four others shared. Thanks to the dog sled gang from Alaskan Icefield Expeditions who let us use their bunkhouse while they were off somewhere else. I left you guys some fishsticks and 3/4 of a bottle of vodka.
When not in the field or the engine bays, it was classroom land. I of course sat in the back because that’s where the cool kids go.

It was an awesome course: no way around it. Being up in Alaska, especially in such a small town, really focused the laser beam on what I needed to do. In the evenings we did assessments and simulations at the bunkhouse, otherwise we’d be out in town taking vitals on random strangers. I’ve probably taken the blood pressure of every child and barstool drunk in Skagway. I’ve auscultated the lungs of infants, found pedal pulses for systolic/palpation readings on neonates, and observed COPD sufferers. Protip: stay healthy, don’t get obese, and don’t smoke cigarettes.

We made jokes about putting a grim reaper sticker on your ambulance every time you screw up and someone suffers, and I watched one of the toughest people I know cry when he discussed a friend who slid in an avalanche and was attacked by a grizzly. The snowstorm cut their visibility down to near zero and as they moved his blood soaked trauma-ridden body out of the avalanche burial. He could still hear the grizzly somewhere close, howling in the hidden whiteout as he provided treatment.

The day after we finished our state practicals we found out about the Las Vegas mass shooting. As the eternal optimist, a silver lining to me was on a day of such madness and mayhem 18 more people walked back into society with the sole intention to help others in their hours of greatest need. It doesn’t cancel out horror or balance the ledger, but it buttressed me a bit to personally know such dedicated professionals that would have been those headed towards the danger.

If any of my classmates ever stumble across this blog entry, I can’t wait to work with you again in the future. Dangling from a chopper or a cliff, pushing the skinny pedal code 3 to a sick child, or just making someone feel better who’s having a bad day: I’d be proud to be there with you.

Yes, as soon as I got home I popped that shit on my sar chest harness. I know I’m on the lowest end of medical professional but here’s me being proud.