Saturday, February 18, 2012

He's Having A Heart Attack, Where's My Tourniquet?

Napping Street Vendor in Amman
When was the last time that a domestic executive protection detail had to provide medical care while under  attack?  I'm open to input, but I can't think of a single instance.  Then why are protectors so hell-bent on spending money and time on learning tactical medicine, i.e. providing medical care while under fire?  The answer is that it's fun and sexy, but the hard truth is that it's useless for domestic details.

I'm not saying that tactical medicine does not have it's place, but that place is on SWAT teams, and in military and other high risk environments, not on U.S.-based executive protection details. Security details and contracting protecters are waisting their time and money pursuing those skills.

What kills?  In other words, if you were pushed into any emergency room which common afflictions are going to get you seen right now by an anxious physician because your life is in immediate danger? They are:
  • Myocardial infarction (heart attack)
  • Active seizures
  • Suspected cerebral vascular attack (stroke)
  • Airway compromise:
    • Anaphylaxis (allergic reaction)
    • Foreign body (choking)
    • Pulmonary embolism (not a true airway compromise though)
    • Severe asthma attack
  • Hypoglycemic coma
  • Severe trauma
That's it, everything else can wait.  Take a seat in the waiting room.

How many of these afflictions are discussed in your tactical medicine course?  Trauma of course, but only as it applies to gunshots wounds while under fire, which, as noted, are exceedingly rare.  The rest, which are infinitely more common, are going to kill your client while you stand by with tourniquet and QuikClot in-hand. 

Tuesday, February 14, 2012

Caught In The Middle In Mexico

I spent last week in Mexico City training Mexican security agents in executive protection practices.  I listened carefully to how they went about their daily jobs of moving their clients around, normally in large, expensive, sometimes armored SUVs.  The agents worked mostly alone, at times they had a driver, but that was pretty much it.  In terms of weapons, suffice it to say that they had none.

I can't envision a worse security practice than this.  The Mexican details travel in high-profile, expensive vehicles, but lack the assets to effectively protect any of it.  They might as well be running a CarMax for the drug cartels.  These security details are attacked often for nothing more than their vehicles, sometimes the occupants can be held for ransom, but the expensive, shiny SUVs are the main targets. A fully armored SUV can cost well over $225,000, a lucrative target to say the least.

I attempted to explain the low-profile/high-profile continuum, but it was like talking to a wall.  They saw the wisdom, but are constrained by the desires of the people that they protect.  In other words, the clients want the flash and luxury of the shinny SUVs, but don't want to spend the money on the assets needed to actually protect them.  "Welcome to CarMax, how can we help you?"

Saturday, February 4, 2012


Soon I will start doing some patient care as a paramedic again.  Its been several months since I've practiced, and I've truly missed the experience of caring for patients.  Medicine, for many years, has been a large part of my life and I'm very excited to be practicing once again.

As a Zen Buddhist I try to seek ways to better the world that we live in.  Some are drawn to activism as a tool, attempting to bring change on a larger scale such as the Occupy Movement.  Others, like myself, look to service as a skillful means of helping humanity, working "eyebrow-to-eyebrow" with one person at a time; attempting to make a difference in that person's life or even death.  

I believe that there are few greater places on earth to practice compassion than an inner-city emergency room.  The opportunities are boundless to check your 'ego at the door' and truly help those that believe that they're in need.  

Thursday, February 2, 2012

Ordinary Mind Is The Way

One of the many things that Zen has taught me is that often you can place problem or a decision in your mind and then simply forget about it, walk away.  The problem will churn away in your subconscious and then out of nowhere, maybe while you are brushing your teeth one morning, the answer will become clear, appearing as if the light were suddenly turned on.

I've been given my first koan by my Zen teacher.  A koan is sort of a story, problem, maybe even a single word or a solitary sound that bumps around in your mind.  At times you dig it out, dust it off and play with it in hopes that one day it will lead to a greater understanding or awakening.  Koans cannot be solved by rational thought no matter how hard one tries.  Regardless of how intelligent your ego believes that you are, the more your mind chases the further you become from the truth.

My koan is Nansen's Ordinary Mind is the Way.  

Jōshu, a student addresses his teacher, Nansen…

Jōshu asked, "What is the Way?"

Nansen said, "Ordinary [or Everyday] Mind is the Way."

Jōshu asked, "How do I approach [or reach] it?"

Nansen said, "The more you try and get to it the further away you get."  

  Jōshu asked, "Then how do I know if it is the Way or not?"

Nansen said, "Knowing is a delusion; Not knowing is just indifference.  When you reach the true way beyond doubt it is vast and open as the sky.  How could it be a matter of affirming or negating it?"

Jōshu had some awakening.