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Seeing the pictures made me really cringe. I wish I could have been there to help. From an EMS response standpoint, here are my thoughts:

 

- The prevalence of lower limb injuries is interesting. This could just be by placement, but it may have been by design as well. 

- I'd really like to see the PTT/INR stats on some of the victims. Bad guys have been known to pack the shrapnel with warfarin containing pesticide to increase mortality rates. 

- Hats off to Boston EMS. Wow. Great job. The response will become required MCI reading in the future. 

- This is the MCI eventuality that a lot of us have trained for and hope would never happen. I hope that it will reinforce the importance of training, preparedness, and preplanning. 

The point I'm trying to make is that in a lot of cases the thing that defends people from corrupt governments is the federal government. The federal government ended slavery. They put Al Capone in jail when Chicago and Illinois couldn't, or rather wouldn't. Its not the federal government scooping up American citizens and throwing them in jail because they look brown, that's Joe Arpaio. The federal government tries to stop things like that. Read up on the New Orleans Police Department. Would you want them being in charge without the DOJ stepping in? What about the financial sector? What happened when the SEC blinked briefly back in the early 00's? Do you have any idea what Wall Street bankers would do to you, your family, and perhaps your sister if the federal government wasn't watching them like a hawk? 

I don't want to come off like I'm championing the feds, who believe me, have their share of cock ups. But I just want to clue you in on something I've learned. The people who complain about the federal government are usually these big fishes in their little ponds of their local areas, who want to abuse their power and get away with it. Also, on its face value answering the question "Why do you need an assault rifle" with "so I can shoot government officials if I need to" does not particularly put me at ease or invoke my trust. 

Chbare, I've heard all of them for just about every piece of equipment that you could possible strap on to a firearm of any sort. Except for folding stocks, that is. I have yet to hear a practical use for folding stocks except for concealing a large capacity, high power weapon, and the only reason you need to that is if you plan on ambushing someone, which is only appropriate in a combat situation. There is no situation in the civilian realm that a normal, level headed person would need something like that.
You know what also cuts down on the noise made by firearms? Earplugs. They're cheaper and you can't screw them onto the end of a Ingram Model-10 and go tooling around the neighborhood.
You know, once upon a time, even before Greenpeace existed, people noticed that a lot species of game were getting wiped off the map by poaching and over-hunting. So hunters came together and helped create laws to protect wildlife and habitats so that they could enjoy their sport responsibly, and thus the conservation movement was born. I think its time that hunters, sports shooters, and others who want to own firearms come back to the same point. If you want to protect what you have, come up with your own plans to regulate, enforce, and keep the people who shouldn't be in your area of expertise out of it. You can either say "look, there's a difference between a break open shotgun and a military grade high capacity rifle" or you can say NO NO NO WE WANT IT ALL, and then one day you'll wake up and have lost it all.
You don't think amendments can be changed, enacted, or repealed? I assure you they can. Prohibition was enacted by constitutional amendment 18, and then repealed by amendment 21. 54% of the population is for gun control right this very minute, and unless this nonsense stops, its only going to get higher.

Here's my take on this. I grew up on a farm in the country, around various forms of firearms. Part of my medical training is the effects of various firearms and the injuries they cause. Part of my operational training deals with the aftermath of sudden catastrophic events. I have personally dealt with more gunshot wounds than I can remember. So any argument that I'm some sort of limp wristed gun grabbing liberal do-gooder is pretty well null and void.
I am not against private firearm ownership. I am against the private ownership of military type firearms, namely, semi-automatic large capacity rifles, and accessories like folding stocks and suppressors, which have no legitimate application. No where in the constitution does it guarantee unrestricted access to any style firearm that is in production. These weapons contribute not only to the amount of casualties per incident but also in the lethality of the wound. The .223 round and the AR-15 style rifle was specifically designed to produce the best chance of achieving a lethal wound against an armed opponent at medium range. There is no place other than a battlefield that such a weapon is appropriate. The fact that a good proportion of these weapons in private circulation are owned by people who harbor anti-government and by into paranoid ideologies should be a cause for great concern.
I have no great use for the term "law abiding citizen" because not only have I seen what supposed "law abiding citizens" are capable of; fist fights, road rage, bar brawls, domestic violence, virulent racist sentiment, just because you've never been convicted of a crime doesn't mean you are any person who should be allowed to own a weapon capable of taking out an armored fire team. I'm not sure which Wal-Marts you've been to, but the people at the Wal-Marts I've been to, the ones getting in pushing matches over the next generation iPad, those are the people who shouldn't be allowed to have access to sporks, let alone a gun. I don't care if they've never been convicted of a crime or not. Nancy Lanza was a law abiding citizen. So was Jared Lee Loughner. So was Charles Whitman. So was Seung-Hui Cho. So was Eric Harris and Dylan Klebold.
What I think though, what needs to change more than gun laws is gun attitudes. I am so sick of pseudo-macho, jingoistic wannabes and their stupid sayings. I know why guys like that have guns. Its not so they can respond with deadly force if necessary. That's not why they want to bring their concealed weapons to Starbucks or Wal-mart or even on an ambulance. No, they want it for when someone cuts them off in traffic, or calls them an asshole, or spits on them. That's when they want to know they have a gun on them, and they are disgusting people.
I am also sick of the NRA. The NRA was once an organization for sportsmen and other firearm enthusiasts. Now it is a haven for domestic extremists and their paranoid, hateful views. If you're a hunter, I suggest joining Ducks Unlimited instead. They're about hunter's rights, wildlife conservation, and you won't find many mentions of the United Nation's invasion plans or who the media's really run by, or where the president was born. The NRA needs to go.
What if you substituted flamethrowers for the type of weapons I'm talking about? Flamethrowers are perfectly legal. Flamethrowers have uses other than killing, like clearing brush or doing controlled burns on fields and stuff, and you know, I'm willing to bet they make pretty effective self-defense tools, too. But no one demands they be allowed to walk into Starbucks or Wal-mart with a flamethrower. No one shows up at political rallies with a flamethrower holding up a sign about tyrants. We'd recognize that as really dangerous behaviour. No one says "You can have my flamethrower when you pry it from my cold, dead fingers," and if the guy in front of you in the checkout line was muttering about his concerns of the government taking away his flamethrower, you'd be probably pretty concerned. Well, that's my view on guns, I consider them to be like flamethrowers.

My $0.02...

If the paramedic doesn't want to do 12 leads on people who are less than 3 minutes away from a hospital, well, that's on him. Maybe he has a reason for it. Maybe that center is a PCI center. I don't know your system and I don't know him. But that's his decision. There is no excuse for belittling others in front of family members. You should address that directly with him. Many times people don't even realize they are being belittling and will apologize and change their ways.
I get the sense though, that you, much like other people who are a lower level provider assigned to work with a paramedic, just doesn't like to take orders. You don't like people telling you what to do. That's fine. It's an understandable sentiment. Unfortunately, the paramedic is in charge, it is his unit, and you are the new guy. Your opinion should be valued and considered, but it doesn't mean that because you disagree, you're right.
You had to fight to get this spot. Well, just because you won doesn't mean it should be ideal for you. Make the best of it, and if serious issues come up, address them then and there.

It's entirely possible to do. First of all, not all paramedics do 24 hour shifts. I myself do 12 hour shifts. 24 hour shifts means you'll be away from your family for two to three days. Compare that with the five days a week people are usually away and you see its not that bad. My wife doesn't have a problem with it, then again, my wife has a super-human ability to put up with the amount of shit that I inadvertently track into her life.
So long as you don't become an asshole and believe its okay to bang person X because of the "stresses" of your job, you can make a family life work just fine. But once you start believing that because what you do gives you license to act like an asshole, i.e. drink, fool around, basically act like a total douchebag, then you will lose the people you love or at least once love. I know many firefighters like that. But I know even more of their ex-s.

This brings into mind a recent incident.  As an EMT-I I generally take direction from the higher level provider (EMT-P)  On one call with a patient complaining of difficulty breathing, the paramedic scolded me for giving high flow (15 L/min NRB) to an asthmatic patient whose SP02 was in the very high 80's.  He took off my NRB and gave the pt. 2 puffs on her inhaler and then 3 LPM via NC.  The patients SP02 was slowly dropping into the mid to low 80's but the medic insisted on no NRB/high flow 02.  He ended up driving and leaving me with patient care in the back.  Due to the dropping SP02, increasing respiratory distress, and at the patient's insistence, I switched over to high flow 02 with almost an immediate (2-3 minute) improvement of SP02 and respiratory distress.  In this case I did not argue with the medic but inside felt I had made the right choice against the medic's instructions. While 02 can possibly hurt a patient, it is very unlikely in the short time we treat them (in my opinion).  I believe it can be extremely dangerous NOT to give 02 and mildy or arguably not dangerous to give 02.  As an Intermediate level provider, I believe that ALS level technicians often forget the BLS aspects of patient care (i.e. giving 02, stopping CPR to give ACLS, not backboarding/taking CSPINE seriously, etc.)

You know twist, I had this entire response ready to go, ready to explain the difference between hypoxemia in COPD and high flow oxygen in the presence of tissue schema, but I'm giving myself a break, so let me just say, you're really, really wrong. You're so wrong I'm not even going to bother going into detail telling you how wrong you are.

I nearly had my arm broken by a guy on PCP. I didn't file charges, because he was on PCP. This reminds me of a patient I had way back in the dark days when I first started working, doing an inter facility transport for a 16 year old with seizures. They called 911, the police responded first. When they arrived, he was post-ictal and kicked one of them. You could say the officers used more force than necessary in restraining him. You could also say they beat the living shit of him. If you can't manage an AMS patient, find another job.

Hi novice, as an American who moved to Vancouver, I think I can tell you a bit about it. First of all its tough to get permanent resident status in Canada. You can either get it through a family or a skilled worker application. I'm married to a Canadian citizen and it took me about two and a half years from the date of my marriage to get my status in Canada. Unfortunately, the news recently said that Canada was so backed up with skilled worker visas that they basically returned everyone's application and have to start over. If you can get a student visa to study at JIBC, that's really awesome, and if you can afford to, go for it. There is a demand for PCPs in BC, to be sure, but like anything in EMS, getting the spot you want sometimes means having to be patient and work a job in a position you don't want. My biggest pieces of advice are: Don't try to do immigration through Quebec. Quebec is an island unto itself and has separate immigration rules. Secondly, don't think about working in Washington State in EMS while you wait on your Canada immigration. Washington State not only has a very insular, protected EMS system that requires a system to sign off on you before you are certified i.e. you have to find an organization to first hire you, then put in your papers for certification, making it very difficult to get a job, in addition, Washington State's economy which relied heavily on timber production was decimated when people stopped building new houses. On the other hand,one interesting thing I found out was that that the BC EMR level is equivalent to a WA EMT-B level, and there is some reciprocity agreements there. Lastly, do not get fooled by anyone or any business that tells you they can streamline your immigration process. They can't. Its not in the province of BC's hands, its in the federal government of Canada's hands, and unless you have some contacts at the highest levels of government, nothing can really be done to speed up an application.
So, if you can get a student visa to study at the JI, go for it, that sounds really awesome. On the other hand, it will be extremely tough to be able to work in Canada, even if you do get the full PCP license, and then even if you get the PCP license and the work, which will be a real feat in itself, you'd still have to work on getting hired, and intakes to various organizations sometimes only happen a couple of times a year. It isn't something that isn't worth working for, but it is very difficult and make take a long time to complete. But remember, people go to college for four to six years to get the job they want. You might have to as well.

I remember saying this a few years back, but I like to appear out of nowhere and say "Please state the nature of the medical emergency."

Wendy, i can understand your viewpoint, but here is mine. When it comes to someone who is terminally ill, it is NOT ethical to allow them to succumb to malnutrition or dehydration or even suffocation in the case of a ventilator when there are other options available. It is not ethical to put any living thing in unnecessary pain or discomfort if the ability to alleviate that pain is available.
I understand your reservations regarding 'slippery slope' when it comes to assisted suicide, but I can tell you that after the Nuremberg trials after World War II and the extent of the Nazis practices of euthanizing social undesirables, there very, very strict rules and laws in place governing that sort of thing. Do not buy into the Sarah Palin 'death panels' concept, you can easily institute a program that provides for end-of-life care without the fear of the afflicted being removed from the gene pool.
Your belief in the sanctity of human life is not misplaced, I happen to agree with you. But even more important than the mere presence or absence of life is the quality of life.

Looks nice, chbare! It gives me some ideas. I'll post a pic of it when I'm done with mine.

If a leg is only being held on by a few pieces of soft-tissue and it is preventing rapid extrication, then I think you should do what needs to be done to save this person's life. If it is mangled but still attached, then I think the best course of action would be to throw a doctor who is qualified on the chopper and have him land and perform the procedure. If your level I has a helicopter but no orders or procedures allowing a physician to perform a field amputation, then I'd say that is an issue that needs to be addressed. If you perform the amputation yourself, you have to be cognizant that you are performing out of your scope of practice, and be ready to defend your actions at an inquiry. If you honestly, truly feel that it is necessary to save the person's life, then you should do what is in the best interest of the patient.

Welcome, congratulations on your discharge. Can't wait to hear some of your input.

My advice on tattoos is this: Having a tattoo doesn't necessarily mean you are a hot-dogging, motorcycle riding ex-con with a meth addiction, but you will find that some employers tend to think so. Getting the job you want in EMS is no easy task. You will be up against many people who are as equally as smart and capable as you are, and your tattoos can and probably will put you at a disadvantage. So if you want to get a tattoo, go ahead, but don't go around complaining if certain doors shut for you. The parents of a preemie getting a neo-nate transport to a specialty facility to do not want to see a tattoo of a grim reaper riding a Harley with a flaming Star of Life in one hand, no matter how cool that sounds.
Me personally, I have no tattoos, I have some really cool looking scars though, and scars, unlike tattoos can only be earned, never bought.