Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Free Downloads Extended until January 17

The free downloads continue –

From January 4 to 10 17, 2011, Kaplan (Kaplan Publishing) will offer electronic versions of En Route for free download.

Free downloads of Kelly’s Book, En Route (and its nearly identical other version Paramedic’s Story) and over a hundred other books, are available for free from Kaplan Books until January 17, 2011. While there were some initial problems with the web address provided by Kaplan, everything seems to be working well, currently. Download some books now and read them later.

Pick your electronic device(s) and click on the name of the device for a link to the Kaplan page for that device. The price should be displayed as $0.00 for all of the titles in this offer. Don’t just stop with downloading both versions of Kelly’s book (they are slightly different), but look at the other titles available. I included a list of the books in their medical category and a list of the books in their nursing category.

They also have a College category, which includes a lot of advanced placement and SAT preparation books. They have an Education category, which includes books on teaching (in a variety of settings) as well as other test preparation books. They have a Graduate category, which includes a bunch of GRE and MBA titles and one on getting in to pharmacy school.The final category is Legal, with books by Plato, Clarence Darrow, Oliver Wendel Holmes and books on going to law school and books on working as a lawyer.

I think that all of these devices will ask you to register, but I doubt that you will be required to prove who you are, or where you are. An address in the US is required to download these free books. For those outside of the US, there is no reason that you could not use some free mapping software, such as Google Maps to identify a US address and enter that address in the form. I do feel horribly guilty providing information that might allow someone to provide false information to obtain something that is free. OK. I’m over it.

All of the electronic bookstores should have other titles available for free, so consider browsing their free bookstores. If you decide to purchase something, you will probably need to provide them with an address that matches your credit card billing address.

There are so many books available for free, that you may be able to keep yourself entertained and educated for months, or years, just on free books. My favorite source is the public library, which uses my tax dollars to buy books for me to read and audio books for me to listen to.

There are many on line sources for out of copyright books (before 1923 in the US), such as Project Gutenberg and some of these books made into audio books by volunteer readers, such as LibriVox. The free downloads of Kelly’s book mean that you do not have to wait for the copyright to expire to get it for free. That US copyright should expire some time after we are dead, so that might interfere with enjoyment of Kelly’s book.

Apple iPad

To get the free iBooks for Apple iPad, iPhone, and iEt cetera software this page will provide you with the information.

Sony eReader

To get the free Sony eReader software this page will provide you with the information.

Amazon Kindle

To get the free Amazon Kindle software this page will provide you with the information.

Barnes & Noble NOOKcolor

To get the free Barnes & Noble NOOKcolor software this page will provide you with the information.

Medical Titles –

Free Kaplan ebook titles: Author
Cleveland Clinic Guide to Arthritis Clough, John D
Cleveland Clinic Guide to Diabetes Reddy, Sethu
Cleveland Clinic Guide to Epilepsy Wyllie, Elaine
Cleveland Clinic Guide to Fibromyalgia Wilke, William S
Cleveland Clinic Guide to Heart Failure Starling, Randall
Cleveland Clinic Guide to Infertility Falcone, Tommaso
Cleveland Clinic Guide to Menopause Thacker, Holly L
Cleveland Clinic Guide to Pain Management Stanton-Hicks, Michael
Cleveland Clinic Guide to Prostate Cancer Klein, Eric
Cleveland Clinic Guide to Sleep Disorders Foldvary-Schaefer, Nancy
Cleveland Clinic Guide to Thyroid Disorders Skugor, Mario
Collected Writings Pasteur/Lister
Corpus Hippocrates
Diagnoses from the Dead Prayson, Richard
En Route Grayson, Steven “Kelly”
Eye of the Beholder Greenwald, Laura
Get Into Medical School Kaplan
Kaplan MCAT Biology Review Kaplan
Kaplan MCAT General Chemistry Review Kaplan
Kaplan MCAT Organic Chemistry Review Kaplan
Kaplan MCAT Physics Review Kaplan
Kaplan MCAT Practice Tests Kaplan
Kaplan MCAT Verbal Reasoning and Writing Review Kaplan
Kaplan Medical USMLE Step 1 Qbook Kaplan
Kaplan Medical USMLE Step 2 CK Qbook Kaplan
Malpractice Cure McCarthy, Edward D
Manual of Surgery Thomson, Alexis
Paramedic’s Story Grayson, Steven “Kelly”
Real Life of an Internist Tyler-Lloyd, Mark D
To the Rescue Harless, Nancy Leigh
USMLE Step 3 White Coat Pocket Guide Giaccio/McWilliams

Nursing Titles –

Free Kaplan ebook titles: Author
Call to Nursing Sergi/Gorman
Change Your Career: Nursing as Your New Profession Arnoldussen, Barbara
Final Moments Sherman, Deborah Witt
First Year Nurse Arnoldussen, Barbara
How to Survive Clinical Martin, Diann L.
Kaplan CCRN Kaplan
Kaplan NCLEX-PN Irwin /Yock
Kaplan NCLEX-RN Irwin /Burckhardt
Labor of Love Muhlhahn, Cara
Lives in the Balance Shalof, Tilda
Math for Nurses Kaplan
New Lives Huggins, Kathleen
Notes on Nursing Nightingale, Florence
Reflections on Doctors Ratner, Terry
Wonderful Adventures of Mrs. Seacole in Many Lands Seacole, Mary





Free Book Download From A Day in the Life of an Ambulance Driver

As of tomorrow, but I don’t know what time, this will happen –

From January 4-10, 2011, Kaplan (Kaplan Publishing) will offer electronic versions of En Route for free download.

That’s right, FREE electronic versions of my book, downloaded directly to your laptop, netbook, Kindle, Nook, iPad or Sony eReader.

Did I mention that it’s free?

Kaplan is using the promotion to encourage customers to try eBooks and increase awareness of their print titles, so by all means, browse the other available titles while you’re there, and download to your heart’s content.

And please, do me the favor of promoting this on your own blogs, Twitter and Facebook as well. My goal is 4,000 downloads between January 4-10. If we could meet or exceed that, it’d be the berries.

A late gift, but a very nice one. I have my autographed copy of the old fashioned pages and binding book format, but I will add this to my electronic library, especially if I want to quote from certain pithy parts without having to retype everything I quote. I am old and spoiled by cut and paste.

AD mentioned that it is free. More than once. So, let me mention that it is good – more than good. En Route, originally published as Life, Death, and Everything In Between is very good.

That is starting tomorrow. Kelly Grayson’s book En Route. Free downloads.


Read A Banned Book To Celebrate Banned Books Week – 2009

This is Banned Books Week.

Also known as Hypocrite Awareness Week. This is about people, who claim to care about education, but wish to ban books because of their fear that students might read. Even worse, students might understand.

Another name for Banned Books Week could be First Amendment Week. Not just because this highlights the threats to the free speech part of the First Amendment. The people trying to prevent children from reading are often pushing the beliefs of their religious sect on those not in their sect. This is also about protecting us from those trying to establish their religious beliefs in law, using the public school system as their weapon.

This appears to be the goal of the book banning mob:

One of my favorite books on education would probably be banned – if it weren’t aimed at the teachers, rather than the students. Teaching as a Subversive Activity[1] is about teaching the students to ask the right questions, rather than teaching them to answer questions. Education is something that continues throughout one’s life. The best way to keep learning is to ask the right questions.

Every valuable human being must be a radical and a rebel, for what he must aim at is to make things better than they are. Niels Bohr.

Every sentence I utter must be understood not as an affirmation, but as a question. Niels Bohr.

Science alone of all the subjects contains within itself the lesson of the danger of belief in the infallibility of the greatest teachers in the preceding generation … Learn from science that you must doubt the experts. As a matter of fact, I can also define science another way:

Science is the belief in the ignorance of experts. Richard Feynman.

Here is an example of the way that pressure is brought to prevent students from being exposed to any discussion of a topic, because just mentioning it could make it happen – knock on wood. The parents signed permission slips for their children to read the book. Others were not required to read it. The fanatical parents still opposed the ability of the other parents to allow their children to read this book. Book bans have nothing to do with being reasonable.

Mule Breath points out that today is International Blasphemy Day.

This is the fourth anniversary of the publishing of some cartoons in Denmark in the newspaper Jyllands-Posten[2]

Muslims wanted to kill these cartoonists for depicting Mohammed, the newspaper employees for publishing these cartoons, and anyone who might happen to get in the way of their desire to just Kill! Kill! Kill!. Many of the same people, who might read and/or produce the newspaper below.

They can print the same cartoons. I guess, they use the phrase, It’s not blasphemy, when we do it.

We even had some home grown commentary on terrorists.[3]

Book burners, promoters of censorship, issuers of fatwas, . . . ; Muslim, Christian, Jewish . . . silencers of opposition; You are all the same.

Μολὼν λαβέ


^ 1 Teaching as a Subversive Activity
by Neil Postman and Charles Weingartner.
Open library link

Wikipedia article about Inquiry Education

^ 2 Jyllands-Posten Muhammad cartoons controversy

^ 3 I Was a Tool of Satan…
Doug Marlette describing the religious outreach from his Muslim brothers, when he printed that comic.

I have outraged Christians by skewering Jerry Falwell, Catholics by needling the pope, and Jews by criticizing Israel. Those who rise up against the expression of ideas are strikingly similar. No one is less tolerant than those demanding tolerance. Despite differences of culture and creed, they all seem to share the notion that there is only one way of looking at things, their way. What I have learned from years of this is one of the great lessons of all the world’s religions: we are all one in our humanness.In my response, I reminded readers that my “What Would Mohammed Drive?” drawing was an assault not upon Islam but on the distortion of the Muslim religion by murderous fanatics –

Then I gave my Journalism 101 lecture on the First Amendment, explaining that in this country we do not apologize for our opinions. Free speech is the linchpin of our republic. All other freedoms flow from it. After all, we don’t need a First Amendment to allow us to run boring, inoffensive cartoons. We need constitutional protection for our right to express unpopular views. If we can’t discuss the great issues of the day on the pages of our newspapers fearlessly, and without apology, where can we discuss them? In the streets with guns? In cafés with strapped-on bombs?…


Jim Page – 5 Years Gone

Today is the 5th anniversary of the death of Jim Page. He was one of the people most influential in the shaping of EMS. He was the person continually pushing for progress in EMS. Dr. Bryan Bledsoe writes about Jim Page and talking with him at various points in his career. He quotes Jim Page a few times.

He said, “EMS needs to be pushed to a higher level.”[1]

Things have changed a lot in most places, but even in the more progressive places for EMS, there is no reason to stop pushing EMS to a higher level.

He then laid out a plan for what he thought I should do. He said, “Bryan, EMS is at a point where we need to move to the next level. Many of our practices are wrong — if not harmful. You are in a position now where it is your responsibility to the help make things better for the profession. You need to challenge the status quo.” Jim went on to detail some of the fallacies he saw in EMS. He specifically mentioned Critical Incident Stress Debriefing (CISD) and public-utility model EMS. So, I began to search the literature and eventually wrote a highly controversial eight-part piece called “Myths of Modern EMS” that was eventually published in EMS Magazine.

I never met Jim Page, but I feel some of his frustration. I have read The Magic of 3am.[2] This is a collection of essays he wrote over the years. I am amazed at how the same bad practices he criticized continue to be problems five years after his death. Why are we so resistant to making things better, not for ourselves, but for our patients?

While I never met Jim Page, from what I have read by Jim Page, I don’t know of anybody who does a better job of continuing to push for the improvement of EMS, than Dr. Bledsoe. He travels all over the place to talk at conferences, in spite of the opposition from the mindless, but very vocal, defenders of tradition.

In stead of an anniversary of the death of a giant of EMS, we should be celebrating the end of tradition in EMS. We are not there, yet.

Many of our practices are wrong — if not harmful.

EMS needs to change, continually. Tradition is resistance to change. Tradition is the enemy of our patients. The only tradition worth following in EMS would be to continually change to make things better, but that is an anti-tradition tradition.

You can find many of the papers Dr. Bledsoe has written on these topics at BryanBledsoe.com.

Some other people have written about Jim Page.

The EMT Spot A Man of Honor

Firegeezer Five years ago ….

JEMS.com Remembering Jim Page, which has several articles, including the one by Dr. Bledsoe.


[1] I Miss Jim Page
Another Perspective
Bryan E. Bledsoe, DO, FACEP

[2] The Magic of 3am
James O. Page
Open Library page with links to libraries and book sellers.


Soylent Green, Sarah Palin, and Sen. Grassley

Apparently the Grassley/Palin version of medical marijuana is to smoke some very potent marijuana, inhale very deeply, and then watch Soylent Green (1973, as with other not yet remade cult movies, Soylent Green is due for a remake. This will be in 2012, apparently without any Mayan tie-ins).

No! No! No! – It’s all true!

Decisions about end of life care should be made by all of us before we are in a position where we cannot make competent decisions for ourselves. If we do not, then we are telling the government that we want the government to make those decisions for us.

By avoiding making end of life decisions, we are saying that we trust the government to make medical decisions for us.

Isn’t that the opposite of what the half-baked Grassley/Palin Soylent Green Truther Movement is telling us?

Exactly. This doubleplusungood duo does not trust us to make those decisions. They probably watched a double feature with 1984, because it would be silly to suggest that Thing 1 and Thing 2 might have actually read Nineteen Eighty-Four.

He who controls the past, controls the future.[1]

He/She who controls death, controls life. This is just a BS attempt to discourage people from making end of life decisions. Islam does not forbid advance directives. Judaism does not forbid advance directives. Christianity does not forbid advance directives. Grassley/Palin’s lack of morality is disgusting.

There will be no curiosity, no enjoyment of the process of life. All competing pleasures will be destroyed. But always—do not forget this, Winston—always there will be the intoxication of power, constantly increasing and constantly growing subtler. Always, at every moment, there will be the thrill of victory, the sensation of trampling on an enemy who is helpless. If you want a picture of the future, imagine a boot stamping on a human face … for ever.[1]

Grassley/Palin want to be that boot . . . for the rest of our lives.

Oh, and don’t expect any compassionate care during the government controlled death. They wouldn’t want us to become addicted to anything. Addicted to anything, except having the government make all of our decisions for us.


^ 1 Nineteen Eighty-Four
George Orwell


A Book Meme

Too Old To Work, Too Young To Retire has tagged me with a book meme. Thank you.

The rules –

Pass it on to five other bloggers, and tell them to open the nearest book to page 56. Write out the fifth sentence on that page, and also the next two to five sentences. The CLOSEST BOOK, NOT YOUR FAVORITE, OR MOST INTELLECTUAL!

As with TOTWTYTR, I am sitting in front of a bookshelf. I have books in front of me. I have audio books on my computer. It would be interesting to use an audio book and try to calculate the 56th page if I did not have a print copy of that book. An Amazon.com search would work, if the publisher permits that. Anyway, the closest book is one I am rereading because of all of the research posts I have been writing lately. It is not likely to produce an entertaining snippet, but it is worth reading in its entirety.

The book is Fiction and Fantasy in Medical Research: The Large-Scale Randomised Trial by James Penston. It is short, only 132 pages – a fraction of the length of the Maryland ALS protocols – but it is essential for understanding some of the ways research can be misleading. The spelling of randomised is due to the author being British. While there are not a lot of large scale randomized trials in EMS research, it does present many of the problems that face EMS research. There is an excellent, brief review of the book here.

In general, the weaknesses of smaller randomised controlled trials become more serious in context of mega-trials.

There are, though, certain features peculiar to mega-trials that create further problems. The purpose of these studies is the recruitment of a large number of patients in order to bestow statistical significance upon a small treatment difference. Thus, every megqa-trial reports only a small difference between the treatment groups and this has important implications. For example, it raises questions about the validity of causal inference and about the meaning of the results to individual patients.

A further aspect of mega-trials is the way in which the methodology is far removed from that of science.

Now to recognize other readers in the blogging world. A bunch of authors. If you wish to buy their books, go to their blogs and buy through the blog, so that they get more of the proceeds. Or buy them from the author at an EMS conference.

For some reason nobody seems to have included A Day In the Life of An Ambulance Driver. Ambulance Driver is a blogger who has written Life, Death and Everything in Between. I have most of my readers by way of AD.

Another published author is Peter Canning from Street Watch: Notes of a Paramedic. After working for a bit as a paramedic, one of the first books I read was Paramedic: On the Front Lines of Medicine. He wrote books first, then began blogging. A lot of my readers come from PC.

The Erstwhile Medic at Strange Dichotomies and Random Occurrences is another avid reader, but he has not published any books, only journal articles. He does a lot of research on aviation safety.

Tom Reynolds at Random Acts of Reality is the author of Blood Sweat and Tea, a view of EMS in England. His blog helps point out to Americans that the frustrations of EMS do not change that much with the change in geography. Only the specifics change.

Gertrude at Ridin’ The Bus will probably write a book about her experiences in EMS, someday. I suspect that she does not have to reach far to find a book.

I posted some links to free online books earlier, here they are again.

eBooks @ The University of Adelaide

The OnLine Books Page at UPenn

Project Gutenberg


If you go to your local library and get a library card, often that will allow you to download current copyright protected audio books. These downloads have a limited life (a couple of weeks) before they are no longer useful – not like the audio tapes from Mission Impossible that would burn up when played. I used to spend a couple thousand dollars a year on books, most of which remain unread. So much is available for free from your local library, that you should consider this as an alternative to buying something that you might not read. Other books are excellent references and should be owned. If you are in EMS, you will probably want to read the books of the above mentioned authors more the once, so buy their books.


But we’re EMS! We don’t do THAT!

Peter Canning, at Street Watch: Notes of a Paramedic, writes The Grapes of Wrath. He describes a call where he did a lot to accommodate a family with more belongings and family members than could easily be managed, either by EMS or by themselves. It is a good post about problem solving. In the comments Peter finishes up with:

My point in writing this is that so much of what we do in EMS doesn’t really relate to health care. It’s figuring out a way to manage life. I get annoyed a lot by patient demands (turn off house lights, get their coat or reading glasses, put some water out for the dog, call their hairdresser and tell them they won’t be making their appointment. When I look at it, it isn’t such an imposition to help people.

Not liking the patient demands is understandable. It doesn’t feel like EMS, but as you mention, much of what we do is not medical.

For the patient who will not be getting Mr. Toad’s Wild Ride, I prefer to ask how things should be left or if they need anything else. We have been asked to come into the patient’s home on one of the worst days of their life (unless this is someone who always calls). I should try to leave things as I found them, as much as possible.

Turning out the lights. Some people worry about their electric bill and putting their mind at ease allows us to get the patient to relax a bit more. An agitated patient is not good. A patient who is agitated, not because of something that was going on before we got there, but because of how we acted, is not good. Unless the patient has depressed vital signs to begin with, we are probably making the vital signs worse by agitating the patient.

Get their coat. I never wear a coat, unless I am outside for an extended period, but I understand that other people feel the cold more than I do. The patient might not be able to get someone to show up with something warm to wear to bring them home. If they will be taking the bus or a taxi home, even if the police will be giving them a ride home, there may not be the possibility of providing warm clothing.

Get their reading glasses. I almost always ask if they want to bring something to read. I try to keep some reading material with me all of the time. Otherwise, I would never get much reading done. As it is, most of my reading is done on line. Most books are small and light and, if they are nearing the end of the book, bringing a second book is not much of an imposition. The patient will probably be in the hospital for enough time to make more than a dent in Remembrance of Things Past, Moby Dick, or even The Grapes of Wrath. Books that are more often read as Cliff’s Notes, than in the full text. Ike at BookScoutLookOut, his books/running/EMS blog, has been reading Remembrance of Things Past and sharing quotes at his site. There are several sites with free downloads, that include many audio books, some of them are children’s books and may help to keep them from wandering or causing trouble. As a parent, if you are not able to read to your child every night, maybe having an audio book to read them to sleep is an alternative. Travelling by car, it is a good idea, as well. LibriVox.org has a lot of free download audio books. If you are not home to read to your child at night, you can always read to them during the day. If you want them to do well in school, there is no better preparation than spending time reading to your child. If you can’t figure out what to read to them, maybe you could read this blog to your child, or maybe not. 🙂

Make sure a pet is OK. If the patient is going to be in the hospital for a while, the pet might not be able to fend for himself. If the patient has been sick for a while, the pet might already be in a state of neglect. I have had a patient call 911 out of more concern for a pet, than for himself. Service dogs should accompany the patient. They may not respond well to lights and sirens and being thrown around, but nobody does and we should be avoiding that, anyway. Pets are family to some, toys to others. We should treat them as if they are family members. Some family members need to be controlled by the patient. Some family members are helpful. Family members usually do not bite unless you antagonize them, but a bunch of people showing up with lights and sirens may be antagonizing.

Call the hairdresser to cancel an appointment. I usually hand them my cellular phone to cancel appointments, but few do not have their own cellular phone, so this is rare. I have talked with a judge, a teacher, employers, parents, spouses, and others to explain where we are going and what is going on – after obtaining permission from the patient. Sometimes they only give limited permission (for example, you can tell them where I am going, but not what kind of medical emergency). No hairdressers, yet.

No. We are not there as a concierge service, but that doesn’t mean that it is wrong for us to attend to the patient’s needs. The question is, “What is reasonable?”

When it comes to unstable patients, some judgment needs to come into play. My preceptor’s regular partner had a CHF patient insisting on getting dressed before going to the ED. The patient never did get fully dressed before he coded. How forceful was this medic? I don’t know, but he knows how and when to be intimidating. How hypoxic was the patient? I don’t know.

I had a CHF patient who was in the bathroom putting on makeup and refusing to come out. We could not justify breaking down the door with an oriented and responsive person on the other side. When we finally did get her to come out, we could see that she had been putting on makeup to try to cover her hypoxia. Fully alert and oriented. 90+ years old. More worried about her appearance. Aggh!

When we can, we should return everything to the way it was before we arrived. If we move a big table to get a stretcher in, we should try to move it back. It usually only takes a few extra seconds, when you have a bunch of people there. If the patient comes home and tries to move it, they may hurt themselves or just be unsuccessful. I’m not talking about a feng shui ritual here, but just putting things as close to where they were as is reasonable. Since I have been very critical of the lack of EMS critical judgment, or the lack of trust in EMS critical judgment, this is one place to demonstrate it.

These are not things that are outside of our scope of practice. If we moved something to begin with, we should move it back, as long as it does not interfere with patient care. The same is true for a medic in the back of the ambulance. You usually have time to clean up after yourself. It should be rare that your partner, or the BLS squad, has to clean up your mess. This is just good manners. Something we should be good at. Something we should be passing on to our children.

Anyway, the links to the free online books are:

eBooks @ The University of Adelaide

The OnLine Books Page at UPenn

Project Gutenberg


If you go to your local library and get a library card, often that will allow you to download current copyright protected audio books. These downloads have a limited life (a couple of weeks) before they are no longer useful – not like the audio tapes from Mission Impossible that would burn up when played.