Supreme Court - NYSRPA v. Bruen - Megathread

[MaverickNH]

I think structural factors have an impact because traffic in Chicago is much worse than in st Louis and this delays intial major support. As you know, time to arrival from injury onset directly influences survival rate particularly when you stratify by injury severity. Either that or Chicago thugs are better shots.

I was talking with an EMT a while back and asked, do you ever whisper into some scumbag's ear "people think I'm trying to save your life but I'm just looking busy while you die." He said "of course not" with a smile. I doubt they do that, given the witnesses and cams everywhere, but they don't come in w/o PD saying it's a cold zone. And sometimes that takes time...

 

[Garys]

One of the reasons that Boston has a relatively high survival rate is that there are now five Level 1 trauma centers. It's generally no more than ten minutes transport time to one of them. The furthest part of the city from any of them is West Roxbury. Which doesn't have a lot of shootings.

Another reason is that since the later part of the 1980s Boston EMS did minimal treatment on scene and prioritized transport for all trauma, especially penetrating trauma. I don't know if it's changed since I retired, but we hardly ever put the cardiac monitor on a trauma patient unless we were planning to intubate using RSI. Bleeding and airway control were the treatment priorities. We used tourniquets while the rest of the EMS world was still afraid to use them.

Philadelphia has a relatively high survival rate because the police often transport shooting and stabbing victims either via cruiser or prisoner van. The 24 hour survival rate is essentially the same as the survival rate for patients transported by ambulance.

Yes, good catch - I worked in all 4 BOS Level 1 Trauma centers at one time or another - plenty of shot, shredded, crushed and torn bodies showing up, many going to the morgue. They transport if not DRT at the scene.

I’m just reviewing a manuscript submitted for publication on deaths in St Louis, MO Level 1 trauma center populations (they have 4) of those with an initial gunshot injury over 2011-2019. Of >10k gunshot individuals, over 93% survived the initial gunshot, with ~4% dead thereafter, half from gunshots (of that half, 2/3 homicide and 1/3 suicide). Gunshot cases were greater than 90% young black males, as expected. Half of the non-gunshot deaths were drug ODs. Median age of death from gunshot was 27, with age 51 for stroke, heart attack, diabetes. The deaths might have occurred anywhere in the US, tracked by the National Death Index database.

Interesting that St Louis has a half or less the gunshot fatality rate of Chicago (7% vs 17%) - they probably aren’t saving more headshot injuries and must be saving more toro injuries. Transport time might be faster in St Louis - minutes count. Chicago’s six Level 1 Trauma Centers don’t matter if people die in the street or a less capable hospital.

The Bleeding of Chicago

America’s third-largest city has built one of the world’s best trauma care systems. But that success might be obscuring the true scale of its gun violence.

www.bloomberg.com

[The link works - it just has a robot warning]

“The vast majority of Chicago slayings—94 percent in 2017—occur in the city’s South and West sides, in places marked not only by poverty but, in some cases, a lack of swift access to medical care. The southeast corner of the city marks a perilous “trauma desert,” where shooting victims are often shuttled out of the city to suburban centers, or north to Stroger Hospital near downtown. It can be a deadly delay.”

 

[xtry51]

Even basic level EMT licensing is WAY above what we were doing in the field 20 years ago. And paramedics (especially air transport medics) have insane resources on hand.

The NH EMT level today probably has 3-4x the scope of practice as my original MA EMT-B license.

In 20 years you're going to see more non-transport. If we could get government out if way we'd likely have brought back traveling/home docs by now.

 

[milktree]

If we could get government out if way we'd likely have brought back traveling/home docs by now.

Thread creep for sure... But... why do you thihnk this? I thought the reason they went away is because the economics weren't there.

 

[xtry51]

Thread creep for sure... But... why do you thihnk this? I thought the reason they went away is because the economics weren't there.

It's roughly $750,000 per ambulance to stay in business. The economics are more than there.

 

[milktree]

It's roughly $750,000 per ambulance to stay in business. The economics are more than there.

I don’t understand. What does a home visit have to do with ambulances?

The vast majority of doctor interactions aren’t emergencies that require an ambulance.

 

[xtry51]

I don’t understand. What does a home visit have to do with ambulances?

The vast majority of doctor interactions aren’t emergencies that require an ambulance.

The vast majority of patient transports don't require invasive care.

I'll give a specific example. I was on a call this past weekend. Male, fallen with shoulder pain. He really needs an xray, not necessarily a ride to a hospital. We 100% could have mobile x-rays and teach Paramedics to then advise patients if an immediate hospital visit is necessary or maybe they should just have sling and schedule a follow up instead of incurring a transport cost and an ER cost.

People get transported for non-life threatening, non-surgical needs far more often than needing a trauma center or other high capability facility.

People are going to call 911. Emergency crews are going to respond. Why transport 50-75% of people who don't really need an ER, they just need a doctor. Put the doctor on the bus.

 

[ReggieB9mm]

My doctor makes house calls. They’re out there.

 

[LTCRN]

The vast majority of patient transports don't require invasive care.

I'll give a specific example. I was on a call this past weekend. Male, fallen with shoulder pain. He really needs an xray, not necessarily a ride to a hospital. We 100% could have mobile x-rays and teach Paramedics to then advise patients if an immediate hospital visit is necessary or maybe they should just have sling and schedule a follow up instead of incurring a transport cost and an ER cost.

People get transported for non-life threatening, non-surgical needs far more often than needing a trauma center or other high capability facility.

People are going to call 911. Emergency crews are going to respond. Why transport 50-75% of people who don't really need an ER, they just need a doctor. Put the doctor on the bus.

Or let's start charging out of pocket co pays for b.s. amberlamps runs. Even charging society's system suckers $10 will help. Simple things like a moron calling 911 for a split lip, chin, or forehead will come to a screeching halt! Vomiting because of drinking to much alcohol the night before and calling 911. Puke in your own vehicle, not the one I'm working in for the day. There are a million more examples that I could think of but I think most will get my point!

 

[milktree]

The vast majority of patient transports don't require invasive care.

I'll give a specific example. I was on a call this past weekend. Male, fallen with shoulder pain. He really needs an xray, not necessarily a ride to a hospital. We 100% could have mobile x-rays and teach Paramedics to then advise patients if an immediate hospital visit is necessary or maybe they should just have sling and schedule a follow up instead of incurring a transport cost and an ER cost.

People get transported for non-life threatening, non-surgical needs far more often than needing a trauma center or other high capability facility.

People are going to call 911. Emergency crews are going to respond. Why transport 50-75% of people who don't really need an ER, they just need a doctor. Put the doctor on the bus.

Ah! Got it. I misunderstood your point.

 

[Garys]

Try collecting that.

My suggestion was to attach $100.00 fee to all cell phone 9-1-1 calls. That could be removed if the agency determined that the call was legit. Police, fire, and EMS waste a lot of time and money responding to "Drive by cellphonings."

Or let's start charging out of pocket co pays for b.s. amberlamps runs. Even charging society's system suckers $10 will help. Simple things like a moron calling 911 for a split lip, chin, or forehead will come to a screeching halt! Vomiting because of drinking to much alcohol the night before and calling 911. Puke in your own vehicle, not the one I'm working in for the day. There are a million more examples that I could think of but I think most will get my point!

 

[MaverickNH]

Scholarship Highlight: First Amendment and Racial Dimensions of Bruen

firearmslaw.duke.edu

More leftist lawyers trying to tie Bruen to Racism and Roe v Wade - dunno how they missed Climate Change…

Here, if Bruen stands, the 1st Amendment must fall, as did Roe v Wade.

“While New York Times Co. v. Sullivan is a foundational, well-regarded First Amendment case, Justice Clarence Thomas has repeatedly called on the Court to revisit it...While Sullivan is a longstanding precedent, the Court’s recent overruling of Roe v. Wade suggests that this does not guarantee its safety. But other Justices may balk at taking a truly originalist or historical approach to the First Amendment, as this could undo most existing First Amendment doctrine. Still, at least one federal appellate judge has already cited Bruen in support of restructuring First Amendment law.“

And, because of Racism, Blacks carrying guns more often will get them killed. So, since we can’t prohibit Blacks from carrying guns if Whites can can guns, the solution is to prohibit all from carry guns? Just cracking down on Whites wouldn’t help much, as Blacks kill Blacks so very much more often that police kill Blacks.

“…the public carry of firearms, particularly by Black people, will likely both exacerbate the number of stop-and-frisks they face, and increase the risk that police will use deadly force against them. In short, while expanding the scope of the Second Amendment right to bear arms, the Court has shown no appetite to address related jurisprudence that makes the bearing of arms more dangerous for Black people...if a Black person does decide to carry a gun as freely as a white person, it will be at their peril. Bruen invokes racial justice without considering the full picture of America’s racial injustice.

 

[Dench]

People are going to call 911. Emergency crews are going to respond. Why transport 50-75% of people who don't really need an ER, they just need a doctor. Put the doctor on the bus.

I agree about putting doctors on the ambulance. I believe many European countries have MDs or RN's depending on the country and situation respond, not some paramedic whose burned out beyond belief looking in indeed for a new job in-between calls.

But I can't see it happening. US EMS is retarded and is obssessed with sending people who don't want to be there in the 1st place to transport people to another location.

 

[Whutmeworry]

Scholarship Highlight: First Amendment and Racial Dimensions of Bruen

firearmslaw.duke.edu

More leftist lawyers trying to tie Bruen to Racism and Roe v Wade - dunno how they missed Climate Change…

Oh, just give them time...

 

[Garys]

That worked out so well for Princess Diana, didn't it? There was a time when interns staffed ambulances as part of their education.

I agree about putting doctors on the ambulance. I believe many European countries have MDs or RN's depending on the country and situation respond, not some paramedic whose burned out beyond belief looking in indeed for a new job in-between calls.

But I can't see it happening. US EMS is retarded and is obssessed with sending people who don't want to be there in the 1st place to transport people to another location.

 

[Picton]

That worked out so well for Princess Diana, didn't it? There was a time when interns staffed ambulances as part of their education.

A French trauma doctor was treating Diana within about a minute of the crash, long before the ambulance got there. Actually, he was the dude who made the first call for assistance.

 

[Mass-diver]

A French trauma doctor was treating Diana within about a minute of the crash, long before the ambulance got there. Actually, he was the dude who made the first call for assistance.

Stay and play is such garbage. She probably would have survived if the accident occurred in the US.

 

[Garys]

The doctor spent 45 minutes treating an issue that could have been easily fixed in the OR. She bled out on scene from a low pressure wound that was highly survivable. In the US she would have been extricated from the wreck and transported to the nearest trauma center.

In France and Quebec the doctors are not on the ambulance, they are in cars and respond separately.

If you want to debate how EMS works, I'm willing to do that. I have 40 plus years experience so know a bit about how it works.

A French trauma doctor was treating Diana within about a minute of the crash, long before the ambulance got there. Actually, he was the dude who made the first call for assistance.

 

[Picton]

If you want to debate how EMS works, I'm willing to do that. I have 40 plus years experience so know a bit about how it works.

Nope. No interest at all. I didn’t care much for Diana, I don’t care much for France, and it was 20 years ago anyway.

And? Nothing whatsoever to do with Bruen.

 

[dingbat]

The vast majority of patient transports don't require invasive care.

I'll give a specific example. I was on a call this past weekend. Male, fallen with shoulder pain. He really needs an xray, not necessarily a ride to a hospital. We 100% could have mobile x-rays and teach Paramedics to then advise patients if an immediate hospital visit is necessary or maybe they should just have sling and schedule a follow up instead of incurring a transport cost and an ER cost.

People get transported for non-life threatening, non-surgical needs far more often than needing a trauma center or other high capability facility.

People are going to call 911. Emergency crews are going to respond. Why transport 50-75% of people who don't really need an ER, they just need a doctor. Put the doctor on the bus.

The sad truth of it is there is an extraordinarily high number of people being transported who are just bored, drug seeking, or both.

 

[yanici]

Man, talk about thread drift!

 

[Garys]

Guilty as charged, your honor.

Man, talk about thread drift!

 

[Cap'n Mike]

The sad truth of it is there is an extraordinarily high number of people being transported who are just bored, drug seeking, or both.

You left out Crazy

 

[Rob Boudrie]

I'll give a specific example. I was on a call this past weekend. Male, fallen with shoulder pain. He really needs an xray, not necessarily a ride to a hospital. We 100% could have mobile x-rays and teach Paramedics to then advise patients if an immediate hospital visit is necessary or maybe they should just have sling and schedule a follow up instead of incurring a transport cost and an ER cost

Or upload the X-Ray to a radiologist working at home for a read and rendering of advice rendered. Solve the license issue, use Bangalore based MDs, and reap obscene profits (not unlike US schools to mark up the tuition they pay for their students "semester abroad" tuition and living and bill at US rates).

 

[Garys]

Off shore radiology sucks. A genius in Bangalore missed a (fortunately small) liver laceration my daughter had from a snowmobile crash in North Conway. When we picked her up we drove right down to the MGH with a DVD of the CT scan.

The surgeon who looked at it spotted it immediately and said, "How the HELL did they miss this?" A worse laceration and we might have lost her.

EFF them.

Or upload the X-Ray to a radiologist working at home for a read and rendering of advice rendered. Solve the license issue, use Bangalore based MDs, and reap obscene profits (not unlike US schools to mark up the tuition they pay for their students "semester abroad" tuition and living and bill at US rates).

 

[Rob Boudrie]

The surgeon who looked at it spotted it immediately and said, "How the HELL did they miss this?" A worse laceration and we might have lost her.

Lack of malpractice risk for the Bangalore based MD???

 

[headednorth]

Off shore radiology sucks. A genius in Bangalore missed a (fortunately small) liver laceration my daughter had from a snowmobile crash in North Conway. When we picked her up we drove right down to the MGH with a DVD of the CT scan.

The surgeon who looked at it spotted it immediately and said, "How the HELL did they miss this?" A worse laceration and we might have lost her.

EFF them.

I got sucker punched back in the 80s. Went to what was then the Whidden Hospital in Everett. They took xrays, told me I was fine and sent me home. Called the house the next day when I was in work and told me to pick up xrays and go to MGH. Woman who gave us the xrays did the eyeroll/head shake thing and showed me and my dad the xray. Even me at age 17 could see the fracture. Scary how hit and miss medical care is.

 

[doxdsgn]

Another ruling for the good guys ——https://storage.courtlistener.com/recap/gov.uscourts.vaed.524643/gov.uscourts.vaed.524643.47.0_1.pdf

Out of Virginia - cannot prohibit 18-20 from purchasing handguns.

 

[MaverickNH]

Litigation Highlight: Federal Judge Upholds D.C. Law Banning Large-Capacity Magazines | Duke Center for Firearms Law

firearmslaw.duke.edu

“On April 20, a federal judge in the District of Columbia denied a motion for a preliminary injunction of a Washington, D.C. law banning the possession, sale, and transfer of magazines capable of holding more than 10 rounds of ammunition in Hanson v. D.C. The decision continues a trend of federal courts upholding large-capacity magazine, or LCM, bans under Bruen (we previously covered decisions from Oregon and Rhode Island reaching the same result). These courts have, for the most part, applied Bruen at a relatively high level of generality and determined that historical laws regulating “dangerous” weapons more broadly evince a historical tradition supporting a modern ban on large-capacity magazines…

Hanson is also notable for relying primarily on 20th century laws at the second, historical-tradition, step of the Bruen analysis. If one accepts that a more nuanced inquiry should be used in challenges to LCMs or assault weapons bans because these weapons represent “dramatic technological changes” or implicate “unprecedented societal concerns” (I think that’s likely correct, but certainly debatable), Bruen is best understood as requiring a more flexible historical-analogical inquiry rather than an inquiry that relies on laws enacted closer in time to the present day.”

A doomed decision. By using convoluted logic, historical analogs that are poor (dirks, bBowie knives, etc.) or outside the Founding era, and maintaining a scrutiny test, this decision will fall. But it may take a while.

It’s almost like Qualified Immunity for gun laws - unless an exactly equivalent law has been rejected by SCOTUS, most gun laws will withstand review by liberal courts.

 

[Rob Boudrie]

Hanson is also notable for relying primarily on 20th century laws at the second, historical-tradition, step of the Bruen analysis. If one accepts that a more nuanced inquiry should be used in challenges to LCMs or assault weapons bans because these weapons represent “dramatic technological changes” or implicate “unprecedented societal concerns” (I think that’s likely correct, but certainly debatable), Bruen is best understood as requiring a more flexible historical-analogical inquiry rather than an

Same could be said of the dramatic technological chances and unprecedented social concerns of the internet, social networks, and uncurated mass communication.