Kyle Rittenhouse's "Acquitted" - a review

Kyle Rittenhouse's book "Acquitted" is, obviously, a Rorschach test. You look in to it, and you read what you want to take from it. There are those who call him a "white supremacist killer", and others who call him a vigilante - sometimes approvingly, sometimes not.

The book itself is apparently self-published, with author and journalist Michael Quinn Sullivan being the co-author; in this kind of collaboration, the risk is always that the voice of the author is lost, or alternatively the co-author doesn't supply enough direction and the book wanders everywhere. Thankfully, the book avoids that trap. It's not a doorstop (only 118 pages), and the line formatting is, frankly, terrible, but it's very readable and packs a lot in.

The first nine chapters - leading up to chapter ten which starts the events of August 25th, 2020 - are an interesting, and at times sad, view into Kyle's childhood and teenage years. His family was quite dysfunctional, with a drugs-and-women depedent father, whom he has subsequently cut out of his life, and a loving mother who nevertheless was terrible with money. Kyle and his two sisters moved around houses a lot, didn't do very well at school given all the disruption, and he recognizes that he was well on the way to delinquency. It was the police cadets at school, and in particular the male role models he found there, which brought him back (mostly) to the straight and narrow, with a new determination to train as an EMT/firefighter. He qualified as a lifeguard, and was working that job in Kenosha when "Saint" George Floyd expired in Minneapolis and the BLM riots started, eventually spreading to that town in August.

Of the riots themselves, he describes being in town the day after the first riot, and seeing both the destruction wrought, and the way that white and black citizens got together in determination to clean up and repair that destruction. He and his friend lent their efforts to the clean-up, but everyone was aware that the riots might well restart that night, so he volunteered to stand guard at a car shop, equipped both with his rifle (legally held) and his EMT kit.

Then the riots kicked off, violent thugs ran around burning and breaking the city, and at some point Kyle was chased into a dead end by Rosenbaum, who grabbed for his rifle...

There's a joke going around Twitter that "Kyle Rittenhouse fired at three random liberals, and two of them were pedophiles." The truth is a bit more nuanced, but Rosenbaum certainly had a record of sex offending against minors, along with a lot of violence, and Huber was a repeat domestic abuser, also with violence. Grosskreutz, the sole survivor, had a list of lower-level offences. Certainly, it seems clear that the two fatalities from Kyle's shooting were not individuals for whom society should particularly mourn.

Nevertheless, Kyle's reflections on his actions that night were interesting. He certainly doesn't celebrate them - he says that he wishes that night had never happened, and with everything that followed it's hard to be sceptical about that wish. In more detail, he wishes he hadn't chosen to go to Kenosha that night - but given that he did, he doesn't regret bringing the rifle. He points out that given the level of violence threatened and demonstrated towards him and others that night, the rifle likely saved his life - from Rosenbaum's likely violence with him cornered, by stopping Huber from beating him any more around the head with his skateboard, leading to head injury and long-term headaches, and probably Grosskreutz by preventing him from firing the (illegally conceal-carried) pistol he pointed at Kyle.

Interestingly, he also regrets a number of the things he said and did after being released from jail on bail, during trial prep and during the trial itself. Some he details, some he alludes to, but in particular he reflects on his naivety with regards to all the grifting that happened around his case, and how his situation was presented in wildly different ways across the media. In particular, he strongly resents Joe Biden whose PR campaign adverts presented Kyle's case in a very different way to the actual facts.

A few people and organizations come out with a lot of credit. The juvenile detention organization, which held him for just short of 10 weeks, bent over backwards to support him, give good advice and guidance, and keep him safe. Things started to get dangerous when inmates came in who had heard about Kyle's case, and the threats started. By the time he was transferred to adult jail in Kenosha, there were already outside organizations briefing inbound prisoners on Kyle, with the clear implication to cause him physical harm. An additional three weeks in effective solitary confinement in the Kenosha jail was even less fun, though again the guards were professional and kept him safe.

Mark Richards, the lead defense counsel in Kyle's case, seems to be a remarkable man, and one of the few lawyers whom I think I could respect. He agreed to write the foreword in Kyle's book, and unlike many other forewords, this is very worth reading. In particular, he notes:

Kyle is 1 of only 3 clients I have represented in a murder case where I personally believed the individual was truly not guilty of what he was charged. [my italics]

Kyle clearly admires Richards, describing him as an incredibly focused man, unafraid to be blunt with his client, a hard taskmaster in trial preparation, and frequently calling out Kyle on his bad judgements. Corey Chirafisi, co-counsel, was also greatly valued by Kyle; as a former prosecutor, his practice court sessions quickly showed Kyle how to present himself in court, how to avoid being tripped up too often, and warn him about different strategies the prosecution could use to elicit damaging testimony from him. Crucially, Kyle described the subsequent trial as holding "no surprises".

The defense team was not pro bono; Kyle was fortunate that his case had caught enough media attention, and that the available facts e.g. from the videos that night, seemed to corroborate his case. A substantial defense fund was raised, and spent, in addition to the $2 million in bail that Kyle was required to raise before being released. Donors from all across the country effectively prevented Kyle from being railroaded into a multi-decade jail sentence. One wonders how many others without such support have not been so lucky.

The prosecution lead, Assistant District Attorney Thomas Binger, no doubt wishes he'd never taken this case to prosecute. I didn't realize at the time, but Kyle (presumably from Mark Richards' observations) noted that the District Attorney had passed on the case - and likely because it quickly became clear that there was a lot of photographic, video and then forensic evidence on Kyle's side. Binger is infamous in the trial coverage as having a strip torn off him by the judge when he repeatedly tried to introduce Kyle's use of his right to silence - which is a big no-no. Kyle clearly doesn't like Binger, which is no surprise, and takes some relish in pointing out that none of the prosecution witnesses helped Binger's case, and some actively helped Kyle.

The rest is history. Kyle did okay on the stand, Richards and Chirafisi did a rock-solid presentation of the defense facts and argument, the jury came back after four long days with unanimous "not guilty" verdicts.

The ending is fairly bittersweet. Kyle has won his case, and has his freedom, but is unable to take up his desired career (EMS/firefighter) for the forseeable future, until his notoriety reduces. There are still civil cases pending from the families of the people he shot, so the remaining money his case raised will probably be eaten up by defending those. He still has panic attacks from the night, but has a support dog Milo who helps him with this. He has started a job as a entry-level political consultant, which I guess isn't a bad choice given the experience he has had with politics - on both sides.

"Acquitted" is available on Kindle from Amazon, and from rittenhousebook.com in paperback. If you care about the American justice system, and the truth, it's worth your time to read.

You can't be too careful - car crashes

The class of systems with high distributed costs and focused but inadequate benefits is going to have another member: auto-calling police in the event of a car crash:

In the event of a crash, the device calls the E.U.'s 911 equivalent (112) and transmits to authorities important information including location, time, and number of passengers in the vehicle. An in-car button will also be installed in all vehicles. The eCall requirement will add an estimated $100 to the price of a car.

$100 on each (new) car sold: so how many new cars are sold in the EU each year? About 14 million in 2012. So this measure will cost $1.4 billion, and maybe $150 million in the UK. What's the benefit?

Each year nearly 26,000 people are killed in the E.U. by car crashes. This new device is estimated to reduce that number by 10 percent, saving 2,600 lives annually, by cutting down emergency response time by as much as 60 percent.

The cost of a life for purposes of safety varies by country and mode of transport, but let's take $1 million as the average. Given the quoted statistics, $2.6 billion saving (though optimistic, probably lower) comprehensively dwarfs $1.4 billion cost (though also optimistic, probably higher). Why isn't this a slam-dunk decision?

The problem is twofold: a) zeroing cost for lives saved, and b) the assumption of 10% saving. Let's consider each in turn.

If an injury is potentially fatal but not actually fatal due to timely intervention, it's almost always due to either early suppression of severe blood loss, or timely (within 1-2 mins) clearing of obstructed airway. The latter isn't relevant due to emergency service response times, so we only consider the former. This injured person will still need emergency treatment followed by several days of hospital care, and quite possibly follow-on care of injuries, rehab, and in some cases reduced lifetime tax payments due to reduced earnings and disability payments, so you're looking at order of $100K average costs. That's still not really significant.

However, consider a typical case where a life is saved: a car driver has an accident in the countryside when no-one is around. His car calls 112 and so the police (not the ambulance service initially, because they are too stretched to respond to wild goose chases) respond to his location. Seeing the crash they call for an ambulance which arrives 10-30 minutes before it would have otherwise arrived due to a passer-by report - people tend to notice a crashed car with no emergency services around it. He would have died due to shock (depletion of oxygen to the critical organs due to blood loss / asphyxiation / traumatic damage to heart and lungs) but the ambulance got there in time to oxygenate him and transport to hospital. Just how common is this?

Fatal road accidents rarely happen on remote roads - unsurprisingly, they happen where there are many more cars and roadside obstructions to run into. If an accident happens where passers-by are prevalent, this system doesn't help at all since nearly all passers-by have mobile phones. So we're only looking at a small fraction - 5% is optimistic - of accidents. The press release assumed 10%, so the benefit has already halved and is perilously close to the cost.

But bleeding to death is not a common cause of death from road accidents for drivers/passengers. Much more likely is traumatic head injury, which tends to kill them right there in the car. Unsecured drivers/passengers fly through the windscreen, or secured drivers/passengers bang their head against the car frame. This kills instantly, or in a few minutes. Another mechanism is the "third collision" where the car bangs into a tree (collision 1), the driver bangs into their seatbelt (collision 2) and then the free-hanging organs like lungs, heart bang into the drivers chest, or their blood vessels bang into ligaments that cheesewire them (collision 3). If you're in this situation and your aorta (the major blood vessel coming out of the heart) is damaged you can expect a 60%-80% chance of death no matter how quickly you get to the hospital.

Therefore, before we stick the European population with an extra $1 billion of annual costs, why don't we conduct a limited experiment introducing this requirement into a single country which is similar to another country in road crash death rates to see what effect, if measurable, this measure has? Or is the notion of trade-offs too alien to the EU?

Gaming the system - ambulance response times

It turns out that if emergency services try to chase response times then the public can get screwed over, in a very real and non-reversibly fatal sense:

Emergency services were called at 23:15 GMT and a paramedic arrived within 15 minutes. The paramedic contacted the control room three times asking for the ambulance to arrive sooner, but it did not arrive until 01:00 GMT the next day, Mr Nelson's family said.

Presumably this was a motorcycle paramedic, who will carry some fluids though probably not blood and certainly not more than a few pints of them. The unfortunate 26 year old Mr. Nelson is described as suffering from haemorrhaging, which was almost certainly internal and hence could not be successfully treated without surgery; all the paramedic could do was buy time pending transfer of Mr. Nelson to a hospital with an on-call surgery team, so that Mr. Nelson could a) receive whole blood in volume to replace his loss and b) be opened up so that the surgery team could clamp the offending major blood vessel to stop the loss. Unfortunately it seems that the required ambulance took another 90 minutes to arrive, which was way too late.

So why did the ambulance take so long? We can reasonably assume that the paramedic made a diagnosis of internal bleeding and called in for an urgent transport, so the available ambulances must have been elsewhere:

He added: "It seems that if they meet the target for the whole of the east of England, it satisfies the government target but the danger is they focus on urban areas where they can easily hit the target and rural areas get neglected.

Bingo! Why is this? Here's one possible explanation.

Suppose you have a reasonable-sized city (e.g. Reading, Oxford) surrounded by a fairly large rural area. Your ambulance, fire and police stations are somewhere in the city. At regular times you have a small number (say 2-4) of available ambulances, waiting to respond to calls. Most of your calls will come from within the city as not only do you have most of your people there but they are in an environment more likely to cause accidents (heavy traffic, concentrated drinking etc.) Anticipating this, you station most if not all of your ambulances around the city ring road and near major junctions so that they can either head straight in to the city, head straight out to the rural towns in their sector, or drive around the ring road to access a different sector. Your hospital will be within the city so your vehicles will go "green" (available) there; you can direct them to go straight to the next call or send them to one of your vacant ring-road sectors.

Blakeney, the home of Mr. Nelson, is 80 minutes from Great Yarmouth and 50 minutes from Kings Lynn (the nearest major towns). Without wanting to second-guess Norfolk ambulance control I'd imagine that they might have had an ambulance stationing point near Cromer or Swaffham, but someone else called first and that ambulance was taken; once they received the priority call from the paramedic, the ambulance would have nearly an hour of driving just to reach Blakeney. Because the incident happened on a Thursday night they probably had fewer ambulances available than on the busier Friday or Saturday nights, and because it happened around 11pm it was during the busiest period.

If the East of England Ambulance Trust wanted to reduce the incidence of long waits for ambulances in rural towns, it would have to position more ambulances way out from its major urban centres. The problem is that this would increase response times for the bulk of incidents during busy times when the remote-stationed ambulances were required near the cities. For the sake of significantly improving response times in relatively rare scenarios (multiple incidents away from the cities) you're going to be significantly impinging on your common-or-garden city incidents.

So what's the ambulance response time target?

Immediately life threatening – An emergency response will reach 75% of these calls within eight minutes. Where onward transport is required, 95% of life-threatening calls will receive an ambulance vehicle capable of transporting the patient safely within 19 minutes of the request for transport being made.

The NHS has at least addressed tail latency here ("95% within 19 minutes") but the problem is that this is a national target. It's much easier to meet in the densely-populated southeast than the more sparsely populated areas of the country. In the latter case, an ambulance trust's best bet is to concentrate resources around towns as discussed above, since they won't have a prayer of meeting "75% within 8 minutes" otherwise. It also allows wildly increasing times for 1/20th of the patients - if you can't get an ambulance to them in 20 minutes, there's no additional penalty for taking 90 minutes to reach them despite the fact you're identified these patients as needing onwards transport.

The dominant problem here is a national service (the NHS) requiring national targets for regional services, not making any allowance for the wildly different demographic distribution across the country. There's nothing conceptually wrong with the form of the target, but they need to vary the numbers as populations become less dense. You'd expect the tail latency requirement to remain fairly constant, but the initial response time to increase as population density decreases, and you should also add a 99% latency requirement (say, 30 minutes) to reduce the long waits for needy rural patients. Your response targets may no longer fit within a soundbite, but at least they are now aimed at saving lives across the country.

McDonalds breakfasts can be fatal

Daily Mail journo Harriet Arkell has no doubt about what killed firefighter Alan Soards:

Firefighter drowned during training exercise at Olympic white water rafting venue moments after he ate a McDonald's breakfast meal

Reading the article, she attempts to justify the headline:

Witnesses said Mr Soards, who was also a lifeboat volunteer, looked out of breath and that his face had turned purple, and he was found face-down in the water at the end of the course.
He was pulled from the water and attempts were made to resuscitate him, but Mr Soards vomited his undigested McDonald’s breakfast while he was being given CPR.

Clearly, it must have been the McDonald's breakfast that killed him. There's no way that someone pounding his chest with nearly their full body weight would have caused anything at all in his stomach (Egg McMuffin, Weetabix or lettuce) to return up his oesophagus. It's not like vomiting is a well-known complication of CPR. Heck, the McDonald's breakfast probably caused him to have broken ribs after CPR.

I can't find Ms. Arkell's degree subject (she studied at Bristol University) but no doubt she specialised in human physiology in order to make this diagnosis. Publicity-seeking empathy-lacking cow that she is. I'd have hoped that Alan Soards's family sue her, but I guess "maliciously self-serving ignorance" isn't legally actionable.

[Hat tip: the estimable Mark Wadsworth]

Wild speculation about the Boston Marathon bombings

What we know from the TV footage: the first bomb that triggered went off just over 4 hours after the marathon started (the clock shows 4:09:53 a few seconds after the explosion in this video footage near the finishing line) at 2:57pm local time. The second bomb went off approximately 12-13 seconds later as you can see in this second video which covers the relevant timespan. You can also see that very few windows near the first bomb are broken, which indicates that the blast either wasn't that powerful, or was focused away from the buildings. Those are the facts.

The next level of information are the reports, and let's remember that first reports are always wrong but we're later i the news cycle so these reports should be reasonably solid. Two other devices are reported as having been recovered. There have been 3 deaths so far, about 130 injured, many limb injuries and amputations. This implies that the devices were not that big. In terms of explosive power they were probably a bit smaller than the 7/7 London bombings where the devices were in backpacks and killed an average of 13 people each - the 7/7 bombs all detonated in confined spaces, which amplified their effects. The Boston bombs detonated in relatively open areas, with the ground reflecting some of the blast up and away from people. They may have been hidden in garbage cans, causing increased shrapnel (and hence limb shredding) but restricting the blast effects which hit the respiratory system and heart, causing fatalities. One of the Boston fatalities was reportedly an 8 year old child - their bodies are more vulnerable to trauma, so the 3 fatalities is more like 2 in comparison to the 7/7 average.

The casualty count was also likely lowered by the presence of many medics near the scene, allowing them to intervene in the seconds and minutes after the explosion, stop potentially fatal bleeding and clear obstructed airways. They would have had emergency kits targeting heart attacks, asthma and similar afflictions of exertions, but the airway management apparatus and plentiful oxygen would have been key in fighting off shock (under-oxygenation of the body) which is a classic killer in trauma.

I saw one particularly messy photo at The Atlantic (you can find it if you search for it, no doubt) of a gentleman with his lower leg gone - flesh and muscle stripped off the bone halfway down the shin, and foot missing entirely. That's going to hurt, no doubt, but it's not going to kill you - the guy looked reasonably alert as he was wheeled away. His lot is much better now than ten years ago. We've had ten years of the Sunni militia, Taliban and the Iranian Revolutionary Guards proxying through Shia militia with IEDs; immediate management of explosive trauma, long-term rehabilitation and the sophistication of prosthetic limbs has made great strides in that time.

If there were four bombs, and hence two duds, it's going to be interesting to see how they were triggered and detonated. Were the duds due to trigger failure or to bad detonators? I find it interesting that the two bombs which detonated were 12 seconds apart - were they on timers, or was there a cellphone trigger for each? Was the intent to scare the crowd away from bomb #1 and have them gather near bomb #2? If so, the timing was off - the 12 seconds was barely enough for people to collect their wits and start to move, let alone travel 100-200 yards. It's also interesting to speculate why the bomb wasn't timed for just after the first runners were crossing the finish, when the crowd and media interest would be at the peak. Where were the other two bombs, and when might they have been intended to explode?

For a more informed take on the composition of the explosives, though, I'm waiting for the expertise of The Register's Lewis Page who will no doubt weigh in on the matter with the benefit of his background in bomb disposal.

You'll notice I have not speculated on the identity of the perpetrators of this outrage. I doubt we'll really know anything for at least a few days.

Conspiracy courtesy of the GRU

Too entertaining not to share, mostly because it's just within the boundary of what's plausible: why we haven't seen much of US Foreign Secretary Hillary Clinton recently.

Within minutes of leaving Bahrain airspace, this report says, the C-12 Huron carrying Secretary Clinton and her US Navy Seal [sic] protectors, "without notice," deviated from their assigned flight path heading, instead, directly towards Iran's Ahwaz International Airport where, coincidentally, Iranian President Mahmoud Ahmadinejad had previously landed on an "unscheduled" visit.
[...]
Upon the C-12 Huron landing at Ahwaz, however, this report says it encountered "extreme turbulence" causing it to leave the runway where its main landing gear then collapsed causing it to crash.

The article quotes the Kremlin's GRU (Glavnoye Razvedyvatel'noye Upravleniye a.k.a. Foreign Military Intelligence) as the source. Obviously there's no possible motive for them to exaggerate...

At least some of the facts are verifiable: Clinton has indeed been out of the public eye for several weeks, and the cause is quoted as concussion after fainting at home, some time in the week leading up to December 16th. The SEAL commander suicide is quoted as happening on Saturday December 22nd though, which is a rather big time gap. The Army alone has 112 C-12 Huron craft so concealing the loss of one is at least plausible.

The main points that jar, though: why would a SEAL unit commander be on diplomatic protection duty, even for Hillary Clinton? Protection work is a young man's game, and Commander Price was 42. Why indeed would you need a SEAL unit? If you're deliberately landing an aircraft in Iran at a commercial airport and the Iranian military are expecting you, then if things go wrong you are already so deep in the yoghurt that even SEALs aren't going to help you. And what would Clinton hope to achieve with a covert meeting that would not be possible with an overt meeting? It's the job of a Foreign Secretary to go around the world and meet dubious people; no-one would have batted an eyelid if the existence of the meeting was public.

If Clinton was "bleeding profusely" after the crash then transporting her out of Iran and back to the US would potentially be dicey - she's 65 years old, and one's response to trauma at that age is less than elastic. However, if they managed to get whole blood in her and exclude the possibility of significant head trauma then a medevac would just about be plausible. I wouldn't have liked to take the risk of moving her far from that crash site though.

Overall this is a great example of conspiracy theories: just on the edge of plausible, some facts lining up but others forming something of a ragged edge, originating from a source with ample reason to foment trouble, and failing to answer the basic question of why all this would be so secret in the first place.

Empire State bystander shootings - no surprise

I'm amazed that this doesn't happen more often: all 9 innocent casualties of the Empire State building shooting were hit by police bullets:

The officers unloaded a total of 16 rounds at a disgruntled former apparel designer, killing him after he shot and killed a co-worker and engaged in a gunbattle with police, authorities have said.

The Zero Hedge article has a video of the confrontation where the guy turns to face the police officers pursuing him, appears to pull out a gun, and then staggers and finally collapses as the bullets hit him. The apparent shooting distance looks to be around 10 feet from the video, although it could easily be 5 feet more for the second officer.

Unlike a lot of commentators, I'm not particularly surprised at the high bystander casualty numbers. This shooting happened at 9am so the streets would have been packed with people. It looks as if the closer officer was firing more or less along the kerb-line of the street, and the farther officer at an angle that would have gone diagonally across the street to the far sidewalk, so the bullets would have had a long way to fly before they got stopped by any buildings or street furniture. But why did so many shots miss at such (relatively) short range?

The police officers would have been reflexively firing their service weapons (9mm automatic pistols) until the threat - Jeffrey Johnson, carrying a .45 caliber firearm - was neutralised, which generally means bleeding out on the floor and separated from his weapon. With the suddenly developing situation, seeing Johnson reach for his weapon, the cops' fight-or-flight reflexes would have kicked in and dumped adrenaline into their systems, causing their peripheral blood vessels to contract and muscles to shake. The chance of their first couple of rounds hitting Johnson, even from 10 feet away, would have been fairly low. They would have attempted to walk their rounds on to Johnson's centre of mass (chest), firing maybe once a second. As he dropped - which he seemed to do quite suddenly - he would have fallen out of the line of their fire and the officers would have taken a moment to realise he was down while they were still firing and bullets passing through were Johnson used to be standing.

You can't really blame the NYPD for this. Johnson clearly wasn't in the mood to stop and surrender; once he appeared to go for his weapon, this was only going to end one way. But why were the officers such (apparently) bad shots? Lack of practice. Look at Joseph Goldstein's report on 2010 NYPD shootings:

Last year, 52 officers from the New York Police Department fired a total of 236 bullets during confrontations with suspects. About half of the officers used a two-handed grip on their firearm, as the department encourages, while the others shot one-handed. And in a sign of just how tense these 33 separate shooting episodes were, and how rapidly they unfolded, only one officer reported using the gun’s sight before firing.

So shootings are relatively rare, and regular patrol officers are very, very unlikely to fire their weapons in anger: there are about 9000 patrol cars in the NYPD, so let's say about 9000 patrol officers - that's only about 6% of officers firing in anger. Many patrol officers can go their whole career without firing their weapon. It's not surprising that the first time they fire, the bullets don't all go into the offender.

Stable Spain

Spain claims it is "stable":

'We're stable': Cash-strapped Spain's finance minister says nation is back on track despite claims it asked IMF for massive €300BILLION bailout

When reading this, I couldn't help but think of the Rules of EMS:

64. Asystole is a very stable rhythm

and perhaps while we're here should modify:

63. Less than 8, intubate (GCS score).

to

63a. If the Finance Minister lies, recapitalize.

24 hours in A+E - the mad-as-a-fish edition

Our last view (for a while, at least) into Kings A+E. "For God's sakes, get me something for the fucking pain!" some bloke was shouting as the programme opened. Either he had a gunshot wound to the stomach, was in the middle of childbirth, or he was being a wuss. You know what I'm betting on.

Clive woke up confused with a slurrying voice - everyone was thinking 'stroke'. He was conscious enough to compliment his consultant on her youthful looks though, good man. Discussing with his nurse people who go away before exam results come back, he commented that if anything was wrong with him he'd want to know. Six years of fighting off depression (subsequent to alcoholism, sounds like), more bad days than good days. I could see how that would screw up your vascular system. Turns out that the symptoms were due to an accidental overdose of his meds.

Here came Joseph, the pre-announced 16 year old with a query stroke. He was a bit confused about times and dates, apparently remembering yesterday's events as todays. Initially you'd think 'head trauma' but there was no obvious history indicating a mechanism for it. Some unilateral weakness in his leg. Handy for diagnostic purposes having his twin brother there, I'd think. Later confirmed that it was a stroke, fully recovered.

A suicidal person with 74 previous attempts went missing from the department. Jenny the psychiatric nurse was trying to find her. Statistically you'd think there wouldn't be too much risk that this would be the one time her attempts would succeed but I guess you can't stake your job on that. Kings sees more people with mental health needs than any other A+E department in the UK. Lots of schizophrenia, lots of bipolar. I'd hazard a guess there's a strong correlation with homelessness. A lot of them are regular visitors which brings its own set of challenges.

There were funny vignettes with the two girls trying to keep themselves entertained for hours and hours while waiting for treatment for fingers trapped in a collapsible stool. A+E needs more entertaining posters, perhaps 'Where's Wally?'.

We had 28 days of filming in which time 9500 patients came through and 6 died. It may sound a little heartless to say it, but that's not bad going.

24 hours in A+E - the end-of-the-road edition.

Now we have Saturday afternoon to Sunday morning. Should be a corker.

Props to the Filipino nurse looking after Ted and Irene - the man was very smooth. Ted was on his way out with a cancerous tumour in the bladder, knew it was there but was very stiff-upper-lip about the whole thing. Irene was apologising for calling the sister over - I don't know what the opposite of 'entitled' is, but Irene feels it in spades. Ted and Irene were stretching to try to see the bright side of life in very trying circumstances. As sister Maria said, you don't always get the privilege of spending time with people like that.

One young chap, Ian, was skateboarding while drunk and broke his ankle. Two components of the pisshead triad at minimum. The exact circs of the breakage may remain a mystery. Ian hated needles, but clearly not enough to offset his like of beer.

Emergency technician Amanda caused my teeth to grate somewhat. Does this make me a bad person? The ambulance crews call her "Peggy Mitchell" so it's not just me. She must have loved kicked-in-the-face patient Duncan as he could barely talk, so she got all the air time.

A patient came in with a heart attack - the team was administering CPR, which is already a pretty bad sign. Sure enough, the consultant called it a day. To be fair to Amanda she was up on the man's chest pumping away like a good'un.

"Every year 7 million people have accidents at work". I'd bet a considerable sum that there may be 7 million reported accidents at work, but there are a good number of those people who have multiple accidents. The example shown to us was a hedge trimmer vs finger; a Polish gardener shooting the breeze with Roman his German doctor. Roman has had to adapt the typical German direct approach to the British patient. "Will it hurt?" "Oh, yes!" gets the nurses telling him off. He sounded not a little irked with a British GP telling a patient with splinter-in-the-thumb from a month ago to come to A+E. I can see his point. God forbid that the GP should actually have to do anything tricky.

70p for a Bounty in the vending machine? Talk about captive audience pricing.

When the resus sister Sharon is saying "Oh my God, this is ridiculous" as the phone rings again, you know it's a good night. From one point of view. "So Stuart, what were you doing up the tree?" He doesn't remember. Alcohol, stupidity, gravity, kerching. Stuart likes to live life on the edge, but is afraid of his mother finding out. You couldn't make it up. "You're silly and you do stupid things" as his girlfriend observed, cutting to the heart of the issue.

A week later, Ted passed on. Stuart and Ian are, unfortunately, fine.

Next week: a 16 year old with query stroke. WTF? A different patient has a history of 74 previous suicide attempts. Let's be honest, she's not really trying.

24 hours in A+E: the Garfield edition

"I hate Mondays" says Garfield. He has no idea...

Ooh, Channel 4 is warning us of "strong language and graphic scenes of stab wounds". That's what we're looking for. What does a non-graphic scene of a stab wound look like? A picture of a set of kitchen knives with a banana skin on the floor?

It strikes me that you can see the initial scenes of the hospital corridors containing patients slumped in wheelchairs and random cardboard boxes stashed around, and be left in no doubt that you're looking at a UK hospital.

I can't think of many worse things than being chocked and blocked on a spinal board in A+E and hearing screams, yells and gurgles either side of you but being completely unable to see what's going on.

For all those mathmos tackling NP-hard problems, you should have a look at Jen's bed allocation juggling. If anyone's going to crack SAT in polynomial time, my money's on her.

Why is Monday the busiest day of the week? That seems counter-intuitive to me. Apparently it's because GPs are closed over the weekend so no-one can go to them, so they wait for things to get bad and then go to A+E. Go figure. "Bit chaotic in here, not your average Monday, is it?" asks one punter. Jen grins and corrects him: "Yeah."

Ah, here comes the first stabbing. Attacked outside a local shop, life-threatening haemorrhage. Curled up on his side, BP 66/29, that doesn't look good to me. Lucky he was stabbed in the backside, unlucky there were a couple in the chest as well. I was impressed the guy wasn't screaming in pain as the medics stuck their fingers into the wounds.

I had to love Jen's impression of an AAA bursting: "plop!" Omar, who owned the AAA in question, was faced with an operation to fix it (50% mortality at his age) or leaving it and hoping for the best. His son had to sign the consent forms saying he understood that the operation was risky -- but without it, mortality was 100%. Talk about Hobson's choice. "Are you happy for us to go ahead?" Well crap, he's not going to be happy about it is he? Like Jen says, it's probably worse for the relatives in that situation because at least the patient is loaded up with opiates - the relatives have no such cushion. I was glad for Omar's son's sake that Omar beat the odds.

As Jen reeled off the list of drugs that suicidal Hany had taken (I lost count around number six and didn't recognise half of them) one was left with the strong impression that this was an actual attempt, not the typical cry for help. He'd taken them from his mother, and I'm somewhat surprised she's still alive if she takes all of those in one day. Six years of heroin and crack seemed to have screwed him up impressively, though I suspect gave his system the ability to survive the cocktail he took where a cleaner-living man would have pushed up the daisies.

Sounds like the urology registrar Jacqui is getting fed up of people trying to call her. Perhaps they are taking the piss (badoom tish).

24 Hours in A+E: the blunt truth edition

This should be interesting - a Wednesday, 10am start. As close to a "normal" week day as you can get. What trade comes through Kings outside the weekend stab/alcohol window?

Firas wanted to be a doctor ever since he had his tonsils out at age 5. Perhaps he wanted to get his own back. Now he's a consultant in A+E, so he's probably paid his dues. His first patient was a 59 year old male, overweight, flushed face and chest with chest pain and a history of heart problems. Bingo, likely heart attack in progress (notable that the ambulance crew brought him in along with a couple of feet of ECG trace so they were thinking the same thing). He's clearly not a believer in sugar-coating things, rather preferring to tell you exactly how bad it's going to be (and daring you to run away). But refreshing that he was open to admitting to Reg, his second patient, that he'd promised to make him better, hadn't yet, but would bust a gut to make it happen. Sounds like his father was ballsy - getting Firas and his brother evacuated from Kuwait in 1990, when he couldn't be evacuated himself, and telling them "chin up and cheer up" as they boarded the coach to leave. If I was in a bad state in A+E, I'd be pretty happy with Firas as my consultant. For the rest of the hospital, hmmm... they seemed to take a lot of chasing by Firas ("I'm going to be blunt, if this man does not get exploratory surgery, he's going to die") before they moved into action. Reg wasn't just knocking on Death's door, he was ringing the bell and chucking gravel up at the window. But he was a pretty ballsy guy too, making a Bogart joke with consultant Andre as he OK'd the life-or-death operation. But they didn't find anything wrong when they opened him up, so what was wrong? Best guess was insulin overdose, but you can never be sure.

Richard had twisted his knee moonwalking (showing off, reading between the lines). Pity his poor younger brother Jake who got to look after him. He was bragging about dating a Kings gynaecologist, which I can only imagine resulted from an overenthusiastic affirmative action policy hiring doctors who are clinically blind -- and deaf. He's pursuing Cheryl Cole, and I leave all the obvious rejoinders to the audience. The triage nurse had his number, telling Jake to do the opposite of everything his brother told him.

Junior doctor Dom looked about 16. Crap, I'm getting old.

Towards the closing of the episode was another stab wound - fit young man, on hi-flo O2, leaving a small spot of blood on the trolley sheet where his left lung would have been; police officer hovering nearby. FFS.

24 hours in A+E - the mandoline slicer edition

The vignettes from tonight's slice of life at Kings A+E:

• "Fall from a tree? He's probably absolutely trolleyed." I'm not taking that bet. We also saw from a maimed carpenter that electrical tape is just as good as, if not better than, Elastoplast.
• A good friend is one like Patrick who will hold a bowl under your jaw while you vomit into it, while he is completely sober. Such friends are rare, treasure them. He even bigs up your past heroic deeds to the nurse who's about to stitch up your nose.
• Oh, another stab victim (left side upper abdo). Didn't see much of him beyond ten seconds just before the ad break, and there was no narration about his injury but it was a small but obviously deep isolated wound to the front of the abdomen. I got the message.
• The poor sod who got stuck between a cherrypicker and a car was, nevertheless, painfully lucky. He just wanted to go home but, as the consultant pointed out, his pain relief choices were between paracetamol at home or morphine in hospital. After that kind of squash, I'd take all the opiates that were on offer.
• Unknown male with a head injury; fall from a ladder onto concrete (height unknown), intubated with severe traumatic brain injury. He had a mobile phone but it's locked - who can unlock it? Turned out to be a chap called Nicholas who, it appears, was very near to biting the big one. He's still a long way from fully recovered but a light year from the state he was in after the accident. Good job by the neuro guys and all the rehab team.
• When the A+E nurse is acquainted with your model of vegetable cutter (a mandoline) it's a sign that you should change to a different one.
• Ironic that Darren who fell through a window while cleaning it, saw his arteries spurting blood over the walls and ceiling, and wrapped his arm up in a towel to control the bleeding, didn't feel he could watch the nurse sticking him with a local anaesthetic. There's no accounting for taste. Incidentally, that's why you shouldn't clean your windows.

The trailer for next week's episode showed an ominous red stain halfway down the ambulance trolley when the patient was transferred off it.

24 Hours in A+E - the violent crime edition

Ah, Saturday afternoon and overnight in Kings A+E. This is going to be a corker. If alcohol doesn't feature in 50% of the injuries, I'll be astonished.

One nurse noted "I had 'ping pong ball in anus' the other day in Trauma". That's got to chafe. "They had four and then noticed there were only three left". Thank goodness she left the detail to the imagination. Wonder what happened with the bats.

Oh, look, intoxicated students, injured after falling from a bar they were dancing on. Alcohol, stupidity and gravity; kerching - the pisshead triad. They were trying to look after each other, which was sweet, but doing so while four sheets to the wind made it a little futile. Amusing to see their friend assert to the nurse that their head injury wasn't serious. Glad that you've got CT-level vision there, sunshine.

Grudging respect to builder Colin who had his forearm opened up by a knife in an attempted cellphone mugging. He seemed quite happy scrutinising the injury which opened up around 10mm of flesh, and was concerned but not panicked about loss of sensation in his finger which likely indicated nerve damage. Had been drinking but that didn't seem relevant to the injury so I'll let that one pass. He seemed relatively relaxed about the docs prodding the injury, that's a man with a substantial pain threshold. This was confirmed by him removing his own stitches to get back to work sooner.

I have to confess to a growing respect to senior sister Jen, who has seen everything and is near-terminally laid back about an increasingly demented night shift. She knows biological facts that no-one should need to know, and confirmed the 50%+ alcohol-induced injury proportion for the key shifts. She handled combative patients and stressed relatives with aplomb combined with don't-screw-with-me-sunshine firmness.

Father and son brought in with "samurai sword" and blunt trauma injuries, though the son's holes didn't look that large to me (they were in dangerous places though) following gatecrashing of a family party.
A couple of predators decided they wanted to come in and "no" wasn't an acceptable answer. Wonder what their crime history looked like.

Catherine was a classic PFO who "started to feel unwell" after an evening out with friends. Drank enough to start inducing apnea, which caused no little concern. I'd suggest hot sweet coffee, p.r.. She claimed that "her drink was spiked". Mmmm...

Moral of the evening: if you need to go to A+E with an injury that will be treated in Minors, don't go on Saturday night; you'll be there until Sunday daybreak. And it's probably your own fault.

Another 24 hours in A+E

The money quotes from this evening's episode of stabbing, slabbing, blabbing and blubbering:

Amanda the med tech: "When people come into the department, they're often very scared and so it's nice to be able to put them at their ease." Just before she rams a wide-bore needle into them and sucks out their blood. "Welcome to Kings, have a nice day!"

(Why do people have the instinct to look away when they get needles shoved in their arm? Wouldn't you expect the natural reaction to be a check that blood isn't spurting out of the wound as from a ruptured fire hydrant?)

John with the abdominal aortic aneurysm: he'd spent 140 quid on a private medical screening which had spotted the ballooning aorta and referred him to A+E. As his doctor said: "Best 140 pounds you ever spent!" So much for GP health screening. They took him off to Coffin Ward (well, that's what he and I thought it sounded like). Nice job, whoever came up with that name.

They have a sandwich trolley in the waiting area. Now that's not a bad idea, and one our local A+E could certainly use. Serving coffee you can actually drink would be quite the advance too. 

Pritpal the sandwich guy: "I wanted to be a doctor, but thank God I have my health and I can play even a small part in making people better." Quite right, chap.

Two chubby smokers come out of the department to light up. "Ah, that's it man, real air, not like that recirculated shit they have in there." The irony meter nearly melted.

92 year old Irene showed Job-like tolerance of a sustained patronising from her consultant Liz. After admitting to a nip of brandy morning and evening, she was told "Since you've got to the ripe old age of 92, I think we'll let you have that." Excuse me Liz, "let you"? Irene got this far in life, having lived approximately three times as long as Liz, she can do whatever the heck she wants.

Darren has hurt his foot from kicking a chair while playing a computer game. If breathing wasn't an autonomic reflex, Darren would be dead in short order. Between him and his girlfriend they have comparable intelligence to a below-average cat, but not quite as much common sense.

On the bright side, only one minor stabbing, and they skipped lightly over it. I was wondering whether this was to give more variety in the programme, but another stabbing featured prominently in the trailer for next week's episode, so fans of deep-penetrating trauma can look forward to it.

According to an advert, Mercedes has "125! years of evolution". I don't think the universe has been around for quite that long. 

Stabbed but not slabbed

It's slightly indirect, but interesting reading the reactions of a response Police Inspector to the programme '24 Hours in A&E'. I've been following it since the start, and it's starting to become somewhat depressing. Filmed at Kings Hospital in South London we see a steady procession of knife victims come through triage. "Oh look, another teenaged / early 20's African-Caribbean guy. Shocker." It's so consistent, it's not even funny. Why aren't people shouting from the rooftops about this? Oh, I think I might know. Commentator VoiceOfReason in the comments notes:

“We all have to be so careful these days, you never know who’s listening and any suggestion that you are not ‘toeing the party line’ will kill your career stone dead.’”

Providing balance, there's an equally steady stream of pissed-as-a-fart agressive, obnoxious and barely intelligible white males in the same age bracket alternating between actual alcohol poisoning and the consequences of intoxication (falls, crashes, fights). This has already been the subject of any number of rooftop shoutings, but is equally depressing.

I'm hoping against hope that the programme makers have been focusing on the "entertaining" gangsta muppets and dickhead pissheads, ignoring a majority of peaceful accident victims and elderly acute cardiac events. But I'm afraid that my optimism is mis-placed.

There are an awful lot of people on that programme who need to be charged the full cost of their treatment, and (since they've already spent their money on booze, bling and clothes) be made to work it off. And a much smaller posse of medical staff (from porters through nurses to SHOs) who should get that money tax-free without any of it being diverted to the bean-counters or suit-wearers upstairs. Like that's going to happen. The Triage nurses in particular deserve canonisation, as the cartoon which used to hang in their room in Chester A&E noted:

The gates swing wide, the trumpets sound, the angels toll the bell. 

"Come in my dear, take up your harp; you've done your time in Hell".