A NPE Story - Rabies and the Hospital

[echo5charlie]

This is a short one: got bit by a stray animal Saturday evening. Unsure of the animal or if I would see it again. Decided Sunday morning that an ER visit for the rabies vaccine would be a good idea given the possibility of a 99.9% morality rate. The whole rabies vaccine thing is enough for it's own post...holy shit.

Anyway, I know most hospitals are a NPE. No way was I going unarmed so I google-fu'd for what to expect for the shots. What I found was that you get the initial shots near the injury, which was my finger. Good to go. My vitals are good so I knew that the likelihood of wearing a hospital gown was virtually zero. I decided my G43 AIWB was a decent choice. Thank God that I decided at the last minute to switch to my LCP in my pocket because a little voice yelled in my brain "What if you have to get NAKED?!". Here's what happened (this is super condensed for those who have never had an ER visit):

Check into the ER. It's Sunday morning so the stupidity from Saturday night is cleared out and the new-day stupidity hasn't kicked in; there are only three people in the waiting room. After a bit I get called into the triage room and give the basics. They check out the "wound" and take my vitals. Cool. I then get to wait in another waiting area. After a long wait I get seen by two nurses. I need an x-ray of my hand (whatever), a tetanus shot, and the rabies vaccine. Good to go. I go wait some more.

Shot time: after waiting some more (surprise!) I finally get called in. I find out I am getting five shots: one tetanus and four rabies, due to my size (6'4"/225). Three in the upper arms and two in the legs. Well, that wasn't expected!

Two in the legs. AIWB/IWB/OWB would have failed me here. I had two nurses in the room...a small room. There was no way I could have even remotely been able to pull off a discreet "drop trou" - it would have been a shit show. But I pocket carried. I dropped trou, got my arms and legs shot up, and that was that. Five minutes later I felt something I hadn't felt since the shot gauntlet of March of '97 at Parris Island...


So, in the end, a little voice in the back of my head at the last moment "saved the day". Google did not adequately prepare me for what to expect - had I relied on it, ultimately, I would have had a very awkward day. NPEs are interesting and hard to plan for with certainty if you have no experience with them. The empty ER waiting room still gave me a 5 fucking hour visit, I can't wait for the bill.

[SAWBONES]

Good job.

As a doc, who's also been a patient not a few times, I'd counsel anyone expecting to enter a medical NPE to employ pocket carry as their temporary CCW, whether as inpatient or outpatient.

[echo5charlie]

Good job.

As a doc, who's also been a patient not a few times, I'd counsel anyone expecting to enter a medical NPE to employ pocket carry as their temporary CCW, whether as inpatient or outpatient.

Thanks. I learned something new that, even given my brief experience, is invaluable. My counsel will be the same.


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[blues]

Glad you're okay and that you had the presence of mind to do what needed doing.

[Hambo]

Most hospitals here have metal detectors. Security is usually nice enough to tell people to go put it in their car.

[RAM Engineer]

Yeah, it's been a decade or more since I've been in an ER that didn't have metal detectors.

[JonInWA]

A couple of years ago I got badly bitten by a pit bull who bit me severely, but only once, and he then retreated (and it was in a closely populated metropolitan neighborhood), so he didn't get shot with my on hand EDC that day, my Glock G21. The ambulance crew and I had an amicable discussion on exactly what to do with the Glock on arrival at the hospital. Turns out that the hospital had a good protocol in place; immediately on arrival, we were met by Hospital Security (who were very professional), who unloaded and secured the gun, tagged it and placed it in their secured storage. Upon my release after surgery, the G21 and its magazine were returned to me, bagged.

Animal control seized the dog, who apparently had also previously bitten a child. Either some breeds inherently just aren't good pets, or some owners aren't aware of or fail to take responsibility for training some aggressively-instincted breeds. The dog involved, despite some interesting equivocation by the owners turned out to be a pit bull mix. Amazing.

After surgery, I proceeded in kind to get a pit bull of a lawyer, which worked out, but I would have much preferred to have avoided having the injury and surgery in the first place.

Best, Jon

[OlongJohnson]

When going to ER, I pack a "go bag" that covers what I may need if I end up being there for a couple days. Don't forget the cell phone charger. Nobody has ever looked in the bag or asked about it.

They do love it when I break out my stack of unread Dirt Bike magazine issues.

[Drang]

A couple of years ago I got badly bitten by a pit bull who bit me severely, but only once, and he then retreated (and it was in a closely populated metropolitan neighborhood), so he didn't get shot with my on hand EDC that day, my Glock G21. The ambulance crew and I had an amicable discussion on exactly what to do with the Glock on arrival at the hospital. Turns out that the hospital had a good protocol in place; immediately on arrival, we were met by Hospital Security (who were very professional), who unloaded and secured the gun, tagged it and placed it in their secured storage. Upon my release after surgery, the G21 and its magazine were returned to me, bagged.

As a local, I have to ask which hospital?

[Maple Syrup Actual]

As a guy who once kicked off a rabies public health scare, I have to ask...what about those shots, anyway?

[JonInWA]

As a local, I have to ask which hospital?

Auburn. Best, Jon

[FreedomFries]

Good job.

As a doc, who's also been a patient not a few times, I'd counsel anyone expecting to enter a medical NPE to employ pocket carry as their temporary CCW, whether as inpatient or outpatient.

I have noticed that health professions are well represented on this board, which is great! I'm a PA and former Army medic. I respectfully disagree with this advice. Pocket carry holsters can be reasonably secure, but in my experience, becomes much less secure when the garment is not being worn on the body or if the person is being positioned outside of the typical standing or sitting. When a firearm falls out of a patient's pocket and lands on the ground, this can be very alarming. Many healthcare workers are not experienced with or comfortable with firearms and this can create a major incident especially if the weapon is prohibited by facility policy and/or by law.

[BillSWPA]

I have noticed that health professions are well represented on this board, which is great! I'm a PA and former Army medic. I respectfully disagree with this advice. Pocket carry holsters can be reasonably secure, but in my experience, becomes much less secure when the garment is not being worn on the body or if the person is being positioned outside of the typical standing or sitting. When a firearm falls out of a patient's pocket and lands on the ground, this can be very alarming. Many healthcare workers are not experienced with or comfortable with firearms and this can create a major incident especially if the weapon is prohibited by facility policy and/or by law.

I am not a health care professional, but share your happiness in seeing many here.

You make very good points about the possible downsides of pocket carry. However, I specifically use pocket carry when I have to get undressed because it is the only method of carry that keeps the gun hidden throughout that process. Being careful about the orientation of the pocket containing the gun has always prevented the gun from falling out.

Fanny pack carry could also work if the fanny pack is well designed not to look like a gun pack. Coronado Leather packs are particularly good for this.



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[SAWBONES]

FreedomFries, I'm not sure what you're thinking of, but if the pocket pistol (ideally something like a S&W 340PD revolver) is secure within the pocket holster (retention better than a "slip fit"), and the pocket holster is secure within the pocket (such that it won't fall out of the pocket if the garment is inverted), there'll be no reasonable chance of the weapon "falling out" of the pocket.

We are, after all, assuming the NPE, and the paramount desire that the presence of the sidearm should remain inobvious to all casual observers.
The capability for effective personal defense, should a genuine need for a firearm defense actually arise, is the reason for the CCW, but is superseded in this case by the need for non-discovery by others.

If a metal detector, "pat down" or other actual search of one's person or belongings is reasonably to be anticipated, then any variety of CCW is pretty much out. Likewise, if one's personal possessions are likely to be stored or manipulated by hospital personnel, as with an in-patient admission, it's better not to bring a weapon, IMHO.

If OTOH, one reasonably anticipates an out-patient experience, with no expectation of ones' belongings being taken or searched, pocket carry will probably be easier to conceal and to keep (securely) concealed than an OWB, IWB, AIWB, shoulder or ankle rig.

Was it your opinion that there is a better method?

[FreedomFries]

FreedomFries, I'm not sure what you're thinking of, but if the pocket pistol (ideally something like a S&W 340PD revolver) is secure within the pocket holster (retention better than a "slip fit"), and the pocket holster is secure within the pocket (such that it won't fall out of the pocket if the garment is inverted), there'll be no reasonable chance of the weapon "falling out" of the pocket.

We are, after all, assuming the NPE, and the paramount desire that the presence of the sidearm should remain inobvious to all casual observers.
The capability for effective personal defense, should a genuine need for a firearm defense actually arise, is the reason for the CCW, but is superseded in this case by the need for non-discovery by others.

If a metal detector, "pat down" or other actual search of one's person or belongings is reasonably to be anticipated, then any variety of CCW is pretty much out. Likewise, if one's personal possessions are likely to be stored or manipulated by hospital personnel, as with an in-patient admission, it's better not to bring a weapon, IMHO.

If OTOH, one reasonably anticipates an out-patient experience, with no expectation of ones' belongings being taken or searched, pocket carry will probably be easier to conceal and to keep (securely) concealed than an OWB, IWB, AIWB, shoulder or ankle rig.

Was it your opinion that there is a better method?

I should backtrack a bit. I am not totally against pocket carry provided the holster retains the firearm when inverted even with some basic movement and there is some reasonable means to prevent the pistol and holster from coming out of the pocket. I am mostly against pocket carry the way I see it commonly done, which in my opinion is very cavalier. I am not an expert on pocket carry technique or equipment, however a lot of what I have seen seems unsatisfactory to me from a retention or safety standpoint. It looks like most holsters rely on friction between the outside material of the holster and the inside of the pocket to anchor the holster. Therefore, these holsters are then designed with light retention so that you can reliably draw the pistol without pulling the whole holster out of the pocket. While some of these soft holsters may retain a J frame well because of the cylinder providing some structure to wrap around, most pocket carriers are now carrying small flat sided semi-automatic pistols. I did experiment briefly with an LCP shortly after its release, and was not comfortable with the retention in some popular holsters. To worsen matters, I have noted that many pocket carriers place them in loose pockets that have no way to secure the opening (such as a zipper or snaps).

For a while, my preferred method for NPE where it is legal to carry was to use a messenger bag with a velcro or snap secured area to keep it from falling out or being seen. I used to carry a laptop case with a discrete Velcro closed area. I would keep it in my control at all times. A friend called it my "chaperone" because I wouldn't go anywhere without it or leave it unattended. He was not aware of its contents other than the laptop and paperwork that I had. I would never advise someone to carry in an NPE where it is illegal to carry. I also have started keeping a steel combination lock box with security cable to secure to my seat frame in my car if I have to leave my firearm in the car.

[BillSWPA]

I should backtrack a bit. I am not totally against pocket carry provided the holster retains the firearm when inverted even with some basic movement and there is some reasonable means to prevent the pistol and holster from coming out of the pocket. I am mostly against pocket carry the way I see it commonly done, which in my opinion is very cavalier. I am not an expert on pocket carry technique or equipment, however a lot of what I have seen seems unsatisfactory to me from a retention or safety standpoint. It looks like most holsters rely on friction between the outside material of the holster and the inside of the pocket to anchor the holster. Therefore, these holsters are then designed with light retention so that you can reliably draw the pistol without pulling the whole holster out of the pocket. While some of these soft holsters may retain a J frame well because of the cylinder providing some structure to wrap around, most pocket carriers are now carrying small flat sided semi-automatic pistols. I did experiment briefly with an LCP shortly after its release, and was not comfortable with the retention in some popular holsters. To worsen matters, I have noted that many pocket carriers place them in loose pockets that have no way to secure the opening (such as a zipper or snaps).

For a while, my preferred method for NPE where it is legal to carry was to use a messenger bag with a velcro or snap secured area to keep it from falling out or being seen. I used to carry a laptop case with a discrete Velcro closed area. I would keep it in my control at all times. A friend called it my "chaperone" because I wouldn't go anywhere without it or leave it unattended. He was not aware of its contents other than the laptop and paperwork that I had. I would never advise someone to carry in an NPE where it is illegal to carry. I also have started keeping a steel combination lock box with security cable to secure to my seat frame in my car if I have to leave my firearm in the car.

NPE carry is worthy of its own thread. For a ten year period, that was what I did on a daily basis.

If you have a friend calling ur bag your "chaperone" then you have created an out of place thing that people will focus on and try to figure out why it is out of place. In particular, the women in the workplace will notice things that the men will not, and they will gossip about it as they try to figure out why it is that way.

It is way too easy for your bag to be separated from you in a variety of ways. Depending on the workplace, your bag may also be more likely to be searched than your person.

Pocket carry depends in part on the pocket itself to retain the gun. Regarding holsters, take a look at the Aholster. It has a perfect level of retention for what it is. It uses either a hook near the rear sight or a hook below and behind the trigger guard to catch the lip of your pocket as you draw, separating the holster from the gun. Both devices are present, and either one catching the pocket will work.

[BillSWPA]

I should backtrack a bit. I am not totally against pocket carry provided the holster retains the firearm when inverted even with some basic movement and there is some reasonable means to prevent the pistol and holster from coming out of the pocket. I am mostly against pocket carry the way I see it commonly done, which in my opinion is very cavalier. I am not an expert on pocket carry technique or equipment, however a lot of what I have seen seems unsatisfactory to me from a retention or safety standpoint. It looks like most holsters rely on friction between the outside material of the holster and the inside of the pocket to anchor the holster. Therefore, these holsters are then designed with light retention so that you can reliably draw the pistol without pulling the whole holster out of the pocket. While some of these soft holsters may retain a J frame well because of the cylinder providing some structure to wrap around, most pocket carriers are now carrying small flat sided semi-automatic pistols. I did experiment briefly with an LCP shortly after its release, and was not comfortable with the retention in some popular holsters. To worsen matters, I have noted that many pocket carriers place them in loose pockets that have no way to secure the opening (such as a zipper or snaps).

For a while, my preferred method for NPE where it is legal to carry was to use a messenger bag with a velcro or snap secured area to keep it from falling out or being seen. I used to carry a laptop case with a discrete Velcro closed area. I would keep it in my control at all times. A friend called it my "chaperone" because I wouldn't go anywhere without it or leave it unattended. He was not aware of its contents other than the laptop and paperwork that I had. I would never advise someone to carry in an NPE where it is illegal to carry. I also have started keeping a steel combination lock box with security cable to secure to my seat frame in my car if I have to leave my firearm in the car.

Here is a really good thread on pocket carry.

https://pistol-forum.com/showthread.php?35160-Pocket-Carry

[Sensei]

As a guy who once kicked off a rabies public health scare, I have to ask...what about those shots, anyway?

The idea behind a rabies vaccine is to give a person killed/inactivated virus so that their body produces antibodies to the live virus that will protect against infection. Anyone who is at high risk for rabies exposure (animal Control workers, rabies virologists, etc.) should get this series of vaccine shots. However, it takes a couple weeks for your immune system to produce sufficient antibodies to protect against rabies infection. As you can imagine that 2 week window is no bueno if you just got bit by a rabid animal and the incubation can be as short as 1 week. Thus, we give people an additional medication called rabies immunoglobulin (RIG) which are preformed antibodies that will bind-up as much virus as possible while we wait for your immune system to respond to the vaccine with your own antibodies. That one time dose of RIG is given in/around the bite to bind-up as much virus as possible which is concentrated at the bite for the first week. For big people who get a lot of RIG, we give about half at the bite site and the rest upstream but away from the vaccine so that it does not bind up the vaccine.

[BillSWPA]

The idea behind a rabies vaccine is to give a person killed/inactivated virus so that their body produces antibodies to the live virus that will protect against infection. Anyone who is at high risk for rabies exposure (animal Control workers, rabies virologists, etc.) should get this series of vaccine shots. However, it takes a couple weeks for your immune system to produce sufficient antibodies to protect against rabies infection. As you can imagine that 2 week window is no bueno if you just got bit by a rabid animal and the incubation can be as short as 1 week. Thus, we give people an additional medication called rabies immunoglobulin (RIG) which are preformed antibodies that will bind-up as much virus as possible while we wait for your immune system to respond to the vaccine with your own antibodies. That one time dose of RIG is given in/around the bite to bind-up as much virus as possible which is concentrated at the bite for the first week. For big people who get a lot of RIG, we give about half at the bite site and the rest upstream but away from the vaccine so that it does not bind up the vaccine.

I like that thorough, informative explanation!

[FreedomFries]

NPE carry is worthy of its own thread. For a ten year period, that was what I did on a daily basis.

If you have a friend calling ur bag your "chaperone" then you have created an out of place thing that people will focus on and try to figure out why it is out of place. In particular, the women in the workplace will notice things that the men will not, and they will gossip about it as they try to figure out why it is that way.

It is way too easy for your bag to be separated from you in a variety of ways. Depending on the workplace, your bag may also be more likely to be searched than your person.

Pocket carry depends in part on the pocket itself to retain the gun. Regarding holsters, take a look at the Aholster. It has a perfect level of retention for what it is. It uses either a hook near the rear sight or a hook below and behind the trigger guard to catch the lip of your pocket as you draw, separating the holster from the gun. Both devices are present, and either one catching the pocket will work.

At the time my bag was nicknamed probably a decade or more ago, I actually did not use it for concealed carry. It was years later I realized that since I was known to carry a messenger bag most of the time, that I could use it on occasion to also discretely carry when it would be socially unacceptable to carry. Back then, I was a young, hip dude wearing tight selvedge jeans riding a bicycle around town with a messenger bag, so it didn't look out of place. I used it mostly for hanging out socially where being discovered carrying would lead to being ostracized, but no real serious consequences beyond that. For people where the consequences of being discovered are potentially more serious than that, then maybe a bag is a terrible idea. I also agree with your concerns about being separated from the bag. If someone routinely carries off body, it is probably very easy to get complacent about securing their bag properly. I hear about this quite often with purse carry and children inadvertently gaining control of a weapon. This is usually tragic when it happens and has to be avoided. However, the topic was basically about a short term single occasion where you might have to change clothes or partially undress. In those circumstances, temporary bag carry is a reasonable choice provided it is legal and you are certain that you will be able to maintain control over the bag.

Unfortunately, when I think about pocket carry, I think about an incident where a patient did not maintain positive control of his pistol, which has left me with a lasting negative opinion about that carry method. Thanks for sharing the thread about pocket carry. I will review it and learn more about the topic.

[Maple Syrup Actual]

The idea behind a rabies vaccine is to give a person killed/inactivated virus so that their body produces antibodies to the live virus that will protect against infection. Anyone who is at high risk for rabies exposure (animal Control workers, rabies virologists, etc.) should get this series of vaccine shots. However, it takes a couple weeks for your immune system to produce sufficient antibodies to protect against rabies infection. As you can imagine that 2 week window is no bueno if you just got bit by a rabid animal and the incubation can be as short as 1 week. Thus, we give people an additional medication called rabies immunoglobulin (RIG) which are preformed antibodies that will bind-up as much virus as possible while we wait for your immune system to respond to the vaccine with your own antibodies. That one time dose of RIG is given in/around the bite to bind-up as much virus as possible which is concentrated at the bite for the first week. For big people who get a lot of RIG, we give about half at the bite site and the rest upstream but away from the vaccine so that it does not bind up the vaccine.

Thanks very much for that! I had no idea there was even a hope of post-exposure inoculation. Over in my "on the island" thread I'll get into the story of my interest in this.

[Aisin Gioro]

Thanks very much for that! I had no idea there was even a hope of post-exposure inoculation. Over in my "on the island" thread I'll get into the story of my interest in this.

The "good" thing about rabies vaccination/RIG is that it also gives you very long-lasting degree of partial immunity, so if you have future exposures, you can generally just get a booster of the vaccine and won't have to go through the whole RIG protocol again. As the WHO says, "The immune response to subsequent rabies vaccine boosters such as Post-Exposure Prophylaxis [PEP] when exposed, can be recalled very effectively even decades after Pre-Exposure Prophylaxis [PrEP]." In more developed settings, they like to titre and get a working estimate of immune response when deciding on whether to booster, but realistically, in a lot of the places where rabies is a concern, this is just not practical or maybe even available, so they go ahead with the booster. The other good news is that the current (post-1970s era) RIG/vaccination protocol has is pretty faultless when given in a First World setting. For reasons related to poor infrastructure and questionable practices, there have been a few instances in undeveloped or developing places where things like a lack of proper refrigeration have compromised the RIG and/or vaccine, but that's really not an issue most need to worry about. A friend of mine in China just had to go through the process last year, and she subsequently received a notice from the hospital that there "may be reduced long-term effectiveness" in the PEP she got, but of course they didn't say why, or even that it was related to any problems. Hmmm, could it have something to do with this?

"Chinese maker of faulty rabies vaccines fined billions of yuan"

https://www.nature.com/articles/d41586-018-07136-z

"The company was caught selling ineffective medicines in July [2018]. The regulator determined that when the company created several batches of faulty rabies vaccine, it broke multiple laws, including: using expired products to make the vaccine; not testing the potency of vaccines according to prescribed methods; and destroying evidence to cover up its actions."

I've had the RIG/initial vaccine series plus one booster session (not in China, thankfully), and while the RIG is not especially fun, it's really nothing more than a set of two large (20 to 40IU/kg of body weight, depending on the type), slow injections, one being as much as possible at the wound site and the rest someplace intramuscular ("gluteal region preferred", as they say). The vaccine portion is nothing, 1mL or 0.5mL each depending on the vaccine, and feels about like getting a flu shot each time. That said, where you need the wound-infiltrating portion of the RIG can make a difference on how uncomfortable it is. I knew someone who needed to get it in the tissue of the ear...ouch!

[pangloss]

The friend of a former labmate was walking by a trash bin on campus one day and pitched a piece of trash into the bin. Unfortunately a squirrel digging around in the bin interpreted this piece of trash as a threat of grave bodily injury, sprang out of the bin, and in a brave act of self defence, bit the guy on the face before retreating up into the trees. The poor guy had to get the Ig injections in his face.

I teach about half a lecture on rabies, and every year I think about getting the vaccine just because.

[ChaseN]

I just want to know where you all live that the hospitals have metal detectors??? :eek:

[BillSWPA]

I just want to know where you all live that the hospitals have metal detectors??? :eek:

Around here, the emergency rooms in the urban hospitals have them. Other parts of the hospital do not. Suburban hospitals do not have them at all.

The last time I had to enter an emergency room that had them, at least one of the security people was wearing his gun in a Serpa holster.




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[Aisin Gioro]

The friend of a former labmate was walking by a trash bin on campus one day and pitched a piece of trash into the bin. Unfortunately a squirrel digging around in the bin interpreted this piece of trash as a threat of grave bodily injury, sprang out of the bin, and in a brave act of self defence, bit the guy on the face before retreating up into the trees. The poor guy had to get the Ig injections in his face.

I teach about half a lecture on rabies, and every year I think about getting the vaccine just because.

I cringe for the friend, but you have to respect that little squirrel. :D

[JAD]

Unfortunately a squirrel digging around in the bin interpreted this piece of trash as a threat of grave bodily injury, sprang out of the bin, and in a brave act of self defence, bit the guy on the face.

https://youtu.be/T_AHCm0urak