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chbare

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About chbare

Previous Fields

  • Occupation Anti-provencial thinkingtologist

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  • Gender Male
  • Location United States

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chbare's Activity

  1. chbare added a post in a topic Thoughts on this? Uber style Narcan delivery!   

    First, we need to be able to divorce human hubris and bias from the discussion. For example, I saw earlier comments go on about heroin. What does the data tell us about the types of opioid overdoses that are killing folks? In many cases, the substances involved were not illegally pulled from poppy fields in Afghsnistan, but rather were from prescription opioids. Once we start attaching emotions and using bias to conflate the picture, it is easy to make incorrect conclusions that can further reinforce prior assertions that may not accurately reflect the actual situation.

    With that said, I would ask to look at the evidence. What is the impact when naloxone programmes are used? Do they lead to increased abuse and more problems as some may assert? In general, how does education and risk reduction compare to the use of coercion (making drugs illegal and throwing people in prison) when combating the issue of opioid associated death via overdose? There is a base of literature out there that could allow us to make reasonable conclusions.

    Regarding this particular article and novel approaches it suggests, I'd ask if it was worth considering the author's thesis based on the current literature. I'm not entirely sure, but would it be worthwhile for somebody to develop a protocol, approach an IRB and gather some data?
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  2. chbare added a post in a topic College Degree: Operations mangement/physics?   

    There are folks with undergraduate physics degrees doing amazing things and even doing research or involving themselves with research. A higher degree will likely be needed for academia and writing research proposals/protocols and obtaining good grants, but I would not discount other folks.
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  3. chbare added a post in a topic LGBT in EMS/Fire   

    I have to disagree with "don't ask don't tell." The subjects of kids, home life, life partners, relationships and so on come up naturally as most humans are socially inclined animals. This is particularly true in an intimate setting such as EMS where you may spend 12 or more hours in close contact with another person or a small group of people. I simply cannot see how such subjects would not come up as a natural consequence of normal social activities.

    Unfortunately, in the United States, a whole bunch of people care. Going into elections, this is becoming an issue that potential candidates are already talking about on national and international multimedia. Additionally, the Supreme Court will be making a decision that will (hopefully) address the issue of equal treatment. Regardless of the decision, this country is markedly polarised on certain issues and to think that the issue will not be in the minds of EMS providers is probably rather myopic and naïve.

    Remember, as little as two decades ago, these issues were largely buried and not at all on the forefront of the cultural consciousness of the United States. Things have changed in a big way and the zeitgeist of our nation and perhaps the world may very well be changing and doing so on the scale of human lifetimes.
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  4. chbare added a post in a topic I really appreciate the help   

    That would be great! Thank you so much.
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  5. chbare added a topic in Training - Everything Else   

    I really appreciate the help
    Good day my friends and colleagues. I need to ask for a big favour. Part of my masters project will involve a survey and I have managed to make it relevant to the paramedic profession. If you are a paramedic that has been educated in the United States and is currently working in the field, I would like to invite you to complete the survey. The survey and data collection protocol has been approved by my college's institutional review board (IRB) and involves consent. I have also contacted EMT City admin and have their approval to post the link to the survey. No personal information is shared and all responses are stored on a HIPAA compliant server with robust encryption. Thank you so much in advance. The link to the survey is as follows: https://ufl.qualtrics.com/SE/?SID=SV_9LyAlBh1akJlmy9


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  6. chbare added a post in a topic Endotracheal Intubation vs. King LT   

    No, a Japanese study showed less favorable results in arrest patients who had advanced airways placed. Unfortunately, I believe some of the issues revolved around the fact that they used a variety of devices including EOA's?

    There was a very small animal study (n=9) that indicates SGA's may decrease CBF in the arresting animals.
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  7. chbare added a post in a topic Combat medics transition to paramedics   

    Hi Ghost. I am saying this as a former 91B who reclassified to the newer MOS designation. I joined the military back in the 1990's and was in until the mid 2000's. I started as an E1 and worked my way into the NCO ranks/grade. While I never deployed OCONUS I did do a contract in Afghanistan a few years after I got out.

    Here's the issue; being a civilian paramedic isn't about providing trauma care in a non-permissive environment. Medical cases abound and the patient populations are incredibly diverse. Additionally, the trauma patterns tend to be more blunt in nature. You are dealing with complex chronic pathology, significant medical issues and a civilian operational environment. This is markedly different than what many 68W series guys get. Certain ASI's such as the M6 have significant civilian crossover however and the newer flight medic programme looks to provide NR-Paramedic credentials. So, as a soldier you potentially have other schools and options that you can choose from with better civilian crossover. However, as a soldier, you are there to serve Uncle Sugar and he's under no obligation to hand you a civilian credential that you may not fully understand but believe you deserve.

    I believe military medics have much to offer, but they will likely need to attend the proper training and education programmes to successfully make the civilian paramedic transition. Luckily, the military is usually pretty good at offering assistance to combat vets as they transition into the civilian workforce.

    Unfortunately, I fear you simply do not know what you do not know. Please attempt to look at the bigger picture and appreciate the fact that you may not have a fully developed appreciation of the role of the civilian paramedic.
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  8. chbare added a post in a topic Pain Management   

    Oh, pain meds were given, but the patient was pretty messed up and giving more than 100 mcg of fentanyl will apparently result in a patient's head spinning around a couple of times, falling off, rolling down the hallway and spontaneously combusting in the Pyxis room.
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  9. chbare added a post in a topic Pain Management   

    Man, just had a rough one in the ER. Older patient fell down and sustained multiple fractures. Screaming in pain, couldn't get orders. It sucks seeing people needlessly suffer. Rather happy my hospital shifts are limited by educational duties these days. It can be a pretty nihilistic environment as far as providers are concerned. Some days are a constant fight against people who just don't care or are really good at making up reasons not to care. Even worse not having any power to facilitate comfort. Don't take the autonomy you have to make more independant decisions out in the field lightly folks.
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  10. chbare added a post in a topic Pain Management   

    [Citation needed].
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  11. chbare added a post in a topic Pain Management   

    Pain is a pretty subjective experience and addicts also experience pain. I ended up in the hospital last year with a prostate infection, in terrible pain. Because I appeared calm and collected I was not given pain medications. I was able to convince a PA to write me a script for a few tablets of pyridium however. Don't assume you know how to weed out fakers, you may very well be incorrect.

    Fentanyl is certainly not a "lower level" medication than morphine. Neither is Toradol. Also remember fentanyl is an opioid analgesic like morphine.

    Twenty minutes of severe pain is twenty minutes of suffering. The evidence is rather weak in supporting the life saving potential of EMS, but being able to respond to pain and suffering is actually something that we have a bit of control over. If anything, managing pain is a primary indication for ALS care.
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  12. chbare added a post in a topic ARming EMT and Paramedics   

    Opinions on an open forum where it's difficult to verify identity are probably not going to be very helpful if you are doing a research paper. You will need to do a literature review and probably look at working outside of the box to make connections. For example, many officers have been killed by their own guns. Could this issue have implications for EMS providers?
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  13. chbare added a post in a topic Tips for studying large amounts of complex information   

    I'm doing medicinal chemistry this semester, but it's been manageable. My courses are taught by pharmacists and the degree is a pharmaceutical science degree but not a Pharm.D. programme.
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  14. chbare added a post in a topic Tips for studying large amounts of complex information   

    Thanks all. Still struggling a bit. The pharmacokinetics really hurt me last semester. I ended up getting help. There are many things that certain classes assume and I had to really dig deep and dive into the quantitative aspects. There are many models that we use and selecting or finding out how to select the right model can be tough. Been doing allot of graphing, slope equations and converting data into log linear graphs to find out how many compartments to model. Unfortunately, calculus, particularly integrating to find AUC's was not a big part of my undergrad. Big learning curve. This semester has been better.
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  15. chbare added a post in a topic Creighton CCEMT-P Online Course   

    It's cool. It looks like a misunderstanding that was cleared up. Everybody appears to be on the same page now. It's cool, really.
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