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  1. Mazrin, Exceptional first post! Welcome to the City! I noticed that you're not naive about the whole 'glory and teary eyed thank yous' that is so commonly associated with entry level EMS people. Since you appear to have your feet on the ground, let's get right down to 'brass tacks': EMS can be a rewarding career. It's got its 'up sides' and its 'down sides'. A lot of people aren't burned out on the helping people aspect as much as they are on the bullshit that's associated. Depending on the service you're with, you've got: 1. Small vollie politics and ass kissing to get ahead 2. Clicques that you'll find any place you work 3. The "You're nothing more than a warm body in a uniform" mentality of some of the larger services 4. The "You're just a mere Basic, while I am a PARAGOD!" mentality of some of the levels of EMS 5. The 0300 "I've got to go to the ER for this stubbed toe!" call Then there's fighting the 'trauma junkie' mentality that is very pervasive in this field. The disappointment of not being able to 'save the world' because you've got your EMT-B, and have been turned loose with peoples lives in your hands. Depending on the call volume of the service you're on, you may or may not get breaks, you may or may not get 'sit down meals', and you may or may not be returned to quarters between calls. In GA, (and other areas of this great country) the average wage for an EMT-B is about $10.00/hr. By the time you factor in taxes and other expenses; no, you're not bringing home a lot of 'bacon' at the end of the week. Because of this, you start 'jumping open shifts' as they come available. This can lead to relationship problems because you're never around, and you're sleeping if you are. Another 'relationship hazard' is not being able to talk to your 'significant other' about the calls, because a) they won't understand a thing you're talking about or you're trying to shield them from the 'yucky stuff' we deal with in the field. EMS is demanding work, and it takes a special breed of person to be able to deal with all that we come across in the field. Many will tell you that once it 'gets in your blood', it's hard to get rid of the urge to 'jump in and take control of a bad situation'. A lot of EMT-B's get 'burned out' because they're relegated to the IFT trucks, where you're not always viewed as a health care provider, but more of a 'horizontal taxi cab'. Because of this, most people tend to lose sight of the fact that for any private service, the IFT is the 'bread and butter' of the company. They also tend to lose sight of the fact that on an IFT truck, you're getting a myriad of exposures to establish and hone your 'bedside manners' and really get your 'hands on' experience. Then there are those that go into EMS 'blind' until they are called to their first MCI and realize that this is NOTHING like they thought it would be and can't handle the patients screaming in pain. (Why does it always seem that the patients with the minor injuries scream the loudest and longest?) EMS is never a 'steady pace', it's either 'feast or famine'. The calls may be hours apart, or they may be back to back....it makes it difficult (especially with a volly or on call service) to make plans for anything. Sick and injured people don't take holidays off, and usually the 'low man on the totem pole' gets to pull all the holidays... Bottom line: EMS is a field that takes some 'tough as nails' individuals that can learn very quickly how to separate the 'business' from the private life. Many people can't do that, and they end up taking the job home with them. You have to be able to balance being compassionate to your patients, and being able to 'shut it off' at the end of the day. This ISN'T a good career choice for those that want to just do 'eight and skate', who can't leave work at work, and who are just too 'soft hearted'. It is also not a good 'fit' for those that complete EMT-B and think that they're at the top of their game. There is no 'top of your game' in EMS, because our patients rarely, if ever, read the textbooks and act accordingly.....
    12 points
  2. Dust forwarded this video. IT IS SHEER GENIUS. What a great way to vent frustration and identify an issue. I have told everybody to boycott the trauma show and A.J at JEMS is doing the same. I have emailed the link to everybody I know and they love it. I could not resist the chance to send the link to Randolph Mantooth. He'll laugh his ass off. I'll let you know what he says (he loves this kind of stuff). Again, sheer genius lurks somewhere in the confines of this list. Thanks for letting me in on it. Bryan Bledsoe, DO, FACEP P.S. There is an "E" at the end of "Bledsoe" (e.g., Drew Bledsoe). But, it's all good.
    12 points
  3. I sent the memo to two of the EMS agencies (fire based, as are most around here) where I work. We are attempting to effect a cultural shift for the benefit of our patients. I guess we will see if it takes hold. There is no question that spinal immobilization is painful and anxiety provoking for nearly everyone. Patients often have back pain induced solely by lying on the backboard, pain which resolves not long after removal of the board, but which may prompt imaging in the ED due to pain and tenderness caused not by the presenting injury but by the backboard. We have seen harm in other ways: the demented elderly patient with a ground level fall who becomes more agitated from the pain and restriction of the board, the patient from the MVC with anxiety disorder who panics in the straps, the monstrously obese patient who has the equivalent of another person sitting on their chest and has to fight gravity to breathe. I've summarized below some notes from a presentation I have given on myths in EMS. The bottom line up front is that spinal immobilization on a long backboard has no evidence to support its use, but substantial evidence of harm. It is predicated entirely upon theories of injury that have never been shown. It has been taught dogmatically to EMS providers, nurses, and physicians for 3 decades, though there is now a swell of thought that we should modify the practice. Using a long backboard makes sense when pulling an injured person out of the water, or moving them out of a smashed vehicle, but once on the ambulance stretcher, movement is minimal, even with jarring movements of the ambulance. Being on a hard, slippy surface of a backboard will worsen that movement rather than improve it. The National Association of EMS Physicians is working with the American College of Surgeons on a position paper regarding backboarding. The gist of it is that we should eliminate backboards for anything but extrication. There's a few things I've discovered in the literature: Backboards do a horrible job of immobilizing the spine, and movement is worse on the backboard than on a soft surface that conforms to the patient. Patients who can follow commands can typically maintain stabilization of their own spine without assistance. Backboarding increases mortality in certain trauma patients. Backboarding does nothing to prevent neurological sequelae from spinal injury. Backboarding restricts respiration, which some patients cannot tolerate. Backboarding rapidly leads to skin breakdown and pressure ulcers, even after a short period of time, and is particularly hard on the elderly. I think there are some steps we can take to eliminate some pain and suffering and reduce some unnecessary imaging. Stop transporting patients to the hospital on backboards. Utilize the long spine board only for extrication purposes. Once the patient is extricated, using log roll or lift-and-slide technique, lay the patient flat on the stretcher and leave the c-collar in place. Do not ever immobilize a patient with penetrating trauma such as a gunshot wound or stab wound. Immobilization DOUBLES the mortality rate of these patients. Even with neurologic deficits caused by transection of the spinal cord, the damage is done; additional movement will not worsen an already catastrophic injury. Emphasis should be on airway and breathing management and rapid transport to a trauma center. If patient is being intubated, and manual cervical stabilization is hampering this effort, the neck should be moved to allow securing the airway. An unsecured airway is a far greater danger to the patient than a spinal fracture. Eliminate the "standing take-down" for backboarding patients who are ambulatory after an injury. Place a collar and allow the patient to sit on the cot, then lie flat. Patients who are ambulatory and able to follow commands do a better job of preventing movement of an injured spine than rescuers do. Selectively immobilize (with a cervical collar) only those patients at high risk for spinal injury or with clinical indications of spinal injury. Remove cervical collars on conscious patients that tolerate them poorly due to dementia, anxiety, or shortness of breath. Leaving the collar on and fighting them will encourage more spinal movement rather than less. Clear patients from any spinal immobilization clinically utilizing the spinal clearance protocol. This protocol indicates those patients who may require immobilization: High risk injury (high speed MVC, axial loading injury), focal neurological deficits such as paralysis, intoxication, age <65, and presence of midline bony tenderness of the spine. Patients without these findings may be transported without spinal immobilization. Patients who are markedly agitated and confused from head injury may not be able to follow commands with regard to minimizing spinal movement, and combativeness may also be a factor. These patients should remain on a backboard if the crew deems it safer for the patient, and this will be at the discretion of the crew. The above measures will reduce pain and suffering, reduce complications, decrease on scene times, reduce injuries to crews who are attempting to carry immobilized patients, and reduce unnecessary imaging costs and radiation exposure. There is no doubt that our crews will get some push back from the staff at the hospitals. Nurses or physicians may rebuke them for having the patient off the backboard. FD crews should be reassured that hospital staff does not determine their treatment protocols or operational policy, and that any questions can be directed to command staff or to me or to the hospital EMS coordinators. 'zilla, MD Hauswald M,McNally T. Confusing extrication with immobilization: the inappropriate use of hard spine boards for interhospital transfers. Air Med J. 2000 Oct-Dec;19(4):126-7. This was a survey of inter facility transport services. 18/30 interfac transport services immobilized for transfer, even if cleared by sending ER MD Additional 4/30 immobilized unless cleared radiographically No services moved pts to softer surface if known to have injury McHugh TP,Taylor JP. Unnecessary out-of-hospital use of full spinal immobilization. Acad Emerg Med. 1998 Mar;5(3):278-80. 51% reported no neck or back pain at scene of accident before full spinal immobilization 13% not even asked about neck or back pain before full spinal immobilization Haut ER,Kalish BT,Efron DT,Haider AH,Stevens KA,Kieninger AN,Cornwell EE 3rd,Chang DC. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010 Jan;68(1):115-20; discussion 120-1. Twice the mortality rate in penetrating trauma if immobilized (14.7 vs. 7.2%) 0.01% had incomplete neurological injury and underwent fixation Number Needed to Treat: 1032 Number Needed to Harm: 66 Davis, et al: retrospective study of 32,117 trauma patients 2.3% with c-spine injury 10 patients with delayed diagnosis of spinal injury AND permanent neurological sequelae Bottom line: "hidden" spinal injuries which lead to paralysis are extremely rare Gerrelts, et al: Review of 1331 trauma patients 5 patients with delayed diagnosis of cervical injury None with permanent deficit Bottom line: "hidden" spinal injuries which lead to paralysis are extremely rare Platzer et al: 347 with c-spine injuries Of the 18 with delayed diagnosis, 2 had permanent deficit Bottom line: "hidden" spinal injuries which lead to paralysis are extremely rare Hauswald: 5 year retrospective review New Mexico vs. Malaya Malayan medics do not use spinal immobilization The difference: Malayan patients had less frequent deterioration and less overall neuro disability Limitations: Small numbers, different mechanisms (more MVCs in the USA, more falls in Malaya) Neuro decompensation occurs in 5% anyway, despite ideal attention to spinal immobilization. Spinal immobilization raises intracranial pressure 4.5 mmHg Manual In Line Stabilization (MILS) led to failed intubation in 50% after 30 seconds of intubation attempt vs. 5.7% without MILS Gruen, et al: Trauma mortality in 44, 401 patients. 2594 deaths, errors in 64. Failure to secure an airway in 16% of those If spinal immobilization led to a failed airway, then it killed the patient. Santoni: MILS doubles force necessary for intubation Santoni BG, Hindman BJ, Puttlitz CM, Weeks JB, Johnson N, Maktabi MA, Todd MM. Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation. Anesthesiology. 2009 Jan;110(1):24-31. Totten, et al: LBB or vacuum mattress restricted respiration by 15% Bauer, et al: LBB limits respiratory function Respiratory failure is COD in 6% of trauma patients Hauswald: Substantial force required to injure spinal cord Post-injury movement probably not sufficient to injure the cord, even if already partially injured Chan D,Goldberg RM,Mason J,Chan L. Backboard versus mattress splint immobilization: a comparison of symptoms generated. J Emerg Med. 1996 May-Jun;14(3):293-8. Perry SD,McLellan B,McIlroy WE,Maki BE,Schwartz M,Fernie GR. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phila Pa 1976). 1999 Sep 1;24(17):1839-44. 3 times more likely to develop pain with LBB than vacuum mattress Trunk movement still significant; no method with a LBB eliminates motion Konstantinidis A,Plurad D,Barmparas G,Inaba K,Lam L,Bukur M,Branco BC,Demetriades D. The presence of nonthoracic distracting injuries does not affect the initial clinical examination of the cervical spine in evaluable blunt trauma patients: a prospective observational study. J Trauma. 2011 Sep;71(3):528-32. 101 blunt trauma patients with c-spine injuries 87% had “distracting” injuries: rib fractures, lower and upper extremity fractures 4% had no tenderness on c-spine All 4% had bruising and tenderness of anterior chest Bottom line: "distracting injuries" are largely a myth. Horodyski M,Conrad BP,Del Rossi G,DiPaola CP,Rechtine GR 2nd. Removing a patient from the spine board: is the lift and slide safer than the log roll? J Trauma. 2011 May;70(5):1282-5; discussion 1285. Del Rossi G,Horodyski M,Heffernan TP,Powers ME,Siders R,Brunt D,Rechtine GR. Spine-board transfer techniques and the unstable cervical spine. Spine (Phila Pa 1976). 2004 Apr 1;29(7):E134-8. Del Rossi G,Rechtine GR,Conrad BP,Horodyski M. Are scoop stretchers suitable for use on spine-injured patients? Am J Emerg Med. 2010 Sep;28(7):751-6. Epub 2010 Feb 25. Log roll creates unacceptable motion Lift and slide technique creates less motion Scoop stretcher may be better as well J Trauma. 2009 Jul;67(1):61-6. Motion of a cadaver model of cervical injury during endotracheal intubation with a Bullard laryngoscope or a Macintosh blade with and without in-line stabilization. Turner CR, Block J, Shanks A, Morris M, Lodhia KR, Gujar SK. Source Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA. turchris@med.umich.edu Abstract BACKGROUND: Endotracheal intubation in patients with potential cervical injury is a common dilemma in trauma. Although direct laryngoscopy (DL) with manual in-line stabilization (MILS) is a standard technique there is little data on the effect of MILS on cervical motion. Likewise there is little data available regarding alternative airway techniques in this setting. This study compared intubations with and without MILS in a cadaver model ofcervical instability. We also used this model to compare intubations using DL with a Macintosh blade versus a Bullard laryngoscope (BL). METHODS: Complete C4-C5 disarticulations were surgically created in 10 fresh human cadavers. The cadavers were then intubated in a random order with either BL or DL with and without MILS. The motion at the unstable interspace was measured for subluxation, angulation, and distraction. RESULTS: MILS did not significantly affect maximal motion of this model in any of the three measures using either DL or BL. There were no clinically significant differences in maximal median motion in any of the three measures when comparing the two blades. However, there was significantly more variance in the subluxation caused by DL than by BL. CONCLUSIONS: We were unable to demonstrate any significant effect of MILS on the motion of an unstable cervical spine in this cadaver model. The BL appears to be a viable alternative to DL in the setting of an unstable lower cervical spine. Ann Emerg Med. 2007 Sep;50(3):236-45. Epub 2007 Mar 6. Manual in-line stabilization for acute airway management of suspected cervical spine injury: historical review and current questions. Manoach S, Paladino L. Source Department of Emergency Medicine, State University of New York-Downstate and Kings County Hospital Center, Brooklyn, NY 11203, USA. seth.manoach@downstate.edu Abstract Direct laryngoscopy with manual in-line stabilization is standard of care for acute trauma patients with suspected cervical spine injury. Ethical and methodologic constraints preclude controlled trials of manual in-line stabilization, and recent work questions its effectiveness. We searched MEDLINE, Index Medicus, Web of Knowledge, the Cochrane Database, and article reference lists. According to this search, we present an ancestral review tracing the origins of manual in-line stabilization and an analysis of subsequent studies evaluating the risks and benefits of the procedure. Allmanual in-line stabilization data came from trials of uninjured patients, cadaveric models, and case series. The procedure was adopted because of reasonable inference from the benefits of stabilization during general care of spine-injured patients, weak empirical data, and expert opinion. More recent data indicate that direct laryngoscopy and intubation are unlikely to cause clinically significant movement and that manual in-line stabilizationmay not immobilize injured segments. In addition, manual in-line stabilization degrades laryngoscopic view, which may cause hypoxia and worsen outcomes in traumatic brain injury. Patients intubated in the emergency department with suspected cervical spine injury often have traumatic brain injury, but the incidence of unstable cervical lesions in this group is low. The limited available evidence suggests that allowing some flexion or extension of the head is unlikely to cause secondary injury and may facilitate prompt intubation in difficult cases. Despite the presumed safety and efficacy of direct laryngoscopy with manual in-line stabilization, alternative techniques that do not require direct visualization warrant investigation. Promising techniques include intubation through supraglottic airways, along with video laryngoscopes, optical stylets, and other imaging devices.
    11 points
  4. Does anyone else find it ironic that we are telling the OP not to believe everything he reads on the internet, on an anonymous Internet forum?
    9 points
  5. It seems like we've been seeing a lot of new faces lately, and from them gaining a lot of strong, smart new members. In the spirit of the City I thought maybe we could throw out some ideas on how to be successful here? Here are a few of mine.. 1) Welcome. We're glad to have you no matter what your certification level, experience, education or what type of service you happen to work at. The fact that we're glad to have you doesn't mean we don't argue these points, it simply means that we value thoughts, and the people brave and kind enough to share them, from every point on the compass and political spectrum. 2) You can gain very little here if you don't participate. Learn here, where it's safe, to air your ideas and encourage constructive criticism. If you can't push yourself out front here then you need to question if you'll have what it takes to push yourself to the front when people are suffering. Also, doing so causes most of us some pressure, allowing you to learn to think with that pressure and accept the consequences of those decisions. 3) No one here, regardless of how it may sometimes seem, wants to see you fail, here or in your career. Too often it seems that criticism is considered derision when in fact the exact opposite is true. We thrash each other's ideas to make each other stronger, not to try and prove our superiority. There is nothing that makes the smartest people here happier than to see those that have been mentored here succeed and even surpass the high standards most often expected here. I'm always very aware when someone has commented on one of my thoughts that this is a smart, successful person that had better things to do, yet made time to help me try and get smarter. I try and remember to be grateful for that. Nothing makes me happier than to lose an argument, because it means that I've fought with every tool in my toolbox to defend something that seemed perfectly logical and evident to me, yet...I was wrong. And now, thanks to someone smarter, that fought harder, I don't have to continue to be wrong tomorrow. 4) Do not Google your answers and then pretend that they are yours so that you don't feel stupid. Being wrong isn't stupid. Being afraid of being wrong, and so allowing yourself to remain wrong is stupid. Give answers from your head, use your own brain, create your own logic trees, that is how you grow and become stronger. Think I'm kidding? Follow my posting history and you'll see some of the most idiotic thoughts you can imagine, but many didn't remain idiotic because I was allowed to work them out with help from my friends here. And when I say friends? I'm talking about some really smart folks that left my ego bruised and bleeding at the end of some gnarly discussions. 5) Please understand that when we critique your spelling and grammar that it is not to belittle you but to help you grow as a professional and separate yourself from the significant number of your peers that everyone else is laughing at every day. Hanging out is fine, but use that time to improve yourself. We all make mistakes. We're looking not for perfection, but for the effort that says you're trying. Spelling and grammar are a practiced skill. We all make mistakes, that's why we push each other to constantly keep practicing. 6) Chat is chat and the forums are the forums though often the two overlap. Please don't bring your playful chat dialog and insert it into forum conversations. Not because 'chat is stupid' because of course it's not. It's just easy sometimes to take the fun, carefree familiar attitude of chat and allow it to distract from conversation in the forums. Besides, most of the people reading the threads won't get your references anyway. One's not better than the other necessarily, they just don't often mix well. 7) Have fun, be brave, make friends, find mentors, ask for help, help others…but most importantly, use this as a resource. This isn't a place that you come to prove how smart you are, but to prove that you want to be smarter. Almost everyone here respects that. Some of the most intelligent people I've ever met I've met here and my life will never be the same because I was gifted with their patience and advice. Use them, but as you do, remember to be grateful and give back. And in case I was somehow not clear...If you see my posts, and you find a bad idea, wrong thinking, bad attitude, poor logic, spelling, grammar, and choose to ignore it to 'be nice?' I will never thank you for that. I will never be grateful that you allowed me to be weaker today than I needed to be..Just sayin'... I'm hoping that many here will add to my silly little list…what do you think guys and gals? Dwayne Edited about a gazillion times because, for some reason, the text I see in my edit window isn't translating well when posted. I don't think I'll cut and paste from Word next time. No contextual changes made. Formating only.
    9 points
  6. It had to happen sooner or later....................... Blonde Men! A friend told the blond man: "Christmas is on a Friday this year." The blond man then said, "Let's hope it's not the 13th." ------------------------------------ Two blond men find three grenades, and they decide to take them to a police station. One asked: "What if one explodes before we get there?" The other says: "We'll lie and say we only found two." ------------------------------------ A woman phoned her blonde neighbor man and said: "Close your curtains the next time you & your wife are having sex. The whole street was watching and laughing at you yesterday." To which the blonde man replied: "Well the joke's on all of you because I wasn't even at home yesterday." ------------------------------------ A blonde man is in the bathroom and his wife shouts: "Did you find the shampoo?" He answers, "Yes, but I'm not sure what to do... it's for dry hair, and I've just wet mine." ------------------------------ A blonde man goes to the vet with his goldfish. "I think it's got epilepsy," he tells the vet. The vet takes a look and says, "It seems calm enough to me". The blonde man says, "Wait, I haven't taken it out of the bowl yet". ------------------------------------ A blond man spies a letter lying on his doormat. It says on the envelope "DO NOT BEND ". He spends the next 2 hours trying to figure out how to pick it up. ------------------------------------ A blond man shouts frantically into the phone "My wife is pregnant and her contractions are only two minutes apart!" "Is this her first child?" asks the Doctor. "No", he shouts, "this is her husband!" ------------------------------------ A blonde man was driving home, drunk as a skunk. Suddenly he has to swerve to avoid a tree, then another, then another. A cop car pulls him over, so he tells the cop about all the trees in the road. The cop says, "That's your air freshener swinging about!" ------------------------------------ A blonde man's dog goes missing and he is frantic. His wife says "Why don't you put an ad in the paper?" He does, but two weeks later the dog is still missing. "What did you put in the paper?" his wife asks. "Here boy!" he replies. ------------------------------------ A blond man is in jail. Guard looks in his cell and sees him hanging by his feet. "Just WHAT are you doing?" he asks. "Hanging myself," the blond replies. "It should be around your neck" says the guard. "I tried that," he replies, "but then I couldn't breathe". ------------------------------------ (This one actually makes sense...sort of...lol) An Italian tourist asks a blonde man: "Why do Scuba divers always fall backwards off their boats?" To which the blonde man replies: "If they fell forward, they'd still be in the boat."
    8 points
  7. Greetings, Comrades. Rumours of my demise have been greatly exaggerated. I can't believe some of you actually bet money I was dead. If you did, may all your children be born naked! Anyhow, I'm down, but not completely out yet. Don't pull your bets yet, because they will most likely pay off this year. I took a long hiatus to avoid creating [more] drama here and distracting from the forum. I didn't want to start a pity party, but as some of you know, I've had serious health issues since my injuries in Iraq. I certainly won't be returning to practice. Or walking. Or even wiping my own arse. My piss glows in the dark. And it takes all the strength, energy, and coordination I have just to type this. But shyte happens, so I'm cool. Nuff said. No worries. I've been devoting my attention to spending my time with family and friends, who keep my spirits up. I'm not a real fan of Walt Whitman (after all, he's from NY), but I often echo his thought that, "I no doubt deserved my enemies, but I don' t believe I deserved my friends." My thoughts exactly, Walt. And many, many of you here are my friends, so I owe it to you to keep in touch. If I have ever pissed you off or offended you, either intentionally or unintentionally, I apologise. I only hope that you recognise that it was most likely my passion for the future of this profession that drove my tendency to get carried away at times. Of course, sometimes I'm just an arsehole, but I apologise for that too. No excuses. There's not one of you here (over the age of 21) that I wouldn't happily buy a beer and get small with. Especially if you're hott. Anyhow, other than the occasional trip to the doctors at the VA, my life is pretty much spent in this bed, in front of this piece of shyte Macbook, so I hope to start spending more time here. I dropped in yesterday and read through some hot threads, and it got my juices flowing like the old days. I do miss you guys! Life is not total boredom here. Family from Japan came to visit me two days before the earthquake and stayed for a week. It was great to see them, but I sure hated to see them return home. The next week, half a dozen colleagues I served with in Iraq came to visit me. These weren't just guys I was stationed with; these are all guys who were actually patients of mine at one time or another. One had been so seriously blown up that I was certain that he died after I put him on the helicopter. Today, he's alive and well and looking great. The scar from my trach is more obvious than the rest of his many scars, lol. He's not complaining though. And getting to see him again was the greatest thing I've experienced in the last three years. I truly hope that all of you have the opportunity to experience that kind of satisfaction once in your career. Okay, getting really tired now, so I'll catch up with you soon. Kisses (no homo, not that there's anything wrong with that). And don't drink any water in Iraq, Rob
    8 points
  8. After a very long and trying week with everything meeting me at the door each and every morning and demanding my undivided attention at once, it was nice this morning to get a phone call that I have never ever gotten before in my life~~ Ring~ Me~ "Hello" Female Voice~ "Is this Tami *****?" Me~"Ummm, yes?" Voice~ "Well, you don't know me, but you know my husband." OMGosh....little voices in my head are running in circles yelling at each other "What did YOU do? Nothing, what did YOU do? Nothing I tell you! I've been sober for twenty years and haven't touched another ladies man....are you sure?? Yes,"......(okay, well you get the picture) Me~"Okaaay?" Then the "voice" starts out with a quiet little laugh that came across with slight embarrassment and then says, "I guess I just don't know where to start but here goes...You met my husband outside of the casino a few weeks ago. He was the one laying on the ground....." The memory comes flooding back easily, I had stopped at the casino on my way home from a meeting and as I was walking towards the hallway I suddenly felt a female security guard grabbing at the back of my jacket and pleading for me to follow her back outside where they had "a medical" down on the ground. Looking around and seeing no-one else following her I reluctantly followed her as she half ran back to the front of the casino where I was confronted with the sight of an older male lying face down in a pool of blood and several people standing around watching as another older male was feeling for a pulse. When I got close he locked eyes with me and said "I'm glad your here ma'am, he doesn't have a pulse." I went thru the usual questions quickly as I felt for a pulse and gathered the important information that despite the fifty people standing around, not one of them knew him and no one knew what had happened....the gentleman kneeling next to him tho tells me that he is an EMT "from 100 years ago" so I quickly inform him that we are now partners and CPR hasn't changed much so we proceeded to flip the gentleman over and begin CPR while the casino First Responders ran and got us an AED and BVM while we waited for the ambulance (did I mention I used to work for this ambulance? awkward) arrive we performed CPR. We managed to get a pulse back after one shock and I assisted ventilations with a plain old BVM while we waited for the boo boo bus to arrive. Seemed like it was a couple of hours but turns out it was only eleven minutes.... Just as we got a c-collar on the gentleman and had him loaded unto the spine board he lost his pulse again so we quickly loaded him into the back of the rig, restarted CPR, shocked and got a pulse back again. Long story short, I rode along with the gentleman to the ED in the back of my former employers ambulance (did I say awkward before?) where they stabilized him and flew him out to a higher level of care within the hour and I went home to wonder the final outcome. I have to admit that I googled his name a few times in the following weeks thinking that I would see an obituary and finally just kind of put it out of my mind.... Then the voice started to break up and said, "I don't really know how to tell someone like you Thank you for giving me 45 more years with the love of my life. The doctors told me that if you hadn't of been there and done what you did, he would not have made it. How do I tell someone thank you for that?" With a few tears in my own voice I replied....."You just did." Turns out he had a defib/pacemaker implanted and is back to his old self again....
    7 points
  9. Alot of threads have been headed in this direction lately, and I personally have been questioning my own career longevity lately. Since I don't blog, I decided to write out my strategies to prolong my mental health, and career, and identify the problems we face as time goes by on the forum. I feel really passionate about this topic, and hope for alot of productive responses. First to identify the challenges: Although the number of years I have been in EMS is hitting double digits, the first time I was truly affected by a call was only about a year and a half ago. I was driving to my farm after treating a post partum hemmorage on a young redhead girl, I recalled all my actions from starting large I.V.'s to performing bimanual massage (not technically in my scope, but try stop me!). Eventually the hemmorage was brought under control, and all ended well for her. As I drove down the highway, I felt like I entered another atmosphere. Suddenly the air got thicker.... I became short of breath, the temperature in the vehicle seemed to rapidly increase, and I got a huge feeling of impending doom, as if something out of my control was going to happen. I pulled over and grabbed some fresh air, and it passed quickly. I thought to myself "man, that was wierd.... I must be dehydrated". I went to work, seeding peas that evening. While driving our 4WD tractor pulling our seeding outfit I crested a hill and looked around my fields, with no neighbors for many miles I got a feeling of being too alone. Almost immediatly, my patient from earlier came screaming into the picture, I could see her freckled face clear as ever, the innocent look in her eyes as she gazed at her first born through tears and wincing in pain as I assaulted her uterus in an attempt to control the bleeding. Finally I had to shut down the outfit, and get out to regain my composure. That evening I went in for supper, and my father remarked that I seemed "distant". I told him I just had a tough call, and needed a day or two to get over it. I returned home a day later (I farm somewhere else), to my wife and kids. My wife proceded to tell me about some problem she was having... likely something about what her sister said on the phone, or how one of the kids smart-mouthed her. I quickly shut her down, telling her she should be so lucky as to have a family. She had no freaking idea what I was talking about, but could tell I was not in the mood for chit-chat. The reason I told that story was to point out 2 very important warning signs that something is going off in the ditch. Warning #1 - Panic attacks. Seem to come on unprovoked, can be anything from minor hyperventilation and anxious feeling, to an all out bawl-fest Warning #2 - Deprioritizing the needs of the ones whom count on us. The story goes on...... Another week or two goes by and I have a dream: It is an older lady that I recognize, it is the first patient to ever go from living, to dead while in my care. We are in a crowded mess-hall, and I get that same choking anxious feeling. I immediatly get up out of my chair (in my dream still) and everyone is staring at me. The lady starts to bleed profusely from under her dress as she sits at her table, she looks oer at me and cries in a helpless crackling voice: "Marc.... I'm dying, you have to help me". I awaken from my dream with severe chest pain, I can feel my heart pounding, I am sweating profusely and can't catch my breath. I have to get up out of bed, and grab a drink to calm myself. I tell my wife about the dream, laughing as if it was no big deal. The next few nights are short, as I have difficulty falling asleep with images of the elderly lady, or the young redhead, or that stupid dream, flash through my mind everytime I close my eyes. As soon as I awaken while i am still laying in my bed a slideshow plays in my mind of faces of people I have treated, I keep seeing pictures of intercostal retractions on a tiny chest, blue lips, concaved chests from CPR, blood running down a cot mattress.... ugh... I gotta get up, no sleep in day for me! I attend some more rather critical calls, being the sole Paramedic for hundreds of miles around has it's perks, and it's challenges. 2 successful neonate resucitations, 1 shakin baby case with increased ICP, a few transfers to the city (3-4hrs away) for different reasons, couple intubated transfers and of course some routine lodge type calls.... all in all exactly what I am educated to do. Please don't let me fool you either, there are many days I don't even do a call. But as I have said before 3-4hr transports makes for some pretty long days too. I'll be honest with ya, I have alot of Paramedics dream jobs. Work from home, Salary nearing an RN, being the only Paramedic in this area the Dr's respect me, and the surrounding (BLS) services look up to me. But this brings great responsibility. like the responsibility I feel as I back up a crew with a pregnant trauma victim, and they look me in the eye and say "thank god you're here" as if I am going to ensure she will surive.... she didn't. Or the responsibility I feel when I get that Difficulty breathing call wondering if this will be the tube I miss, with backup many many miles away. But this is not exclusive to me. Yes I may be in an extreme setting, however those in air medical have similar resources. Even a overworked city ambulance may not have backup available. These are the regular stresses of the job. The problem is, if you do not deal with them, one day... they sneak up, and tear you down when you least expect it, just as they have done to me. So as I sit here now, on another night shift, with my heroic Paramedic eppaulettes, and my tactical looking narc pouch on my side, I feel totally unprepared for battle. I have lost the will to prepare or seak out a good healthy meal, I am not sleeping as much as I should, and I am pretty quick to snap at my family since thier problems are not "real", not like the problems of my patients, so i have no time for them. This brings me to Warning #3,4&5 Warning #3 Failing to maintain a balanced diet & excersise Warning #4 Sleep disruption Warning #5 Flashbacks So just what do I intend to do? Well here is my plan of action to increase my longevity in EMS Find an arbitrary confidant. An EMS provider from outside this area I can bounce calls off, and discuss treatment without too much judgement. Someone without thier own agenda of always "1 upping" as we often do Make a conscious decision, starting today, that fast food is no longer a part of my life. It can and will be avoided. Fast food is a fast track to failure in this industry. Occasionally seek a professional: Periodically I will be making an appointment with a mental health professional. i go for physical checkups.... why not mental health checkups?? Make sure holidays are not EMS related. This means no popping in to staff meetings during holidays, no wearing wacker gear, no scanner, no accepting cell phone calls from co-workers, nothing! Just family, and friends. Find an outlet: I loooove being alone, but with a family of 5, it is harder and harder to do. I need to find an outlet where I can be in my "happy place" and organize my thoughts and do some filing. I think I`ll buy a vintage car to tinker on. I always think of my life as a car, I am driving, but right now all the shit that should be in the trunk is cluttering up the dashboard and making it hard to see what is ahead, and for some reason I have a HUGE rearview mirror I can't stop staring into. It's ruining my driving experience, and I know I am headed for a crash. Define the line between work and home. This has gotten to be a grey mushy mess, I spend way too much time writing work emails and work related calls from home. That is not nesessary, when I walk into my house, the uniform shirt gets hung on a hook, and THAT is my mental signal - switch - You are a husband, father, son, and brother now. Thoughts?
    7 points
  10. I am not trying to sound like a jerk, but I learned this lesson a long time ago: You decide what kind of day you will have every day. You can not let others control your life, which is what you do when your blood pressure goes up over what someone else said or did. The minute you show any emotion because of what someone else did, you have given them control of your day, it is like you are a puppet on a string. Example: If I said something mean about your momma right now, it could piss you off to the point of you punching me. But on the other hand, you could say "crotch does not know my momma, he has never even met me, so therefore he is trying to piss me off and control my day". Let it roll off of your back, its not worth being upset about. I worked for a large urban system that was on 24/48s and the shifts were brutal with the normal EMS abuse you would expect. I went to work cussing and I came home cussing. Then they switched to 12-hour shifts, and I figured out I could transport 6 patients, or not transport 10 patients. Once I quit argueing with the dumb patients and just started transporting, all the stress was gone, and my smile returned. When I saw that change I realized I had been letting others control me.
    7 points
  11. 1. I think part of a best friend’s job should be to immediately clear your browser history if you die. 2. Nothing sucks more than that moment during an argument when you realize you’re wrong. 3. I totally take back all those times I didn’t want to nap when I was younger. 4. There is great need for a sarcasm font. 5. How the hell are you supposed to fold a fitted sheet? 6. Was learning cursive really necessary? 7. Map Quest really needs to start their directions on # 5. I’m pretty sure I know how to get out of my neighborhood. 8. Obituaries would be a lot more interesting if they told you how the person died. 9. I can’t remember the last time I wasn’t at least kind of tired. 10. Bad decisions make good stories. 11. You never know when it will strike, but there comes a moment at work when you know that you just aren’t going to do anything productive for the rest of the day. 12. Can we all just agree to ignore whatever comes after Blue Ray? I don’t want to have to restart my collection…again. 13. I’m always slightly terrified when I exit out of Word and it asks me if I want to save any changes to my ten-page technical report that I swear I did not make any changes to. 14. “Do not machine wash or tumble dry” means I will never wash this – ever. 15. I hate when I just miss a call by the last ring (Hello? Hello? **** it!), but when I immediately call back, it rings nine times and goes to voice mail. What did you do after I didn’t answer? Drop the phone and run away? 16. I hate leaving my house confident and looking good and then not seeing anyone of importance the entire day. What a waste. 17. I keep some people’s phone numbers in my phone just so I know not to answer when they call. 18. I think the freezer deserves a light as well. 19. I disagree with Kay Jewelers. I would bet on any given Friday or Saturday night more kisses begin with Miller Lite than Kay. 20. I wish Google Maps had an “Avoid Ghetto” routing option. 21. Sometimes, I’ll watch a movie that I watched when I was younger and suddenly realize I had no idea what the heck was going on when I first saw it. 22. I would rather try to carry 10 over-loaded plastic bags in each hand than take 2 trips to bring my groceries in. 23. The only time I look forward to a red light is when I’m trying to finish a text. 24. I have a hard time deciphering the fine line between boredom and hunger. 25. How many times is it appropriate to say “What?” before you just nod and smile because you still didn’t hear or understand a word they said? 26. I love the sense of camaraderie when an entire line of cars team up to prevent a jerk from cutting in at the front. Stay strong, brothers and sisters! 27. Shirts get dirty. Underwear gets dirty. Pants? Pants never get dirty, and you can wear them forever. 28. Is it just me or do high school kids get dumber & dumber every year? 29. There’s no worse feeling than that millisecond you’re sure you are going to die after leaning your chair back a little too far. 30. As a driver I hate pedestrians, and as a pedestrian I hate drivers, but no matter what the mode of transportation, I always hate bicyclists. 31. Sometimes I’ll look down at my watch 3 consecutive times and still not know what time it is. 32. Even under ideal conditions people have trouble locating their car keys in a pocket, finding their cell phone, and Pinning the Tail on the Donkey – but I’d bet my ass everyone can find and push the snooze button from 3 feet away, in about 1.7 seconds, eyes closed, first time, every time!
    7 points
  12. Crotchity, in the original article, at the start of the second paragraph, it states “City Councilman Kenneth Stokes has threatened to reverse the contract American Medical Response has to serve in the area if the company doesn't send its workers into violent crime scenes, even before police arrive.” I think that makes the intent of Councilman Stokes’ comments very clear. As much as you want it to be, since you have brought it up in other threads, this Councilman is not basing his comments on race, and the replies from EMS are not either. It is a question of “is the scene violent? Yes or No.” End of story. Using race as an excuse, or a crutch in situations like this is just that, and excuse or a crutch. The true issue is that this idiot wants EMS to respond prior to police to violent scenes. Race is only an issue when we allow it to be, and instead of looking at the sins of the past, how about looking to the future, and trying to solve problems instead of creating problems where none exist. Let's keep this thread on topic - that this councilman has his head up his *** and needs to be educated about scene safety and the role of EMS.
    7 points
  13. Just to add my 0.02. I don't think it is necessary for a woman to have an exam in the field under most circumstances. Obviously if she is giving birth then it might not be a bad idea to take a look. Heavy bleeding will be another reason, but should usually be obvious from the outside. In all other cases, you don't have the proper tools to do the proper exam, so why do it half assed? Does anyone carry a speculum on their ambulance? Has anyone been trained to do a bimanual exam? An exam by someone in the field will add very little (no, I do not mean that to put anyone down) to the pt's care. I would have to say in this case, keep the pt's dignity and let her go through the exam, only once, in the ER.
    7 points
  14. How many of you carry printed Vial of Life papers to pass out to anyone who comes to your station, or stops your ambulance if you stage in different places. Theres so many people that dont know about these sheets that not only make our jobs easier but they can prevent possible mistakes from being made due to the pt being unable to speak for whatever reason, or a mother who is losing it and cant tell you what is wrong with her child. Something to think about. Get them printed and get them out there, its a free 1 page print of the vial of life website.
    7 points
  15. Hey guys, this is Franco Colon. Found this because I decided to Google myself. I just wanted to clarify some things. I had decided not to really say anything regarding this since I had planned on fighting this with my Union but the more time that passes by, the less I feel like drawing this out. First off, I was a Full Time EMT at LICH with no prior instances of ever getting in trouble. I've never banged out of a tour and I've always been comically early. As an EMT in NYC we don't have a station that we hang out at in between calls. We sit at our assigned locations in the ambulance and respond to calls from there. We were parked at our assigned location for about 3 hours. I have my personal laptop with me when I work and so we were passing the time. Obviously we ended up going on chatroulette and since our gas masks where with us we put them on. It was stupid and a bad idea. As you know, pictures were taken an put on Flickr. Another stupid, bad idea. What did NOT happen. We didn't flirt with girls, we didn't write anything obscene or vulgar, you couldn't identify what hospital we were from, I was NOT driving and texting (a photo was taken of me while I was sitting there texting on my phone but my left hand happened to be resting on the wheel) and that photo was NOT named "Franco likes Safety". It was 10 minutes out of our 16 hour shift. We responded to our calls, pt care wasn't compromised, nobody would have even known about it. That is until the reporter from the post found the photos, came to the hospital, threatened us with a story. She was just out for blood. Because of the issues our hospital has been facing lately, we were terminated without a chance to say anything in our defense. I've never even received so much as a written warning. Technically we weren't terminated because of the article, we were terminated for a series of extremely grey policies that allows the administration to fire you for just about anything. The really ridiculous thing about this all. Nobody from the hospital except the reporter, my partner and myself has even seen the photos in question. It's all been based on the word of the reporter. I have no desire to distribute these photos but I'll say this. Friends of mine who have seen them agree when I say, it's absolutely crazy so much fuss is being made over such simple harmless boring photos. I love my job, and it pains me that something like this happened. I feel like I was struck by lightning, just in the wrong place at the wrong time. I would love nothing more than to just move on and get a job somewhere else. I just hope this doesn't hang over me like a black cloud while I try to do so. Watch out guys and gals. Big Brother is watching.
    7 points
  16. Rookie Ease up on yourself. You'll thank yourself for it in time. EMS practitioners are by far, the worst offenders of being one's own worst enemy when it comes to looking back and wondering what could have been. After 21 yrs in EMS (17 + as an ALS practitioner and 18 as an EMS educator) this I know; trauma patients die. A lot. And mostly in spite of what we do. Five years ago on Memorial day weekend, my brother in law suffered a cardiac arrest in the driveway. He was 43. I was with him the day before when he was complaining of palpitations and like all of us would, strongly advised him to go to to the ER. Not strongly enough. I, like you, beat myself up over it, over and over until the weeks turned into months and the months to years. In the process I began to lose my faith in my abilities as an ALS practitioner, insomnia set in, then came a couple of med errors, (strangely things continued to get worse despite my avoidance of the real issue), my long term relationship failed (not related to this incident), and my desire to care took flight. I was the poster child for EMS related stress and Accumulative Stress Disorder. I existed as a shell of myself for a little over two years, until I became seriously ill. The illness was the last straw and I ended up on stress leave. Four months later I walked away from my twenty year career without blinking an eye. After a year and a half of unemployment, some menial jobs for minumum wage, and five months on welfare, I returned to prehospital health care. I kicked my arse for a long while for not getting the help I needed when I needed it. Don't make the same mistakes many of us have made, Rookie; everyone makes a mistake or two, and most of them are not life critical. Some mistakes are, but I doubt yours was. Given the chance to do the call again, knowing what you know now, the outcome would be the same. Trauma patients die. A lot. If you need to speak with someone professionally have your service provider make the arrangements. Speak with someone outside of your service / agency. And stop beating yourself up over something that would have happened regardless of what you, I, or anyone else would have done. Also keep in mind; you weren't the only one on scene; if whatever it was had been obvious, someone else would have caught it. I don't have all the answers, just a lot of experiences of things not to do again. I wish you only the best, and then some. Take care of yourself, Paul
    7 points
  17. Sorry all, I only have a few minutes with internet so can't answer all of the questions... What I ended up doing is writing out my concerns, loss of leg, shock, loss of life, etc, etc. I had the manager on site witness while he read it out loud to his wife on the phone and then had him and the manager sign that it was read aloud and understood. Had the supervisor assign a worker to sit with him until his wife came with instructions to call if his mentation or physical condition seemed to change in any way, and left him there. I do understand that I could have forced him and later justified it with his refusal being an obvious sign of altered mentation, but as mentioned above I'm a true believer that I am a patient advocate first. This guy understood the risks, he's just had a lifetime of experience of ignoring such risks and having things work out ok for him. I wasn't able to convince him in my limited time that his experience might not work this time. I left him on scene. About an hour and a half later I got a call from the site supervisor telling me that he'd decided to go to the hospital due to increasing pain. The employee had driven him instead of calling me back, which was faster anyway...I lost track of him after that... Thanks all for the discussion. I do find these types of cases sometimes more mentally challenging than some medical patients... One thing that I have come to believe, that trying to be morally and ethically sound with these types of patients seems to be becoming less and less popular. That the, "Screw it. Take him and tell them he was altered, no one will ever question that.." is more and more prevelant...That's a shame I think...
    6 points
  18. Hey there Mike. That's a great question, and like the others have said, much of requirement for pacing requires a substantial foundation in education related to the topics Island had mentioned. That's the reason it's an ALS skill, if you were to learn everything there is to know about pacing, well, then you'd be able to do that skill, but you'd also be in school for much, much longer. EMT school curricula simply does not have the educational basis for many paramedic level skills. I believe that the biggest difference between the EMT level skill set and the Paramedic level skill set is that if used wrongly, it could kill your patient. Without the knowledge to understand what we are doing, why we are doing it, when to do it, what should happen if we do it right, and finally, what to do if we did it wrong, we'd be killing people left and right. Pacing is just not a case of slapping on the pads and turning a knob or pushing a button, it's much more involved. To answer your questions now.... Pacing is the use of an electrical current delivered through the defib pads to the heart when pharmacological therapies do not work or the patient is too unstable to wait for meds to work. Typically, the electrical conduction is in the area of 100 - 140 milliamps (mA). slightly less than half that used in defibrillation. The indication for pacing is a symptomatic bradycardia, often a 3rd degree block or a 2nd degree type II. If the patient is conscious, alert, and has otherwise normal vital signs...just a low heart rate in the 20s or 30s, transcutaneous pacing is not indicated...but if the patient begins to decompensate, then it would be. Pacing is an extremely painful treatment, so sedation is also required. Usually midazolam. Therefore you'd also need more pharmacological training. When we pace someone we start at a low amperage setting and increase it slowly. We are looking for a change in the ECG rhythm that is known as electrical capture. Once we see this change...and it will be a drastic change, we evaluate the patient to determine if the heart is actually beating at the same rate we see on the monitor...usually it isn't, so we have to increase the amperage until we have mechanical capture, ie a pulse rate equal to that being paced. Finally we increase the power level 10 mA more to ensure mechanical capture is maintained. Following this we will continually monitor the patient and ensure that mechanical capture is being sustained. I hope this answers your question appropriately.
    6 points
  19. When I was a third year medical student on surgery rotation, we had a patient in his late 30s-early 40s with a large pleural effusion (fluid around the lung). He was doing okay on a NRB mask as long as he remained seated upright, but each time we laid him down, he would desaturate. He needed a chest tube to drain the fluid so he could breathe. As a med stud, I was eager to do the procedure. We were on a med-surg floor. I brought the appropriate gear, gowned up, and prepped appropriately. I thought through every step of the procedure: when to put on the sterile gloves, how to position him, filling the bowl with betadine before putting my gloves on, drawing up the right amount of anesthetic and what size needle to use, getting the right scalpel, setting up the Pleurevac and filling the chamber with water, suture, foam tape, everything. The attending, a surgeon who has been cracking chests since the year I was born, stepped into the room, looked around, then out into the hall, looked around, then back into the room. "Transfer him to ICU. We'll do this later." Disappointed, I put the kit away to be resterilized, knowing that it would be done by someone else. Later, we had our daily wrap up meeting between the attending and 4 of us med students. He asked, "Do you know why we decided not to do the chest tube then?" Not really. "How many nurses were in the room helping you set up?" None. "How many nurses did you see in the hallway or at the nurses station ready to jump in if things went sour?" None. They were all in patient rooms, going about their duties, taking care of the patients on the floor. "Do you know if they are experienced running codes? Do they know where all the code equipment is on this floor? How much practice do they get? We know that the resources are available in the ICU, that the nurses there run codes all the time, and know where the equipment is. If something happens, you know there is manpower there to jump in." He meant this neither as a slight to the MS floor, nor a ringing endorsement of the ICU, but a reflection of the bigger picture of anticipating where we would be. He continued. "I'm not thinking about the procedure. I know I can put a chest tube in. I can do it with my eyes closed. I'm not worried about that. What I'm thinking about is, what happens if the patient decompensates? You always have to be thinking ahead of the procedure. Your mind has to be one or two steps ahead, preparing for that event that comes next. Otherwise, he goes down the tubes and you aren't ready to deal with it." I preach this to my residents. Don't get lost in the procedure. Intubation is a physical skill of muscle memory, not a mental exercise. Your practice has taught your hands how to intubate. You know how to intubate, and if you are thinking only of this, you will miss the big picture. When you are in the ER, the OR, the ambulance, or on the street, take it all in. Think beyond the immediate, and wrap your mind around what comes next. Don't think, "I'm going to intubate." Think, "this is what I will do if I can't intubate. These are the parameters that will tell me if I need to intubate, or just give oxygen. This pulse ox level is when I will quit attempting to intubate and bag the patient. This ETA will determine if I need to tube now, or use other methods to support the patient until I get to the hospital." Concentrate on where you are going, rather than how you get there. The little things, like the procedures, will flow. 'zilla
    6 points
  20. You would be surprised at the amount of people that believe that God is in control of all things in their life.This is a very complicated theology for most Christians and most definitely for non believers to understand. It is rooted in a Biblical teaching that God is all powerful and sovereign in all things. We believe that His perfect will work all things together for the good of those who love Him. Therefore, nothing is impossible for God. I believe this theology. I have seen definite miracles but most often see circumstances develop through the normal administration of science and natural law.. I understand that miracles are extraordinary and have a adequate balance in my beliefs and their expressions. I mention this so that you can understand where your classmate is coming from. I think that she is sure and confident in her religious beliefs but has very little experience with society at large. Many times people like your classmate say things like what you describe to demonstrate their faith, but more often than not it is simply the way they normally talk to their family and circle of friends. They do not realize that people with different socio-religious backgrounds might think their behavior is odd or weird. I think you can help her by talking to her from a clinical perspective and say that although we all believe different things we have to respect the patients beliefs as well as avoid the dangers of inducing the patient into unhealthy theocratic projections stemed from their psychopathology. It is gonna be up to you to decide if you want to help her understand limits and boundaries. I would explain the situation to her because of the commonality of beliefs and because I bet she is a really good and caring person that can help many as a provider.
    6 points
  21. I am very dedicated to my work. I wear Paramedic/EMS shirts every day, even when I'm not on duty. The EMS station is my second home, and my second family. It often seems as if my life revolves around the EMS department, but it means nothing compared to my little girl. I am normally a very friendly person, but if you hurt my little girl you will make me mad. I know my little girl is growing up, even if I don't like it. She seems to like you, so I'll tolerate you dating her, but here are a few things for you to think about while you're with her: First of all, I go into hostile situations to save people that I've never even seen before, you can't imagine how protective I am of my little girl. I once broke a man's sternum by accident while doing CPR to save his life. If that's how I help people what do you think I do when I'm pissed off? I know who investigates arson fires. They know exactly what clues to look for to prove it was arson, so they also know what not to look for should I mention anything... and I know where you live. I've worked more car accidents than you'll ever see, the sight of blood doesn't bother me one little bit. It's normal for me to IV catheters, Syringes, paralytics and extremely strong sedatives in my car.. Touch my little girl and me and you take a little ride. When my firefighter friends burn down a house for training, nobody ever looks in the closets. I use the jaws of life to tear doors off wrecked cars. They cut though solid metal like a hot knife through butter. So watch your paws or get the jaws. Sirens and air horns can really muffle the sounds of someone screaming. Most of my friends are cops, paramedics, or firefighters. WE ARE 911. If you make me mad who do you think you're going to call for help? I have access to explosives. I am well trained in emergency medicine. I know exactly which arteries are the easiest to sever and which ones bleed the most. (Remember the Medical training, IV catheters, Syringes and drugs!?!) Even though my little girl insists that you are a "nice guy" and not like most other guys, I know better. I was once your age, I know EXACTLY what you're thinking. Because of that I already have plenty of reasons to not like you. It wouldn't take much at all to push me over the edge, and I just stocked my med kit. So if you want to date my little girl you better keep these things in mind. Medics are protective by nature, and there is nothing we are more protective of than our little girls. Whenever you're alone with her, you better remember that someday you may be alone with me! (I modified this from "Dating a Firefighter's Daughter" I am having this printed on a nice paper and framed for both of my girls ) Race
    6 points
  22. Signs and symptoms of PTSD have been documented in ancient literature from several hundred to several thousand years BC. Nothing new about it. However, the pejorative statements people make about PTSD patients are quite harmful and do little to describe the facts about this problem. Attached, is a link to a study on PTSD documentation in ancient literature, and this study was done outside of the United States, because I would not want to use anything from the "pharmaceutically" tainted literature in the States... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990839/ Take care, chbare. On a side note, I am not sure I would say I suffer from PTSD; however, I have had a few nightmares relating to experiences I've had in both the United States and Afghanistan. Also, I remember being out walking and had a minor incident shortly after returning from Afghanistan. Apparently, there was a foot ball game and when one team won, a massive fire works show started (Homecoming I believe). There was a sudden, large boom and for an instant I though it was an IDE/VBIED and went to the ground. Had I been a little more aware of the fact that the game was going on, I do not think it would have taken me by surprise. I have had no other incidents since and generally think I am doing just fine. However, I can appreciate what some of these people who experienced "real" action may be dealing with. Take care, chbare.
    6 points
  23. Crotchity, you truly are an asshole. I guess my father-in-law (Navy corpsman stationed in Vietnam with the USMC) was just pretending when he would hide under the covers every 4th of July because the fireworks made the flashbacks uncontrollable. It was even funnier when he couldn't take it any longer and overdosed, leaving behind a wife, 8 year old daughter and 5 year old son. Yup, must have been the pharmaceutical industry's fault, especially since he was on no meds. So how long until you make this thread about yourself and turn it into a racism thread? You truly are a worthless piece of shit.
    6 points
  24. Don't you EVER ask for a discount. EVER. If it's freely given, you may accept, circumstances depending (thanks for your story Squinty). To ask, or to be offended because one previously given is not extended, is churlish in the extreme, and reflects poorly on our profession. Just what is it that makes you so god damn special that somewhere you ate is OBLIGED to give away part of their profits to you? We get prodeals through my SAR team. If they stop being offered, which companies occasionally do, we don't say a word except thanks for the previous years of prodeals. Do we *ever* go into a shop and ask for discounts? Absolutely not. That's actually grounds for dismissal from the team. In the rare instance that something is offered to us, we ask that the business make a tax deductible donation instead (which I know has happened). That way, it benefits the whole team and not just one or two of us who happened to be in uniform. Man, this kind of stuff REALLY chaps my ass. It's so stupid. Really. Just don't do it. Wendy CO EMT-B
    6 points
  25. What is it with people and the internet? You, "flaming", are not real. Here. You're a virtual name, a number. What is the forum judging? Your words and thoughts. I'm just gonna shoot from the hip here, and speak from my own mind. Although, I haven't given any "negative ratings", I could see why some would. Having never met you in person, we have a "screen name", and a character in words. So, if this were a book, you would just be like a character. Like, say, The Boxcar Children. AK would be Henry, you would be Benny. That was just for visual. If another user is judging someone, they're not judging your personality, your human character.. They're judging your words in print. You're not speaking from your mouth. You're typing, you're not face to face, so you're probably typing in some instances with a smidge of rage or intense inner anger. That's okay, let it out big boy. ha ha. It's not because you're different, alone. We're all different. Nobody is alike, each individual on the face of this earth is unique in their own way. So what, you're gay, that's who you are. But that doesn't define you. I'm gay, it doesn't define who I am. I'm damn good at what I do, and at the end of the day, that is all that matters.. As an EMT. I don't tell people who I've slept with, what I'm into, porn, sex, etc.. I may tell my friends, who respect me for who I am, but would I tell a co-worker that may or may not be a true to heart friend? No. If you want to let being gay define your entire personality, then you open yourself up to hearing what other people have to say. Back to your statement, because if it doesn't have a "?", it isn't a question. Are you being judged for being Gay. Yes, your screen name is. You're being "difficult", not different. You're taking your view, plastering it on a wall per se; and when people give their opinion, instead of accepting it and moving on, you're resisting it, and pushing their head closer to your views. At this point, I don't think your cause is really to get opinions, I think your only goal here is to get attention. In fact, I really don't believe that you're "representing" homosexuals. I believe you're a past user, that has returned in order to stir up trouble. All I see is, a little boy, stomping his feet, jumping up and down, crying, because nobody wants to see life his way. Get yourself a tootsie pop, and go watch cartoons.
    6 points
  26. Man, Lone Star just killed your thread brother, as that is nearly a perfect post in my experience. There is no way to describe here what the job means and entails to everyone, but if you choose this path you will instantly recognize each and every point that he made. I'm going to highlight a few simply so that I can feel superior and believe if I've added something pertinent to the conversation... I never get tired of pts.in general. There are moments, but they are incredibly rare. My coworkers sometimes make fun of me, mostly in a good way, because I tell them that my theory is to 'love all of my patients. If I love them then I talk to them right and all of the other decisions become easy.' And I believe this, that I share my life with each and every pt that I encounter. (Understand that I have never worked a high volume system with the exception of being overseas, so others may feel differently, and justifiably so) I forget most of them almost immediately when I leave the ER, or in my current gig send them off to the hospital or clinic. But for the few minutes/hours/days that I am with them I try and open myself up and truly see them... I love that. Some here will tell you that that is just a bunch of wanker bullshit. And they will also be right..for them. But sometimes we all get tired of the bullshit we work around. I recently came into contact with a medic that was telling me that the only use he had for Hydrogen Peroxide in his ambulance was convincing the drug addicts that it is an HIV/AIDS test. You bring it into contact with blood, and if it foams, that that is a positive test. I completely destroyed him in front of God and everyone. I forced him to try and explain in front of about 15 people how convincing someone that has almost nothing to live for that they now have absolutely nothing to live for was proper care? I asked him to define the role of a paramedic in healthcare, to define the word compassion. It's wasn't pretty, but I'll bet he's more careful about talking idiotic macho TV crap around people he doesn't know in the future. He doesn't like me much now, and that's ok, because I don't like him at all. Unfortunately he will tell that story to many, many of his coworkers that will think that it's hilarious and will use it on their trucks. Of course the flip side is that you will also run with many providers that will almost take your breath away with their kindness and competence. And for me, that keeps me working, and thinking and studying every day, so that I can try and throw my hat into their ring. But the truth is, if you truly want to be a rockstar provider you will always be in the minority. You will always make others at least a little bit uncomfortable. But fuck em...This isn't a popularity contest. Akflightmedic, chbare, billygoatpete, Mobey, hell...there are probably 30 more here that I could name if I took the time..Being in a profession that allows me the priveledge of having folks like that to council and guide me? Priceless. Yeah, I'm not sure where you're at, but these wages sound well above the national average. I do pretty well now, by my standards, but I work a min of 14/12s in a row in some pretty cool, but weird places. Yeah, this is the down side of having a career that is dominated mostly by kids. They are willing to go crazy, burning themselves out working a gazillion shifts a week. It's not healthy, but it pays the bills they would say. I'm thinking that if you have a family, a house, a boat, a motorcycle and a jetski, that you need to redefine your priorities and what it actually means to pay the bills. Another great point. Plus, if you have a hard time keeping your dick in your pants there is plenty of opportunity to cheat on your spouse or sleep with someone else's. Judging from the quality of your first post though, you don't strike me as someone that has trouble with logic and focus. As far as stories...yeah, mostly they are best left at work unless you have something that hurt your heart, and then of course you should share that with your mate. My wife could not possibly care less about EMS. She's proud of me for being a medic but has no interested in the blood and gore stories, etc. Once, early on I had 6 patients in one day and three of them died. After the last pt was delivered dead to the ER (two were end stage pathologies that died during transit and one arrest.) I swore I was going to duck calls for the rest of the day. As I was walking back to my ambulance, another pulled in so I reached out and opened the doors for them and they had a pt in arrest. My partner was waiting at the truck and saw me riding in on the cot doing compression and almost died laughing at the coincidence of me getting stuck on another dead person. I was laughing my ass off telling this story to my wife who said, "Honey, that story is very funny, I'm sure it is, but please don't tell that to any of our friends or family." Heh.. It's a crazy world... I wish if firemen really needed to get whacker hero tattoos that they would replace the 911 nonsense, (unless of course you were actually there) with some of the words in bold. Ok, not the IFT part, but you know what I mean. Lone Star has pretty much created an EMS primer for you as it relates to your questions. I've got almost nothing to do in the clinic at my current job, which is why I feel the need to chime in and give long winded answers where there often weren't really any questions. But you know what? One of the things I love about being a paramedic? Is that those here get that I'm bored out of my mind, they will allow me my drivel, even support me if I need it, until enough is enough, and then one will be kind enough to say, "Ok man, it's way past time to stop being an asshole. you've had your time, now suck it up princess and go do something productive!" Heh...I love my job.... Dwayne
    6 points
  27. Of course it was me that gave you the negative. Normally you're whining and whatever nonsense you spout in the chat room keeps others feeling sorry for you and prevents them from doing so. But why do you assume that I'm a jerk for giving you a negative? Why can't you, like an adult, assume that I thought that your arguments were shallow, one dimensional, self serving, cookbook Basic level medicine and simply not good educational material on the board? Isn't that what the votes are for? To show others my opinion of your thoughts, either exceptionally good, or exceptionally bad? You continue to espouse 'proper' exam. And I couldn't agree with you more. You simply go so far out into left field that your opinion loses my support. Wasn't it you, months back, that said that if we let a speeding car pass, or one drive through a yellow light without calling the police that we may have just allowed a kidnapper to escape with his victim and that we should be ashamed? That's what I'm talking about. Your thinking is so one dimensional. It's too shallow. You sound as if you're constantly doing scared medicine. "What will the ER complain about? What can I claim that I do that everyone with think is very unusual and heroic?" I'm hoping that I misunderstood you when you asked why we take blood pressures when it won't change my treatment as I can't raise or lower blood pressure? I can do both...did I misunderstand? If so, then I apologize, if not, then they should shred your medic ticket today, right now. I hope that you're a good provider, but I don't believe that you are, and I'll tell you why. You are too inflexible. You take the first thing that pokes itself in front of your nose and makes sense to you and you commit to it, fully unwilling to change your mind. The very best educational moments in my short career have come from exposing my own process to others, having them say, "But what about X?" At which point I often said, "Holy shit...I don't know how I missed that..I screwed the pooch on that one." Also, your skin is so thin as to be near transparent. No one simply disagrees with you because they don't respect your opinion. They "don't like you" or "have it out for you" or some other such nonsense. I've been watching for the shout out, if we still have them, saying something that resolves in, "Oh poor me, everyone is so mean!" Ive not known a provider, and I've known a few really good ones now, that are so easily offended, nor so quick to discount a valid opinion as simply mean spirited harassment. I've gone to the friggin' mat with Dust, ak, an many others here much smarter than myself and at times left feeling pretty good, at other times bloody and beaten, but still I count each here that has intellectually bashed my head in amongst some of my closest friends. When Wendy used to correct my grammar and spelling I wanted to choke the shit out of her! But I know present myself, though not as well as I'd like, much, much better than I did before she took me to task. (Watch, now she's going to shred this post...and I'll say thank you, though perhaps it will be hard to understand through my gritted teeth.) Do I like you? No idea. I've not given you enough thought to develop an opinion. Why do I care then if you give opinions that I disagree with? For two reasons. First, I believe that there is great power in strong debate. If I confront your best argument with my very best argument, perhaps we'll both leave with some wholly unexpected piece of knowledge that neither of us would have gleaned on our own. Secondly, and much more importantly, there are many, many young, and/or new providers here that come with the belief that we are here to help them, as well as learn from them. You are willing to take an argument that you believe Dustdevil would have made, only he was most often right, and present it simply to feed your ego, to have the young/new come to you and say, "My God! You are so brave!! I would never ask a woman to expose her vagina and use her hands to spread her labia! You're a rockstar!" You plant the seeds that will send them into the ER glowing only to have the ER physician say, "What were you thinking? Where did you go to school? Are you an idiot!?!" Do I believe that you would always employ those interventions? I don't. I believe that often you simply present them, and then swear by them, for effect. What is a proper exam? Initial impression, good sets of serial vitals, an in depth current/past history to include current medications whether compliant or not, an attempt to get a decent feel for my pts frame of mind, and depending on their chief complaint exposure up to the point that I believe it is necessary to support or retard my working diagnosis. SPO2, monitor, etc? Sure, if indicated, but they are mostly toys and I can't really think of a time that I couldn't guess what they were going to say before I read their fancy little screens. And as expected, you ignored my questions, which I'd presented carefully to make them relatively easy. Do you spread the cheeks of your 70 y/o hemorrhoid pt? Palpate? Do you expose your kidney stone pt that has radiating pain into her groin? Ask her to spread her labia for a peek inside just in case your working diagnosis is incorrect? I worked with a new medic that wanted to put 15L NRB on every pt that she believed needed O2. I suggested that she use more appropriate amounts when required. She said, "Why? It's not going to hurt them, and it's better too much than too little." I told her that in the vast majority of cases that she was right, the pt was not going to be hurt, but she was. That the people that view her treatments, or take transfer of care of her pts are going to expect her to know how to determine, and then use, appropriate interventions. She thought I was silly and is now little respected around her peers, and worse, her betters. That seems to be what you're suggesting here. I will expose the genitals and ask an already damaged pt to spread her labia so that I can best examine her whether or not my thorough exam reveals that this is a prudent step. A vagina is an amazing and wondrous thing, but I promise you this. No matter how macho you think you are, how many "babes you've bagged", nor how many books you've read or videos you've watched, you will never know more about the inner workings of that freaky little machine than it's owner. Peds and trauma excluded of course. Is it leaking icky stuff? Sure, and it smells nasty! I can't justify being down there under the guise of alerting the ER to this fact. Is it swollen? Yeppers! How come? Beats me, and I can't justify collecting that information under the guise of alerting the ER. Is she tachy, diaphoretic, appearing to be trying to smuggle a giant watermelon under her shirt while she screams "I think it's coming!!!" Ah, see, this might dictate not only a peek, but a good hard look. But my physical exam already told me what to expect before I dropped her drawers, right? I once exposed a rape victim and examined her genitals because she claimed that her attackers had stabbed her multiple times in the rectum and vagina with an ice pick. And the area was a mess. It was ugly, disturbing, but it turned out that she had inflicted the wounds herself. Did I need to expose her? I believe that I did, as I could see blood through her clothing at the vagina and rectum and believed that bleeding control might be necessary. Would I have exposed her if I hadn't seen blood? Absolutely, as she told me that she had been stabbed in that manner and I'd want to look for signs that she had compartmentalized bleeding or that it had perhaps been tamponaded (? Not sure that that is a proper word) in some way. I also checked femoral/pedal pulses, checked cap refill, and did a lower extremity neuro exam on the way to the ER (as well as prudent, associated interventions) in case there was hidden vascular/nerve damage. Those are things that I believe the ER might benefit from knowing at, or prior to my arrival. A lot of people here have tried to express their views of your opinions and you've narrowed it down to "everyone thinks I'm right except those that don't like me" again. You need to let that go brother. Many here, such as Wendy, Matty, Dust, akflightmedic, Kaisu, etc, etc, have told me that at times I'm an arrogant, ignorant asshole. And you know what? In each case I went back, reread the posts that caused them to draw those conclusions, and I can't think of a time that they were wrong. Despite my best efforts, sometimes I simply go off into the ditch. And I thank the powers that be that there are people here willing to say, "I know you think that you're right here, but you need to trust me when I tell you that you are thinking and behaving in a way that you wouldn't like if you could see it from the outside looking in." Step back from the self pity man. Stop making an argument simply because you believe you will look ignorant if you reverse your position once chosen. There is not a single person here that I respect that doesn't say, on a regular basis, "I don't know" or "ooops, I see your point." It won't kill you...trust me. Dwayne
    6 points
  28. Ok, I guess it's 'confession time' here.... As an EMT, I looked at a lot of the medics I came in contact with as 'pompous asses' because of their attitudes toward the lower license levels. This thread has forced me to re-evaluate my position. As I climb through the license level ranks, I find more and more that there’s so much I DON’T know. I’m not the first EMT to come to this stark realization, and I know I won’t be the last to ‘figure it out’. Working my way through EMT, then EMT-I and eventually onto EMT-P, I find that when I was a ‘mere EMT’ I thought I knew it all. This feeling was great to hold onto, and gave me confidence to do my job. Then I went on to the EMT-I portion, and realized that I didn’t ‘know it all’ like I thought I did. But I learned more, and still felt good about it all. I was still confident, but looked at things differently. When I started my medic class, I quickly learned that what I really knew nothing more than oxygen, stop bleeding; and keep broken body parts from moving. Those that know my story know that I had to drop my medic class for reasons beyond my control. I haven’t given up, and will be working toward getting into the next class. As I wait for the next class to start, I realize how painfully inadequate my education has been, and how much I still have to learn just to be able to call myself ‘competent’. Terms like ‘good, great and exceptional’ will just have to wait. I do not deserve them … yet. As with every ‘confession’ comes the opportunity to eat a little crow. I think I’ll have mine with a generous dose of A-1, to make it more palatable. To all the medics that I call ‘friend’: I offer each and every one of you a sincere apology. While I thought that many of you were ‘harsh’ in how you dealt with the lower license levels, I’ve come to realize that it wasn’t out of ‘meanness’. You were challenging me to not only prove you wrong, but also push me into learning more. For that, I owe each of you a great deal of thanks and appreciation. This confession serves as a warning to all of those medics (and the Doc’s too!): Since you all have pushed me into going further than I thought I could, each and every one of you will be ‘hit up’ as an information source with even more questions than I’ve already hit you with! To everyone else: This site is a great place to ask questions, debate theories and ultimately LEARN. These ‘grouchy old medics’ may seem harsh and ‘mean’, but they’re only want you to push to be the best that you can be. We’re taking people’s lives into our hands, and the patient’s deserve more! When the ‘old hands’ around here challenge your posts; whether for content or spelling/grammar, they aren’t being ‘meanie-heads’, they’re pushing you to correct the ‘little mistakes’ before they snowball into ‘big ones’. One misspelled word on a PCR can change the entire meaning. It’s been said that those that have successfully completed the medic course (especially with a degree), have ‘forgotten where they came from’. Some have gotten ‘arrogant’ because they’ve completed the course; but most appear to be coming from the same position that the previously addressed medics are. In the United States, our EMS education is very lacking in content. The cliché “You don’t know what you don’t know’ is so very true. The ONLY way to get a glimpse of this is to pursue your education above and beyond the minimal course called ‘Emergency Medical Technician – Basic’! When I finish my degree, I hope to remain the same person that some of you have come to know and at least ‘like’. I’m going to push you as I always have to get more education. I’ve had to re-evaluate what I thought I knew and now have to look at things much differently than I did from the ‘safety’ of my EMT-B world. I hope that many of you will find yourselves in the same position! ER Doc, Thanks for reviving this thread!
    6 points
  29. I was with your train of thought, bro (because I know Airborne thinking patterns) until this last bit. Here, I think you dropped the ball, and you're going to catch a LOT of flack for it(not just from me, either I bet.) OK, I get the whole "balls to the walls" hero mentality... and I understand that combat medicine involves treating while under fire. WTF is wrong with you that you don't take the 15 seconds to protect yourself? How about popping a pair of nitriles on under your tactical gloves, so that you don't increase your chances of exposure to bloodborne pathogens? I know there's not always time to stop, put on gloves, etc... but you can prep yourself as your unit's medic. Lead by example, dude... you're smart enough to wear a condom, right? This is no different. You wanna die of hepatitis? Nasty way to go... and the thought of going to the VA for care for that for the rest of whatever life you've got is scary indeed. Way to disrespect the SISTERS AND MOTHERS AND DAUGHTERS who are fighting just as hard as you are. I dig that there's no chicks in the Airborne, and there's not as many women on the front... but there are women in intelligence and support and medical who are just as vital to the operation of the military as you are. One of my acquaintances just graduated boot and is on contract to be in an aeromedical drop unit. Your first phrase, "it's about a soldier's life" is absolutely spot on. The rest is realllly narrow thinking. Get your head out of your ass. Just because your unit is a bunch of hopped up male adrenaline plane-jumpers doesn't mean that you wholly represent the entirety of the armed forces. No, it's not, from our perspective. We're looking at your education and understanding of medicine, not your setting. I understand that "medic" is a near and dear term to you where you are. It's a badge of honor. Medic means something different in the military- it means "the nearest dude who can maybe plug my bullet holes" and I get that this is different from civvy EMS. But you're on a civilian forum, discussing *medicine* with a group of people who are mostly civilian with some former military and reserve mixed in. We appreciate YOU for what YOU do... don't piss on us and get all touchy because we refer to your actual civilian EMT level. You are indeed a separate breed of EMS, but when it comes down to it you're an EMT-B with some EMT-I skills and less education than nearly any paramedic on this forum. Have some respect for yourself. Step back and try to think outside your military box for a little bit. If you don't protect yourself with something as simple as gloves and don't recognize that you are speaking from a viewpoint that many of us will never be able to fully understand, you're just going to piss people off here. Have you ever stopped to wonder WHY 101st Airborne has such high suicide and mental illness rates? Couldn't have anything to do with the mentality and culture of the unit, could it? Sure, you're getting exposed to gnarly shit... but I bet the special ops folks have a lot more skeletons than you, and for some reason they don't seem to have as many issues proportionally speaking when they get out of the service. Just food for thought. Stay safe out there. Wendy CO EMT-B
    6 points
  30. If you cut someone's property without an imminent medical need, you're really not thinking clearly and just being a douche. Sorry. You can dislike the "emo kid" and all his jelly bracelets... but unless you can't get them off without cutting, you have no right to destroy his property. What's wrong with you? If there's a medical need, you do as little damage as possible but do what needs to be done. If there's no medical need, and the original post doesn't really indicate whether or not there was, then keep your scissors to yourself. I'm actually really disgusted by this... is it OK to cut off someone's coat because you don't like the designer? Because you think it makes them stuck up? Where do you draw the line here? Wendy CO EMT-B
    6 points
  31. I take no credit for writing this. I found it at: www.medicmadness.com If Chuck Norris was a Paramedic March 20, 2010 Posted by Sean If you have never heard of Chuck Norris, then you have been living under a rock with no daytime cable. From the “Delta Force” to “Walker Texas Ranger”, he has shown the world that he is one certified badass. Now today we are going to talk about what happens when you take Chuck Norris from the role of kicking ass to saving lives. So now the big question…… What kind of Paramedic would Chuck Norris be? Shifts Chuck Norris doesn’t work shifts. He tells people when they are allowed to have emergencies. This is done around his busy schedule. At no time will he be tied down to scheduled hours. Scene Safety We all know the “Texas Ranger” doesn’t need to cleared to a scene. As a matter of fact, he prefers to live life on the edge. The more dangerous the scene, the better. My guess is law enforcement wouldn’t be dispatched to any of his calls. Response Chuck Norris doesn’t respond to calls. The calls respond to him. When he gives the OK to have an emergency, patients will make their way to his location. He can’t be bothered with driving and trying to find peoples homes. Vehicle Chuck Norris doesn’t need a vehicle to respond in, as he doesn’t respond. Patient’s seeking his services must provide their own form of transportation. Partner Come on now…..we all know Chuck Norris works alone! Equipment Chuck Norris doesn’t need medical gear, tools or medications. Disease processes quiver at the very sight of Chuck Norris and have no choice but to immediately comply to his demands. Patients suffering from trauma usually got their injuries as a result of a Chuck Norris beating. There isn’t much treatment that can be done to improve their condition anyway. You can’t end a post about Chuck Norris without including some old Chuck Norris facts….. Here are some health/medical related Chuck Norris facts that I found for your reading pleasure! The leading causes of death in the United States are 1. Heart disease 2. Chuck Norris 3. Cancer TNT was originally developed by Chuck Norris to cure indigestion Chuck Norris will never have a heart attack. His heart isn’t foolish enough to attack him. Chuck Norris doesn’t get frost bite. Chuck Norris bites frost. Chuck Norris’ tears can cure cancer. The only problem is, Chuck Norris doesn’t cry.
    6 points
  32. Actually hyperglycemia has been shown to contribute to morbidity and mortality in many acute conditions, MI and CVAs being 2 of them. Multiple studies have shown that it can reduce hospital survival rates and glucose levels are often looked at as predictors of outcomes. Pt's are started on insulin drips to strictly control the glucose levels even when they are only slightly elevated no matter what the cause of the hyperglycemia. There are plenty of studies out there and it the adverse effects of hyperglycemia with head injuries and sepsis is also well documented. Here are just a couple of article to get you started: Controlling hyperglycemia in the hospital. hyperglycemia and MI Just learn from this mistake and remember that none of the treatments we administer are completely benign and all have some degree of risk associated with them. Cheers!
    6 points
  33. Ive seen some local fire trucks around here at Subways, KFC, and the such. I wonder just how wrong, i.e. funny, it would be if one of these trucks pulled up at KFC with the PETA ad on the side...lol And I just have to say that meat is muder.................... Tastey, tastey murder. Yummmm *I wonder if I will start getting negative votes now lol
    6 points
  34. Wow. Just.... wow. It seems that there are at least three different questions here: Should abdominal palpation be done on this patient? Should it be done by an EMT or EMT student? Should it be taught to EMTs at all? Was the situation handled correctly by the OP? 1. Yes. Abd palpation is indeed indicated in the general examination of abd pain. However, it should be done at the proper time, by the proper person, utilising proper technique. And, of course, it should be deferred if the clinician determines a potential for exacerbation of the situation by the manoeuvre, or if it causes too much discomfort for the patient. Remember, it's going to happen again, probably at least twice, in the ER, whether yo9u do it or not, so there is little to be risked by deferring it in the field. 2. I'm a little mixed on this. There are instances where I would say this may be indicated. However, none of those instances would involve an acute abdomen, as in this case. And even then, it should be done only under the close supervision and guidance of an advanced clinician who has confidence in the EMT or student. 3. As already well stated by VentMedic, with the current state of EMT training in the U.S., I have to say 'no', abd palpation probably should not be taught in the basic EMT curriculum. Hell, for that matter, there are a lot of paramedic schools that shouldn't be teaching it either, because their students are neither the anatomical or physiological foundation necessary to properly implement and interpret the results. Most of them are wholly incapable of even identifying where organs and structures are located within the abdomen (and yes, my students get verbally quizzed on that within the first hour of showing up to my ambulance for a ride). And I am not for just doing shyte that looks cool, just to look busy, when it offers no benefit to the patient. 4. Should the OP have stopped the student from palpation as he did? Yes. No doubt about that. However, the reason he had to do so is because he FAILED to establish the ground rules and a clear line of communications with his student at the beginning of the shift (this, of course, is an assumption. He may have, and the student may have just been an idiot.). Before you ever make it to your first patient with a student, EXACTLY how things will work should be discussed, understood, and agreed upon by all parties involved. As an educator, I encourage my students to be assertive and pro-active, using initiative to be a part of the team. This should be tempered by the student's knowledge of his/her own limitations, of course. If a preceptor wants to play 'mother may I', then such problems are obviously going to arise quickly. For this reason, I also counsel my students to establish the communications and ground rules mentioned above, whether the preceptor brings it up or not. In this case, it appears that both student and preceptor FAILED in this, and both need to learn a valuable lesson from it. Ideally, the student would have known the limitations placed upon him by the preceptor ahead of time, preventing him from overstepping his role. This would have prevented the embarrassing incident in front of the patient. And it would have given the student a good question to write down and remember to ask the preceptor and instructors about after the run. I do believe I would like to have seen the verbal intervention handled a little more diplomatically, if for no other reason than to avoid worrying the patient. Instead of the old, "DON'T YOU EVER..." line, perhaps a gentle, "Uhhh... I think we're going to just defer the palpation to the ER, okay?" Yeah, I know that when you see something wrong about to happen, it is sometimes difficult to remain calm and diplomatic. However, that is what is expected out of a preceptor. You are, after all, a professional educator. Try to sound like it.
    6 points
  35. Everybody should make their own decision about the vaccine. I don't believe that any vaccine should be mandatory UNLESS failure to vaccinate puts the rest of the population at risk. I remember, as a grade schooler, going to my elementary school and getting the flu vaccine in the 1960s (it was mandatory). I am taking the shot as soon as I get to Las Vegas early next week. As a group of emergency physicians (at UNSOM), we decided not to take the nasal vaccine because it is a weakened (attenuated) form of the H1N1 virus and we were afraid that we would shed some of the virus which might adversely affect some of our patents who may be immunocompromised. But, we are taking the injection. I am making sure my two kids (in their 20s) and my son's pregnant wife (also in her 20s) get the injection vaccine. I intubated two people last shift at UMC who had H1N1. I had one patient, a male in his 20s, who was in the hospital for 7 weeks, spent 5 weeks on the vent, had bilateral chest tubes, a DVT, and ARDS. He was low sick. This H1N1 is scary and if you are in your early adult years or pregnant, you should be concerned. The Obama administration has done a horrible job of providing information about the H1N1. While in Texas last Friday (I am in San Jose now), the TDSHS web site showed that two pharmacies near my Texas house was supposed to have the vaccine. I went by both to try and get the vaccine for me and my family. Neither pharmacy had the vaccine and neither knew when they would get it. It is available in Clark County, Nevada. Go figure. I was in Mexico when this H1N1 emerged several months ago. The way it affected children in the Mexico City area was scary. Although the predominant strain in the US appears to be less virulent than the one on Mexico City, it is still a bad deal. Vaccines save lives. If you give people enough of a substance, be it vaccine, drug or placebo, a few will have an adverse effect. This does not mean that the vaccine is dangerous. The links between childhood vaccines and autism are pseudoscience. Far more kids will die from not being vaccinated than will suffer ill effects from the vaccine itself. Look at the evidence and make your own decision. I, for one, will get my vaccine next Monday.
    6 points
  36. This isn't about being careful with what you say, it's a valuable lesson in identifying pathological issues in someone who's supposed to be a patient advocate. I'm glad this guy's license has been revoked, at the very least. I'm surprised that it got this far, with allegations of roughness throughout his past... if that is the case, someone screwed up somewhere along the line and this guy should have been identified and yanked a long time ago. Scary stuff to be sure. Wendy CO EMT-B
    6 points
  37. Hi Caduceus, nice to meet you I'm going to be the one irresponsible adult in this bunch who walks over, shakes your hand, and hands you the code to access my ambulance shed door..... Then we are going to sit down together and have an in depth visit. In some of your previous posts you've alluded to having witnessed or possibly having been a part of some traumatic events, or maybe some medical events. I'm going to ask you further about them, what they were, what your part of them consisted of, how it affected you in the following days, weeks, etc. During our chat, I'm also going to give it to you straight. We see things in EMS that most people can't even begin to imagine. Things that we carry with us for the rest of our lives. I only have three decades in this business and I'm sure I haven't seen it all and there are probably more things I have yet to see, but honestly, I still have a few accident scenes and traumatically abused young patients come and visit me in my dreams.........but I also have some wonderful memories of being the first person to hold a newborn baby in my hands and can still feel the arms of a mother who's son we revived after he plunged into an ice cold lake hugging me and thanking me for not giving up on him. So we are going to talk about those things together. We are going to talk about the good, the bad, and the boring. We are going to talk about how a profession in EMS can either make or break a person. Then I'm going to ask you to go home and take 24 hours to really think about whether or not you want to come along with me in my ambulance. 24 hrs later...............you show up at my bay and say "I thought about it and I still want to do it." And then I'm going to give you a pager which you will carry with you at all times. He probably will be quiet for the first few days that you carry him and you'll probably push down on the little protruding button on the on/off knob a couple of times a day "just to be sure" it hasn't gone off and you've missed it...... And then finally, when we least expect it, (most likely at 0600 hours) Mr. Pager is going to scream/beep/tone at the top of his lungs to tell you that "Old Mr. Creeky Hips down the road has fallen and can't get up." and your going to jump out of your nice warm bed, throw on that set of clothing that you have had nicely laid out for just this occasion for three days now, wipe the sleep out of your eyes and try to calm your shaking hands while waiting for me to swing by and pick you up for the ride to the ambulance bay. I'm going to pick you up outside your house and on the way to the ambulance bay I'm going to coach you to slow down your breathing and shake out the tremors running thru your body and just relax. I'm going to calmly remind you that this is Mr. Creeky Hips emergency and not ours. And we're going to talk about what we might be heading into as we get to the bay and transfer into the ambulance with the rest of the crew. I'm also going to remind you that this is the time of day that heart attacks happen and that we can't always rely on what "Mr. Pager" tells us so we need to be mentally prepared for the "worst case" scenario as well as a simple fall. As we pull up to the front door of Mr. Creeky Hip's house I'm going to ask you again if you are ready and if you want to come in. If you don't, that's fine with me and I really won't mind if you decide to sit this one out in the front seat of the rig and just wait for my partner and I. I will not hold it against you either, so don't be afraid to tell me that you've changed your mind. I'd rather know now than have you come in against your better self judgement. But if you do decide to go in, then you need to know that I can't hold your hand. I can keep an eye on you and guide you if needed, but once we step foot into Mr. Creeky Hip's house, my focus and my attention need to be on him and what is happening with him. If we get in the house and it is a simple fall, great! We can do a rapid trauma assessment while we question Mr. Creeky Hip and try to find out what caused him to fall and get him all packaged up and ready to transport (if needed) or if he doesn't want to go in, do a thorough assessment both medical and trauma, call medical control then help him up off the floor and be on our merry way. Most likely the entire time I am going to be observing you and how you handle yourself, how you interact with Mr. Creeky Hips and his family, and how you interact with myself and my crew and hopefully you will be wonderful at it. But if we walk in the door and Mr. Creeky Hip is exhibiting agonal respirations and his family is hysterically screaming at us to "do something" then I may even forget for a few minutes that we brought you along because we will be in full "code" mode and you may have to fend for yourself for a few minutes until we get CPR started, the AED on, get IV's going, etc....so I hope you are okay with that and secretly I am probably hoping that you jump right in and ask if you can help with CPR. Whether I need you to help or not doesn't matter, but your offer to help will be immeasurable in the amount of faith I put into helping you continue along your chosen path should you choose it after this call. And when it is all said and done, and the call is over, we are going to talk about it. And we are going to talk about you. And should you decide you want to continue on this path I will urge you to first get your Emergency Medical Responder patch.... And I will probably give you my personal cell phone number and tell you that any time you want to talk about it to call me. Any time. I will be honest with you and tell you that I would much rather you get your EMR patch before your EMT patch because of your age. I'm not trying to downgrade you or say that you aren't ready for an EMT patch but rather just saying that "at your age" the logical step is to get an EMR patch which will allow you to ride on the rig but the ultimate responsibility for a patient's life will never lay in your hands. That's a huge responsibility to have at 15. As a side note, my son, who is 12, has his EMR patch and it might be a shock to some, but he is allowed to ride on the ambulance with me on certain calls. Granted he has grown up in EMS and has practically lived in an EMS classroom since he was about five years old, not to mention been witness to several car accidents that we have come upon while traveling and watched from afar as I've treated the patients. The last class that I taught he decided he wanted to take the State final and practicals..........and he passed......he passed all the skill stations and the written so "legally" he can practice as an EMR but legally and mentally are not always the same. I am fortunate that I work full time for a small service and I can pick and choose which calls I allow him to go on, but I always know in the back of my mind that at some point we could be called to something I know he shouldn't be involved in because it will be totally different on scene than what the call came out as. Thankfully my town is small enough that if he isn't able to stay in the rig, there will most likely be two or three extra people on scene that can take him home again and I can talk to him later about the call and why he wasn't allowed on scene. But in your case, it will be a totally different deal and I worry a little bit that you may get in over your head by mistake.....especially if you are running with a bunch of guys who maybe won't think twice about how something may or may not affect you....but on the other hand, I applaud you on the research that you have been doing and how you found this site. Your maturity level speaks to me of far older than 15 and I may be worrying for naught... Please keep us posted and let us know how you are doing....and never be afraid to talk to us about stuff..........good luck!!
    5 points
  38. **sneaks in the door, crawls over to the fireplace, grabs a wool blanket and sets a spell in the rocker** Hi all, I'm an old villager looking for a new home~~not sure I'm up to the "City Life" as I am truly a country hound.... but I will try to play nice with all my toys and be agreeable to disagree at times . I'm an EMS'r from the dinosaur years at times it seems, things I learned when I was brand spanking new in this world have gone away and somehow been reinvented and come back again... Truth be told, I started EMS in the early 80's and hit it hard for about fifteen years, then took a five or six year hiatus to try and make it in the "real world" but found that they didn't accept my way of thinking that sometimes, just sometimes (not always) you just have to just let natural selection run it's course and they forced me back into the world of EMS where I've been 'at home' ever since and will probably die doing this "job". Actually, I've never really considered this a job if I think about it, more of a way of life..... I've been known to be stubborn at times, but if forced with an appropriate and knowledgeable mallet, I may sometimes admit that I may have, or may not have, been wrong~~only time will tell if I can be housetrained for the "City Life" and I look forward to meeting and greeting all of you...I think I see a few "villagers" here so maybe they will accept me and still have one of my broken toys lying around somewhere and will allow me to sit in the corner and gnaw on them while the discussion goes on around me if I am contentious.... **waves at Kat and Ed** I am currently an Intermediate who is also an instructor~~soon I will be a thing of the past again and will be considered an AEMT and I'm really hoping that it's true what they've told me that my knowledge and wages will triple the minute I open the envelope that labels me as an AEMT...I think they also said something about "World Peace" happening as well... but I am excited about the national push to stabilize, equalize and verifize EMS across the board in the states and if it brings more uniformity and "togetherness" to the world of EMS to help us all grow up, then I am all for it~~yeah, like I said, "world peace" as well :0)~ I also work full time EMS, work at a local store on my off days to collect a pay check that makes up for what I don't make in EMS...lol, and run a rural volunteer ambulance service which has seen it's call volume almost double in the past year due to the "oil boom" in the western part of our fine state, and as the call volume doubled, the crew numbers decreased to half the size.... So as I said, I will try to play nice here in the "City" but I am a bit biased at times and if nothing else, have always been a strong advocate for my patients and what is and always will be right for them.... **sits back down in the rocker and sips her Rum and Coke and plays with her bloodhound SAR dog**
    5 points
  39. A key thing here is to know the difference between a dystonic reaction and tardive dyskinesia. Both can occur with the "typical" antipsychotic medications such as Haldol, Thorazine, and others. Medications such as Reglan and Compazine can also do it. A dystonic reaction is similar to what you describe. It can happen with the first dose or any subsequent dose of a medication, particularly if combined with other similar medications or after a dose adjustment. The onset is fairly sudden, and they may not have had anything similar before. I have seen this effect also from "energy drinks". I also saw this after administration of a dose of Zofran in the ER, but failed to find any reference in the literature to such reactions being common. Treatment is supportive, and benztropine (Cogentin) or benadryl can be given for the effects and is usually pretty effective. A dystonic reaction is reversible with no lasting effect. Tardive dyskinesia is an insidious movement disorder that can be caused by long term use of antipsychotic medications. It more closely resembles Parkinson's disease, with movement difficulties, ataxia, and cogwheel rigidity. The onset is over weeks to months and is not reversible. It is typically permanent. 'zilla
    5 points
  40. You believe in aerial spraying of Prozac... You believe the waiting room water fountain should be fitted with a valium proportioner You have ever reffered to a new ED Doc as a shit magnet You have ever eaten chocolatte pudding out of a chux to see if you can make the new resident puke You have ever had a patient look you directly in the eye and deny any knowledge of how some foreign body came to be in some orifice of their body You have ever asked a patient if she is sexually active and she answered "No I just lie there" You believe chocolate is a food group... You refer to vegetables and are not talking about a food group... You believe a good tape job will fix anything... You disbelieve 90% of what you are told and 75% of what you see... Your idea of comforting a child includes placing them in a papoose restraint... You believe that "shallow gene pool" should be a recognized diagnosis... You believe that the government should require a permit to reproduce... You believe that unspeakable evils will befall you if the phrase "Wow, it's really quiet" is uttered... You threaten to strangle anyone who even starts to say the "q" word when it is even remotely calm... You are totally astounded when someone on a convalescent home's staff is understandable... You say to yourself "great veins" when looking at complete strangers ... You have ever referred to someone's death as a "Celestial Transfer"... You have been called out on a police tactical response and the call turned out to be for a shooting pain... You refer to someone in severe respiratory distress as a "smurf"... You have ever wanted to hold a seminar entitled "Suicide...Doing It Right"... You have ever had to leave a patient's side before you begin to laugh uncontrollably... You think that caffeine should be available in I.V. form... You have ever restrained someone and it was not a sexual experience... Your most common assessment question is "what changed tonight to make it an emergency after 6 (hours, days, weeks, months, years)?"... You carry your own set of keys to the "leathers"... Your idea of gambling is an blood alcohol level pool instead of a football pool... Your bladder expands to the same size as a Winnebago's water tank... Your feet are slightly flatter and tougher than Fred Flintstone's... And finally: You might be an EMS professional if you find any of this funny!
    5 points
  41. "What's up?" "What's going on today?" "How are you doing today?" "How can I help you today?" I'm thinking about transitioning soon to "Please state the nature of your medical emergency."
    5 points
  42. It's come to my attention that we on the City are often very inconsistent as to what biases we will accept, and what kinds of "stereotyping" we take for granted. For example... the shit storm of a thread prompted by a single joke about hysterical black woman syndrome. Wow! Just looked at that this morning... and I gotta say... holy Jesus (hey, zeus!) what a mess. On the one hand, you have the ethical provider, with a no-tolerance policy... (but nobody likes someone who likes to point out the rules...) On the other, you have folks saying "well, we've seen it... and no, we don't treat patients differently..." But I challenge you.... how can a stereotype NOT influence how you view someone? The second you know they are (let's keep the original group here) a black woman, you're going to have that little joke pop up in your head... and consciously or unconsciously, the way you interact will be influenced. Doubly so if you happen to be a different race than said black woman. We could get into comparative racial psychology, if anyone wishes... that's a tangled web all unto itself, my friends. But wait! There are those who purport that just knowing someone is in a certain group won't change how they interact with that person... and then turn around and DO THE VERY THING THEY SAY THEY WOULDN'T. Want to know what group I'm referring to? Fire personnel. The second some of our illustrious posters hear that someone is a member of the fire services, or a person steps up to defend their group, whom they perceive as being unjustly attacked, some of us jump both feet forward and go so far as to cast PERSONAL ASPERSIONS on that individual. Wait! I thought we said we didn't make broad assumptions, just because someone was a member of a particular culture? Hmm.... it appears that we do. I know a lot of us have an axe to grind and feel that the fire system in the US is holding back some of the development of EMS. This is true. The system is rigged. There are injustices. But to point fingers and play the blame game with individual peons who are within that power system, who really have no influence over how it all works? That's just plain stupid. It's like those of us who become frustrated because minorities cry "unfair!" with regard to academic opportunities and job opportunities... yea, there are some institutionalized biases that most of us don't even see, and boy, don't you feel attacked when someone points the finger and says "You have all this privilege because you're white, so YOU (as an individual) suck!" Sure. There may be some advantages conferred by being a member of a certain race or culture. But is it MY fault that the school systems in the ghetto suck? Well, my friends... simply insert "firefighter" for "white" and "EMS" for "minority".... take a good hard look at this parallel, OK? Recognize your biases. Own them. Illuminate where they are influencing your arguments. But don't pretend you don't have them, as that's hypocrisy at its finest. Wendy CO EMT-B
    5 points
  43. First, I think this suicide business needs to be put into context: The human body is a biological organism that is entirely built around survival. In fact, it's only been the past several thousand years where we had creatures on this planet that have been able to really think and ponder concepts that do not directly stem from "survival instinct" if you will. We in health care, who are also scientists in a sense should be keenly aware of just how important survival is. It's built into our nervous systems, we see in in the ability to clot, we recoginse it when we undergo physiological changes at high altitudes, we see it in the physiology of our patients who are experiencing various forms of shock. With that said, when a person is at a place where they are essentially overiding millions of years of evolution and natural selection based around survival, this should be considered profoundly abnormal. I know many people simply look at suicide as being a sin or a profoundly selfish act. However, a person has to be profoundly disturbed to overcome basic survival programming. Unfortunately, we often do not really appreciate the absolute seriousness of a person who is suicidal. If we can appreciate suicide for what it is, then we can appreciate how desperate and profoundly sick these patients are or were. We clearly appreciate the gravity of the situation when a patient has severe DKA, but often fail to appreciate that with people who are suicidal. With all of that said, we should also realise that mental illness is not a problem with the "soul." It is a real, tangable and potentially devistating problem that requires aggressive treatment just like the DKA patient mentioned above. Even after initial treatment, this is often something that will not go away. Just like insulin dependant diabetes, we understand that a life long battle will ensue. Also, just like diabetes where even compliant patients can end up with serious exacerbations such as DKA, we can expect people who struggle with depression and suicidal thoughts/ideation and the like to also experiences exacerbations in spite of treatment. Religion is a tricky subject. While I believe it can play a positive role in some cases, we need to put religion in to proper context when considering the physical world. Religion is not a particularly good mechanism for exerting control over the physical world in the sense that things can magically occur as a result of divine intervention. I could be wrong, but have not appreciated evidence to suggest my hypothesis is incorrect. However, religion can play a significant role in people who can use it to help make sense of "life" and esoteric questions that cannot be answered by science. Religion can give us faith, hope and fellowship. These are all potentially important and helpful. Religion is a good way for like minded people to get together and support one and other and hopefully support others who are not as like minded, but that is another topic and another discussion. Clearly, this can become perniscious in some cases, but can be very helpful and supportive for some people. I see religion as playing a role in helping people in certain situations, but it cannot get in the way of therapy that is based on observation and emperic experience within the physical world. It may sound like I am an atheist; however, many here know that is not the case at all. With that, we cannot let our faith based ideas encroach upon the emperically derived physical world. My best wishes and thoughts go out to people who struggle with these issues because I gather the struggles can be difficult and are life long.
    5 points
  44. "The road to Hell is paved with good intentions" It doesn't matter how deep you've paved the road with your 'good intentions', it's still the road to Hell.... First off, you stated that you administered the Nitro, then you change it to you 'helped him by getting it out of his pocket'. In the world of documentation, you're dispensing medication without a license, and THAT my friend is illegal. Secondly, in all your 'gear' that you have stashed in your personal vehicle, how much of it are you traned in using? How much education (aside from advanced reading the EMT books) do you have in interpreting your findings? How much of an assessment are you trained in performing? What education do you rely upon to interpret your findings there, and what education are you basing your planned course of treatments on? What equipment do you REALLY have available to you in case the patient needs more than band-aids and a c-collar? You jumped a call for the 'adrenaline rush' and you put yourself, your 'patient' and anyone that had to come rescue you and your patient at risk because you have no clue what you're doing! The fact that you 'snuck off' after the EMS crews took over (especially when they made it perfectly clear that they wanted to talk to you) shows that you KNEW that you did things wrong and didn't want to face the consequencs of your actions. This is NOT a 'good quality' for a future EMT to have! Compounding things is that you came to this forum and asked 'What did I do wrong?', and when your errors were pointed out; chose to try to 'justify' them and shif the focus from your screw-ups to blaming everyone that responded for being 'mean to you'. Another negative attribute. As has been pointed out by people who are much more intelligent than I am, you 'screwed the pooch' on this one, and all the heat you're taking is well earned. I've noticed that your story is starting to change from your initial post to the incarnation of the tale we see now. There are several facets of this whole incident that beg to be addressed: 1. DITCH THE SCANNER! It and your actions have already dumped you in a steaming pile of cow puckey, and potentially cost you everything you've ever HOPED to have (up to and including your dreams), and you could be facing jail time on several charges. 2. PUT THE 'GEAR' AWAY UNTIL YOU'RE EDUCATED AND TRAINED IN IT'S PROPER USE! Just because you've read a couple books doesn't qualify you to do anything more than stand at the edge of a scene and look at the pretty lights. The best way you can 'help' right now is to keep your cell phone bill paid so you can call 9-1-1, and get QUALIFIED/EDUCATED responders en route and on scene... 3. LEAVE MEDICATIONS ALONE! You're not qualified to administer drugs, or even assist in the administration of drugs. If you keep this up, you WILL find yourself in jail on some SERIOUS charges! 4. DROP THE RANDY/RACHEL RESCUE MENTALITY! This will only set you up to get sued, land in jail or injure/kill the person(s) that you're supposed to be helping, because you've got no education/training do do ANYTHING other than put a band-aid on a 'boo-boo'. 5. OWN YOUR FUCK-UPS! The sooner you start owning up to your mistakes, the sooner you can start learning that every action you do has consequences. Even the 'Good Samaritan Act' has limitations on what you can and cannot do. You've violated most of them; if I were you, I wouldn't expect that act to provide much cover from the shit-storm you've started. If you REALLY and truly want to help people, leave it alone until you've completed your education and training so that you can do it without doing more damage than you prevent....
    5 points
  45. First, do you think his death has impacted me any less than the others here because I lack belief? Second, are you stating my coping mechanism has no relevance here since it is not religious in nature? The topic is how we cope, I shared, others shared. I knew Rob personally, I also knew his beliefs or should I say non-beliefs. It is entirely relevant and entirely appropriate place to share...unless you have a different copy of a rule book somewhere?? Dust, still able to stir up a thread without actively contributing...awesome!
    5 points
  46. Brother, let me break this down for you, and I'm not being shitty, as it can be hard to understand where people are coming from if you don't live/work in this field. You believe that you helped, that you showed that you care by leaving your home and showing up. Many others do the same, and like you, most often they harm people with their ignorance. Now, don't confuse the words ignorant and stupid. You can fix ignorance... The bent steering wheel is a huge deal to most of us here as it tells us that the pt, in one way or another, transferred a ton of energy from his body to the stearing wheel, and that almost never comes without significant injury. Almost every injury that can happen from that mechanism is going to be life threatening, and most of them will cause the medics to have a battle to control and maintain the patients perfusion. (blood pressure) Now the body will fight to keep that blood pressure up, to keep the organs fed. But by giving him the Nitro you gave him a medicine chemically designed to fight against the body's efforts to save itself. You claimed that his 'vitals were fine' but not a single paramedic in this conversation, no matter how many years they've been practicing would make that statement on this patient without taking them again and again over a period of time. If this patient had any of the injuries common with this type of accident there is a very good chance that you killed him with your treatment. It is likely a good thing that you ran away, as there is also a good chance that you would be in jail now if you hadn't. It looks, from the outside looking in, like people are doing a bunch of mindless bullshit when you watch them on scene. But most of the important stuff is happening in their heads, not in their hands. You hurt a man. You claim you wanted to help, but all here are telling you that you almost certainly harmed him instead, yet your response remains, "Well at least I did something!" This is a professional forum full of people that have payed their dues for the right to go behind the yellow tape. Most have payed with years of their lives. They are intelligent, and have the ability to help people. You should really, really not kid yourself into believing that just by running to an accident and being willing to get bloody makes you a good guy. As in this case, it doesn't. Stop pretending that you want to help by buying bandages and hanging out with the local volly squad and actually get committed to doing some good and get the education necessary to do so. In this case, this man would have been better off if you had never shown up. He would have been healthier and safer if he has sat there alone until professional responders showed up. That's not your fault, because you didn't know better. But now you do. So what are you going to do? Continue to cry about it, or get the education to Do good, instead of Pretending to do good? Not running away, and continuing to participate in the forums is a good start. If you have the balls for it. Dwayne
    5 points
  47. You rang? I'll start by saying that I think the OP is BS (either that or Dust is screwing with us from beyond. I wouldn't put anything past him. He's probably loving every minute of this). Assuming it's legit, let's start with the fact you practiced medicine without a license. Show an EMT book that says it is legal for an EMT to give nitro. I doubt any generic EMT book, such as Brady, will say what is and isn't legal when it is used in multiple jurisdictions. A protocol manual from a specific certifying agency might say it, but no general EMT book will do so without saying something like, "See you local protocols to see if this is allowed in your jurisdiction." Secondly, you are not an EMT so it does not matter what the EMT book says. You had a good chance of killing this guy and are lucky you didn't. Your actions could have landed you in jail and no, you would not be covered by Good Sam laws. You were practicing way beyond your scope. You fucked up big time. Lucky for you, you didn't get caught. Eat your slice of humble pie and move on. Learn from your mistake. It's great that you are eager, we encourage that here but take it down a notch before you do some damage. You are under 18 and will have plenty of time to get on those awesome, adrenaline filled calls. Learn what you need to learn so that you don't hurt someone next time. Remember-Primum non nocere. Don't let your ego exceed your knowledge. As others have said, turn off the scanner. The only equipment you should have in your car is basic first aid supplies. If you stay in this field you will come to learn that the more stuff you carry, the less experienced you are. I hope you stick around, there is lots of good advice here, but you need to check you ego and attitude at the door. EDIT: As for why not today, have you looked around. There is a huge banner across the top of the page and a huge thread about it. We lost a great member today, someone who has tried to move EMS ahead. He was a personal friend to many and a mentor to many more. To come on here today and act the way you did is disrespectful to those who are mourning. Think of it as being similar to making Sept 11 jokes in a NYC firehouse.
    5 points
  48. Misunderstanding Alert. I didn't say what was wrong with the patient, b/c that wasn't the purpose of my quip. I don't post when I cut a trauma victims clothes off.. There was swelling, bilaterally, they were stretched so tight I just barely got the tip of the pen cap/pocket doo hickey under them. I cut them so as to restore color and use to the hands. I was just sharing my story of how I coined battle scared silly bandz. They're annoying. If the patient already had them on "tightly" b/c of arm size, consider what will happen if the extremities swell. Thanks for assuming I hate the patient b/c the patient wears black. Thanks for making me feel bad, I should have said that I cut them off b/c it was medically necessary. But since it's a big fad now, I thought I'd share my first experience with silly bandz. They stretch, but not enough, dozens of tiny tourniquets.. I've been an EMT for eleven years, paid and volunteer. Never had one complaint from a patient. I have my own way to go about things, I'm big on the statement in our protocols that allow to form them for the best care of the patient. I like to be able to go home and ask myself if I did the right things, and I did that best I could. The same protocols, b/c they aren't shaped for rural EMS, ended my week badly. They didn't allow me to save my patient, b/c of a technicality.. I thought this was a funny story, not too often can you get a funny bit out of a horrible situation. They don't teach how you talk to someone who doesn't want to see tomorrow. Nowhere does it say that I didn't like the patient. The pt., lacked appreciation of life, per se. I tried to pull them off, got one of those cause bands off. But the others were screamin', said I'll buy ya new ones kid, but they're coming off. I do that sometimes, if someone says it's my only good pair or.. or my only good.. I feel guilty and offer, once I obliged. I got called stuff that would make a preacher faint. The pt. was pissed, but when I told the pt. what (the pt) could do with them now, well that was funny, and it opened a rapport, more info was spilled out, and that was that. But nobody wants to hear about that.
    5 points
  49. I earned the negative rating it is not linked to this post but rather me. It wasnt easy to get this rating it required alot of effort and I get really upset when someone agrees with me and gives me a positive rating which ruins the whole thing. I was at -21 just a few days ago and 3 rude dogs went and ruined it by giving me positive feedback. As far as cheating on anything the old saying that 'your only cheating yourself' is true, education uses testing to measure whether the approved subject matter has been presented well and that the students have retained it to a level considered acceptable to the governing body in charge of the discipline studied. It is not the end all of the curriculum just a tool to measure teaching skills and student retention. When students fail a course the person at fault is not only the student but the teacher. If you teach a course and your students do the bare minimum or cheat to get by you either did not impress upon the students the importance of your course or did not weed out the students that were not suited for your course.
    5 points
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