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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

It's on again... http://med.wright.edu/em/caplab/ Dayton OH at Wright State University. It is our 4th annual Cadaver, Anatomy, and Procedure Lab for EMS (CAP Lab). It is an all-day (one day) seminar on cadavers, live tissue, and simulators covering a variety of topics, held on Dec 9 and 10. We are offering it for $35 to EMS providers of all levels, and it's good for 6.5 Cat 1 CEUs. The Lab starts with a 45 minute lecture and anatomical review. The students (usually about 100 per day) are divided into groups of 10 to rotate through several stations, which are all taught by residents and faculty from the Dept. of EM as well as PAs from the EM PA Fellowship at WPAFB. Students get to practice procedures as well as get hands-on with the cadavers for close instruction. Stations include: Surgical airways Rescue airways Field amputation Tactical/battlefield medicine Neuro, with cadaver brains Cardiac, with cadaver hearts and EKG review Cadaver airway, chest decompression Vascular access Chest and abdomen anatomy Musculoskeletal anatomy Website: http://www.med.wright.edu/em/caplab/ When you register, put EMTCity and your username in the "comments" area. Registration is not open yet, and I will post here when it is. Attendees must register to receive directions and important info, including disclaimer forms. Email address is on the website if you have any questions. Slots are open until they are filled. No, you can't stay at my house. With any luck I'll be teaching it again if they let me out of Iraq in time. From last year: http://www.emtcity.com/index.php/topic/13528-cadaver-anatomy-procedure-lab-for-ems-dec-3-and-4/page__st__140 'zilla

Both are guys I know! I haven't read Kelly's book because I just don't read books anymore. But he was at EMStock with tniuqs and I last Fall. Good guy with a great way of presenting his insight grippingly, with a humour that sinks his wisdom home. I've known Bob Mason for twenty years. Wonderful guy. Although not as commercially successful, I felt his follow-up book, "Chickenhawk: Back In The World" was even better than the original. Brutal honesty. And it foreshadowed things to come in my life. But yeah, the way the original book ends is a good lesson for those in the emergency services. http://www.robertcmason.com/ Incidentally, Bob is also the author of a book called "Weapon", which was made into a movie called "Solo" back in the 90s. The book (SciFi) was a lot better than the movie! http://www.imdb.com/title/tt0117688/

Also, although not to any extreme, take a clue from M*A*S*H's Frank Burns. His attitude was, any patient who died on him was either unsalvagable, God's decision, or someone else's fault. Having said that, NEVER let it just roll off your back. Follow any and all of the suggestions made, and that will be made, in this string. One or more of them will be the right answer(s) for you.

Good for you brother. I'm grateful you took my comments in the spirit intended. I too think that you will do outstanding. Sometimes we get kicked in the boys and need to rely on our friends to tell us to stop, think, then rethink, and then get back to work. I'm practically a mistake factory. What keeps me up and running is identifying what I would have liked to have done differently, make a plan to help insure that I do so in the future, and then refuse to waste a bunch of mental energy, that my patients can use, telling myself what an idiot I am. I'm proud of you for deciding to be a professional, to take a little time to be confused, accept that that's sometimes necessary, seeking help, steering yourself back up out of the ditch and onto the road and going back to work. Good for you man... Dwayne

That's quite a story, Paul- thanks for sharing it. Sounds like you went through hell and back. Yours is an object lesson anyone can learn from. I tell all my students and new guys/gals that one of the most important things you can do is watch the back of your coworker. We have had several members commit suicide or drink themselves to death over the last few years. I realize you cannot help someone who isn't ready to accept it, but you have to try. Hopefully you can intercept someone before they go down such a dark road that turning around is nearly impossible. Here's a little story. About a year ago, a friend of mine- an Iraqi war vet returned to the job after his tour of duty. As with many vets, he was having trouble adjusting to life back home and ending up with personal problems- a divorce, anger issues, and discipline problems at work. I notified our employee assistance people that this guy probably needed some help. To make a long story short, there was no program in place to deal with vets and their issues unless the person requested it. We all know how stubborn public safety folks can be about asking for and/or accepting help, so clearly we need to be more proactive in our efforts to reach out to folks. My buddy was approached by the counseling staff, was agreeable to the help- thank gawd, because it may have saved his life. He received counseling, the divorce was settled, after awhile felt a lot better, and he's dealing with everything in a healthy way.

A slang term used in the North East and New England for firefighters.

Lying union fags. And wtf is a "jake"?

A Majority of my calls are now flu related in ur an ems, and the area hospitals are over run. Maybe if people would pay attention to the news and not call 911 or go to the ed for the flu this wouldnt be an issue.

My first critical call and I missed something too. It tore me up. I got a great deal of support from my EMS family but it took time for me to feel better about it. One of the things that helped me was that I knew I would NOT make the same mistake twice. The protocol for that type of call is forever seared into my soul. I knew that I will use what I learned on that call to save someone else. I later found out that the mistake was meaningless as the patient was doomed. Perhaps if you follow up on the patient, you may find information that will put your .01 into perspective. The other thing is a psychological point. It is hard to accept that sometimes you cannot do everything right and people die. Your overall responsibility in the situation is very small. You did not create the illness/crisis and I am certain that you did the best you could at that time. By raking yourself over the coals, in a way you are trying to control what is essentially uncontrollable. It will happen. Take this as an opportunity to be a better provider and learn from it. Forgive yourself and move on.

As long as it isn't written by some twit who became and worked as an EMT after dealing drugs for 20 years while working at Walmart. Then felt enlightened so much he/she had to write a book to occupy all their time since they retired after a year because he/she couldn't handle the stress.

Though I most often disagree with Spenac as he tends to parrot the more popular opinions expressed by those before him, I do think he makes a half assed decent point here. My first call on my own truck at the service I work for now was a 3 month ped arrest. First friggin' call. In fact it was relatively famous locally. I got pulses back but the child died when removed from life support two days later. There were tears all around me, but what did I feel? Nothing but an intense need to review my personal performance as well as my direction of the team. I was told by others that I would be damaged after I had a chance to think, but thanks to Akflightmedic I'd had Afg to refer to and knew differently. This child was in a trouble not of my making, and though I did the best that I could, I made many significant errors in treatment. But, on this day, it was my best. One of the many debts I owe to EMTCity, Dustdevil, Ak and many others is that I entered that situation with the knowledge that it was unhealthy to let other, non psychiatric professionals, tell me how I should react to that situation. You did, in my opinion, exceptionally well with your pain. EMS is going to bring pain sometimes. We know that, and should accept it I believe. But deciding whether to seek sympathy, or instead find the help we need to stay healthy and then move forward separates the men from the boys. I'm glad you let us see, hear, and thus learn from your experience. It was brave, and we're all the better for it. Look me up if you get to Colorado. Dwayne

Think about it, if you're moving to NY on a CNA/EMT salary, how are you going to be able to afford rent in a gated community? Sure, Belle Harbor and points west are nice to live in, but how do you expect one to buy property making 10-20/hr? When I said stay away from Rockaway, I took into account that the more affluent and safe areas would be out of reach financially speaking. Anyway, if these areas are so safe, then why is a security force necessary? Also, If one wants to move into a decent part of Far Rockaway, don't they need to be Jewish? There are decent people as well as nasty ones anywhere you go. What important though, what matters is your surroundings. I've been redeployed plenty of times to the Rock, typically near PenGen, on 53I, 53D, and 54Y. I know what goes on. I worked for Hunter Ambulance as well, and drove around when not on a job. Going east of 116th, you can't tell me that anything in that direction beats living in Middle Village or similar areas. Sorry. And, if you're commuting by car, you need to pay a toll to get into Queens the quick way, and the train takes forever. Speaking of 116th st, I've been going to the beach there as long as I can remember, up to around 1995 or so. I have plenty of pictures in the family photo album from there. I've seen it slowly change for the worse over the years. Now I wouldn't be caught dead there at night. Smart move restricting street parking west of 116th during the summer. It keeps the rest of Rockaway segregated, as well as beachgoers from Queens and Brooklyn. Really, when you get to Belle Harbor, it's like night and day compared to Far Rock, Arverne, Rockaway Beach/Park, and anything else in the area. Long Beach, Jones Beach and Robert Moses are much better choices. Riis park is okay, but there are much better places to go. Anyway, for Floridastudent, I have a simple solution. when considering a neighborhood to live in, drive around the neighborhood around 1900 hrs, and again at around 2300 hrs or so. Observe who lives there and what goes on. I'm referring to criminal activity, loitering, police activity, not demographics per se. Are there thugs IFO every bodega at midnight, watching you intensely as you drive past? Check for an abundance of graffiti, the condition of buildings (well maintained or in a state of disrepair?), and how clean or dirty people keep their property. Do the math, so to speak, and decide what environment you're willing to live in. Plenty of work in Queens, Brooklyn and the Bronx. Some privates off the top of my head are transcare (IFT/911), Citywide, Hunter Ambulance, Midwood, North shore Ambulance (not affiliated with the hospital) and AMR (IFT/911). Hospital based EMS in the outer boroughs include NSLIJ CEMS, NY Prebyterian (Cornell), NYHQ (Booth)and Jamaica/Flushing/Brookdale. St. Johns on QB and Mary Immaculate went bankrupt and closed due to a scourge of uncompensated cases. Pulse and a patch are good for privates, the hospitals take more work or a hook. Your best bet for getting hired and breaking into NYC 911 would be Transcare or Northe shore LIJ. My advice, get an ER tech position, maybe go per diem at a private, and try to get into EMS at a hosp. if that's what you want to do. NSUH Manhasset was paying ER techs 22/hr back in 2007. Look there, and try for NSUH EMS if you want.Otherwise, go ER tech>RN>challenge medic. It's easier to get into RN school and also get work as one than it is elsewher in the country. Only go FDNY EMS if you plan to stay in NY for life, and value a so-so pension and decent medical over hourly compensation. Otherwise, it's not worth it. Now that I think about it, the state gives pensions. A friend of mine left NSLIJ to work as an RN at Stonybrook hosp out on the island. 65k to start, 25 and out pension. If I had planned on staying in NY, I would have gone that route myself.

I read a great book by Kelly Grayson called "enroute". It is essentially his memoirs over his career in a series of short stories. Each story relating to a memorable call he had been on. From the joyful to the bizarre to that one call none of us will ever forget for the rest of our lives, I found myself reading his book and thinking, "yup, I've been there and I know exactly where he's coming from." Another book you might like is the memoirs of a Vietnam vet dustoff pilot. Even though there is a slight lull in the book at about the 3/4 point the first few pages and the ending left me amazed at what this man accomplished and how he ended up after the war. The book is called "ChickenHawk" by Robert Mason.

Hello all! After coming here once only every few months, my life has stabalized to the point that I can come back! Annnndddd with that being said, on to the topic at hand! I decided to forgo prehospital education in favor of med school, and seeing as I kind of lazed around in high school (it wasn't so much like that as I opted to work and a long story... But that is most likely what medical schools will think of my transcript), I have decided to co-author 2 articles that I am going to try to get published. The main one, on the mechanism of apnea occuring secondary to oxygen administration in patients with associated COPD, does not really concern prehospital providers as much as the second one (that and I have a lot more work done and insight on it )... The effacacy and safety of traction splints versus manual traction and narcotic administration in suspected midshaft femur fracture. I got the idea for that after attending the 2009 Wilderness Medical Society's annual conference. Basically a review of the literature shows almost nothing about traction splints. Are they effective in reduction? Are prehospital providers in general capable of employing them effectively? In an urban setting do the pros outweigh the cons? How many patients are seen for soft tissue injuries secondary to traction splint application? How does the pain control compare to narcotic analgesics (fentanyl is what I am thinking specifically)? If you guys could let me know what you think the likely outcome of this study would be, or even if it would be something you would be interested in reading, let me know! Also, if any of you ER docs out there are going to be willing to partner with me to complete it, I would be eternally grateful! This goes for either study.

THere's a super great book..not really EMS but it's about wartime medicine...called On Call in Hell. It is written by CDR Richard Jadick who is a recipient of the Bronze Star with a Combat V for Valor. Inside Jacket: "Not even working as a resident in a shock trauma center in downtown Baltimore could have prepared Richard Jadick for this. The two-month-long Battle of Fallujah would be remembered as one of the bloodiest episodes of the war, with some of the worst urban combat seen by American troops in decades. And here he was in the middle of it... In spring 2004, with the military reeling from an acute doctor shortage, Jadick, a Navy doctor, volunteered to accompany the First Battalion, Eighth Marine Regiment (the "1/8") to Iraq. Five days after the birth of his daughter, he shipped out. When his unit was ordered to take the center of Fallujah, Jadick found himself under fire--and in hell. But instead of letting the wounded come to him, he went to the wounded, setting up a makeshift emergency room in the middle of the battlefield. For eleven days at the Forward Aid Station--and many beyond--Jadick and his team worked tirelessly and courageously around the clock to save their troops. It is estimated that without Jadick at the front, the Marines would have lost an additional thirty men. Of the hundreds of men he treated, only one died after reaching a hospital. Wrenching and at the same time uplifting, On Call in Hell offers a portrayal of brothers in arms--and a snapshot of war--that few will be able to forget. Awarded a Bronze Star with a Combat V for valor, Jadick has become a modern American legend--and a hero for the ages." One of the best medical books I've read in a long time

Definitely not bashing it as a few of the hospitals I have been at support it for medical uses and do believe it is better than Marinol. It definitely is a better perspective on marijuana than reading the numerous threads on an EMT forum about "I smoke pot. Can I be an EMT?"

Oh darn I missed it ...pfft. The reference to Tony D from NCIS .... I must protest that guy's hilarious and can act, does a great Shawn Connery

Has anyone seen this website yet? It's called Post Secret, it allows you to send your secret to this dude in complete privacy on the back of a post card. I read through some of them, man some people have serious secrets they are hiding! Regards S

They change the secrets every week. I love that website!!

First of all, congrats! Talk to your school about what vaccinations you will need for the course. Some programs dont require any, some will require everything under the sun. Of course its always better to be safe than sorry. As others have stated, strengthen your core as much as you can. And since you will be lifting with your legs quite a bit, work on your squats and lunges. The most important advice i can give about taking an EMT-B course is to always volunteer to be part of the in-class activities. Practice makes perfect. There will be plenty of people who are too embarassed/scared to get up in front of the class and try the scenarios, and those people arent getting the most out of the class. Nobody picks this stuff up on their first try, so dont be afraid to mess up, we all did.

I think words such as busted and dusts favorite Pawn3d come to mind. http://news.bostonherald.com/news/regional/view.bg?articleid=1207257&srvc=home&position=emailed "According to EMTs and internal e-mails between firefighters and Boston EMS, city jakes have long complained on the rare occasion they are required to go to what are known as lift assists. The caller is rarely injured and needs nothing beyond help getting up. (Its) just another attempt by the firefighters to distort the truth and draw peoples attention away from the real issues of drug and alcohol testing, said Meninos campaign spokesman Nick Martin." "In January 2004, under the title “Proposed EMD/Dispatch Changes,” Fire Superintendent John Henderson refers to the fallen elderly calls as a “nuisance” that Local 718 members are overqualified to deal with."

So very true, some of them are seriously funny to.

I love that website! I own all the books as well. The author/creator is a local to my hometown so we heard about it pretty early on before it became such a wonderful website/books. It's a great idea, although some of the secrets are so sad

Everyone handles these type of situations differently. Some can cut the mustard, some can't. Almost everyone will have some sort of 'uneasiness' went confronted with the 'hair, eyeballs, and teeth; blood, guts, and gore'! My advise to you may differ from many other providers out their. Dependant on the situation, one must realize that this is a 'patient' that you were summoned to help. Whether is be a simple or complex scenario, always remember your there to do the job to the best of your ability, to provide patient care and comfort. Is this always possible.....no.....but you must always strive to do the best you can. Don't be afraid to step back for a second, take a deep breath and put yourself in the right frame of mind to handle the job. Again, this may not work for everyone, but it has for me. I've dealt with 7 pediatric codes my first year as a Paramedic before my first adult code. That's a pucker factor! I have also dealt with MCI's (aircraft crash of DC10) with multiple patients, young and old, with all the patient descriptors you could think of. Look back and rely on your training. Prepare yourself for the job and one addage I use is: never approach your thinking as 'if it happens, what am I going to do', but 'WHEN it happens, what am I going to do!' The right frame of mind and confidence in yourself will go a long way. Good luck with your career!

Before the start of my EMT-B course I had to get the following: - DTap - Hepatitis B - MMR - Varicella - TB Test

For most people, you can either deal with it, or you can't Some people it doesn't bother them at all. Me for example, I have see a wide variety of "gore" and gross things. I kept my composure where it needed to be. Seeing such things doesn't always get to me, but sometimes it does. We are not statues, we are human. This is one of the many reasons there are CISD teams. So you can talk things out, or even get further help from a professional. Don't be embarrassed! Seeing pictures of things is definitely like it is in person. It kind of hits home more, but looking at pictures might prepare you for what you might see. People try grossing me out by sending me nasty pics, and quite honestly, I don't even look. I deal with this stuff in person, I don't need to go looking for it on my down time. If you come upon a scene and you don't feel good, excuse yourself and walk away. There is NO shame in it, even if some people give you a rough time for it. But it's all in good fun! You will make it through.

Lots of good points. I don't know how to multi-quote, and there is no need to recap on them all. Just a few and probably out of order. Yes, you can buy an ambulance off of craigslist if you look hard enough. Whether it is stocked or not, I guess that is up to the seller. (The phonies only saw the outside anyway, they didn't know for sure what was inside) Dressing up for hallween at work (in EMS/Hospitals) is unprofessional, but I suppose depending on what you are wearing, it could be alright. For example, a lab tech wearing a vampire costume or something. I am only 26yrs old and I know about Goldfinger and the chick laying there near dead in blue, did remind me of the chick from the movie in gold. I have seen flight crews do ground calls in extreme situations, but not actively "running" calls from dispatch. LifeLion, out of Hershey, for example has a NICU ambulance. Also, seen a flight crew transport by ground when they came onto scene and the helicopter had maintenance problems and was not flyable. But again, extreme circumstances. When weather is bad, HEMS is grounded until further notice, like Richard said, weather breaks. Now your crew is out joy riding when they could be landing on my house to save my choking dog. The collar guy was asked to leave, and it appeared he walked away. I would still have called PD because these people often do come back, which this guy did. PD showed up REALLY quick and I don't recall anyone radioing for help. Sorry, but San Fran is a very known city for homosexual population, and The Castro is also a well known gathering spot for them. They are famous for Halloween there. As far as Boone not liking gays, maybe he doesn't. A lot of people feel uncomfortable around them. As for his "partner" being gay, that was just funny/ironic. Not sure if Rabbit hates kids, or it just intimidated by them. I think maybe he had a rough child hood or something like that. The kids he was around, he was nice to them. I think there is a lot more to this guy than they are leading us to believe. He is a know it all jerk that is a rebel. We all know people who are like this, in AND out of EMS. I think this char will develop a lot more and end up being a cool guy teaching others (like he did with hot pilot chick). Pilot chick turns out to be pretty cool and capable of doing her job outside of her "job". Even though it might be out of protocol? Not sure if EMT-B can do IV there. these are not hits on you Richard, just my views on the things you pointed out and yes, we should discuss each episode. It's not THAT BAD of a series. Needs a lot of work, but it gives us something to talk about.

When I first started, I really thought it would bother me. A good friend, who is a child psychologist by day, gave me the following advice when you're on a really nasty gory scene: Label how you are feeling. So you show up and see blood and guts and vomit everywhere, recognize the emotions you are feeling and put a label to it. "I'm feeling queesy and like I could faint." By putting a label to it, you are recognizing the emotion and feeling and not letting it take over how you are feeling. You might still throw up or feel faint, but I have really found this little trick to help on all scenes. With child abuse or elder abuse it helps me keep a level head on scene and not get pissed off at the abuser. By saying to myself "I am really angry at this person" it calms me down. Not sure how it works for all but it is how I deal with it and it distracts a part of my brain from getting disgusted. Labeling the emotion tends to distract your mind from dwelling on how gross the scene is or how upset or angry you are. Hope this helps, and best of luck to you!

Very nice catch, Rich! I too was beginning to wonder just how old this guy is supposed to be because of that. Another nice catch! I missed picking up on that. I was looking for it too, because every episode has had them set us up for something like that, and then something completely different happen. I figure he starts off as anti-gay, just so they can develop his character later on. I've been trying to figure out if the flight op is even part of the SFFD EMS system, or if it is a separate entity, as they are around here. I thought it was separate, so was surprised to see them take to the streets. Yeah, even the most ghetto operation would take it out of service. Not like Ford windshields are hard to come by. Maybe I just have advanced gaydar, lol. All the actors in this show come across entirely too metrosexual. But that guy especially stood out as a little more light in the loafers. And when he kinda mumbled about working in so many different places before SF in a previous episode, I immediately figured he had some personal issues. I pretty well guessed he was teh ghey. The Station Nightclub Fire - Rhode Island A friend of mine from my band days is from RI and was actually going to go to that club that night, but didn't at the last minute.

I am sure it probably actually happened!

So far my favorite part of the whole series, was the guy in the collar beating the crap out of the rig with a baseball bat over his bill. Extreme yes but i'm sure there are alot of people who have thought about doing it.

Speaking as a non-paid EMT...yes, that's right, a volunteer: Take her out of the system. ...not all of us are motivated to serve biased on what we can and can't get. And some of us don't even earn money to motivate us; some of us just do our jobs because we have high hopes that when we're in trouble, someone will come to our aid. My department still hasn't recieved H1N1 vaccinations; we've had them going out around us, just not to us. You don't see me throwing down my stethescope and refusing to answer calls. I have N95's if I feel in real danger. We've also had more than just one confirmed case in our area, thanks to the county fair. :/ Thank MFRI for keeping us up with that...

Helicopters make house calls? I have to call medical command and kiss his ass to justify flying a CVA victim, and we're nearly 60 ground miles from a stroke center... Great idea to give the public. "Why didn't you fly him like on TV?" The props dude needs to inflate and glue closed, the bags on the oxygen masks. That way it looks real.

I think it's important to decide why you messed up, and why it's effecting you so severely? I mess up something on every call. I know, as I find something else I wish I would have done, or asked, or discovered while reviewing them later. That doesn't destroy me for two reasons. One, I'm never likely to be perfect, so I review each call to help guarantee that I'll be the best that I know how to be next time. Second, in my opinion, EMS is a learning environment. On the most critical calls I rarely have as much time as I'd like, nor access to the amount of competent help that would allow me to perform at the level that I would like. But you know what? It's the gig I signed on for, I don't really deserve the luxury of having people pat me on the back for my mistakes...I learn from them, make sure others have the benefit of learning from them, and then move on. Did you miss something because you don't have a good plan for running calls? Were you tunnel visioned by one thing, causing you to ignore something else? Did you trust part of care to someone else that didn't follow through? All of these are correctable, none of them should cause the kind of angst you're showing here. Why did you miss what you missed? Answer that question, and then follow Kaisu's advice and make sure you don't do it again. That's kind of how this game works brother. I'm not sure what level you're working at, medic/intermediate/basic but I'm guessing that you may be overstating things just a bit as well, and that's certainly easy to do if you don't have a lot of experience. It's a rare thing when we make a massive difference in the mortality of our patients in pre hospital environment, and even more rare when a 'slight error' (.01 % I think you said?) would have made any difference at all. Is it possible that what you're agonizing over is the difference between your treatment and following the protocols to the letter? If so, then you should stop that. It's simply making you miserable and not producing anything positive. I'm sorry I don't have more sympathetic things to say, but not discussing the call really only leaves room for general advice and shotgun sympathy. The first I gave my best shot, the second won't really do anything but make you a weaker person and less potent provider, so I'll let it alone. I hope you find whatever it is you're looking for. Dwayne

I thought yesterday was Sunday, so I didn't reset my DVR to record anything. I'll have to do so with a TV schedule. Oddly, when the power goes out, the DVR keeps it's time and settings, but erases the programming. Ba*tards.

Come on guys, "Community" is so much more entertaining. THAT is worthy of an hour time slot.

I'm not interested and I think it was a valid question... but I guess you feel differently...

Or maybe just a fake video. How the hell did this guy get to store if he was that wasted? That's frightening. I think he presents with terminal stupidity. How long did it take for someone to notice this guy floundering around on the floor banging into things?

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.

If you are lamenting the lack of pride and blaming it on the young and/or the absence of mentors, the culture, etc. then I have news for you. You are part of the problem. A single person can make a difference on the shift and on the station and then on the company. I am living proof. I am still a newbie medic at my company. I have not hit the magic 2 year service that qualifies me to be an FTO, a mentor in any official sense or eligible to precept anyone. (as it should be). I have no interest in advancement for the company and thus it is in no one's interests to kiss my butt or to do anything I ask of them, but I know I have made a profound difference on my shift. Once regarded the red-headed step child of the company, we are now considered the premier shift and it is acknowledged by all shift supervisors that we don't have a single "bad apple" among us. How is it done? First and foremost by example. I will not tolerate half-assed anything when it relates to the job. My rig is spit and shine and ready to run at the beginning of each shift. I come in 20 minutes early to make sure and I don't give a crap who turned over a bad rig to me - If it ain't right, I fix it. I am extremely tolerant of people's idiosyncrasies, personal likes and dislikes, sexual orientation, bad language, poor sense of humor, ever hungry ego, etc. etc. anything at all AS LONG AS IT DOESN'T IMPACT patient care. I sure don't want to sound like a know it all saint, but I am in this business for the right reasons. I also have the added bonus of financial independence, so I can pretty well take stands on anything of importance to me without fear of retaliation. I will not tolerate slipshod performance, lack of pride or professionalism or anything less the the very best from myself and anyone in my control (my EMT partner). It is done with sensitivity and tact, but 0 tolerance. It spreads. Amazing but true. If you truly care about your co-workers and your job, and take the initiative to go the extra mile, you can influence all around you and create positive change. Do not sit around and wait for someone to fix this. Take on the role yourself in whatever part of the EMS world you find yourself.

Now who gave youze guyz my baby photograph, or permission to post it?

I figured you wouldn't take my post like that. I just wanted to be sure, so you didn't get the wrong idea. Well said though. We can actually learn a few things from this show.

Firemedic65, I don't consider your comments as "hits", rather, I consider them to be furthering along my own comments. Perhaps the discussion here is for, if only a short one, stopping to think, and perhaps improve our own treatment of patients. By the way, and this is to all, as long as you have a good reason to do so, feel free to disagree with me. Your disagreement might be with information that might swing me to your point of view, or I might swing you to mine. This is as it should be, an idea exchange, without name calling (non here, but some have gone foolish and did some name calling on other strings).

I agree 100%... people keep placing emphasis on age and experience and how young people don't have life experience to yadda yadda yadda... I'm 22 and have gone through more than most 45 year olds. I have been a patient, which I think made me a better provider 10 fold. Age has nothing to do with it. It is the individual and you can't make generalizations when it comes to a topic such as this.

You can bash this reply all you want, but I ALL FOR THIS. Marijuana isn't all that bad. It's surely not as bad FOR YOU as cigarettes are. I will admit, when I was younger and I did smoke it a few times. It wasn't super duper awesome or anything. It was, relaxing. I had a good enough enough on my shoulders, that I treated it just like I do with alcohol now. If I smoked, I did not drive. Yes, it does impair you! Face it though, so does alcohol.. A LOT WORSE. Anyway, it my my belief that it should be allowed for medical use, if not for everyday use. But only if it is regulated like alcohol is. My father, had MS. He smoked it. His disease left him in chronic (no pun intended) pain. He was dizzy all the time from medications treating the MS. I don't feel I need to list all the symptoms he had with the MS. But when he smoked the marijuana, he felt better. Hands down, felt better. That was enough reasoning for me. He was a sick man, and it made him feel better.

You were right on for a while... the reputation system enforces Group Think. Think like the group, get +1s. Think unpopularly, get -1. WE ought to be dealing with differences in ideas via responses with counterpoint, not votes as that is mental laziness. However, I'm not grading people on their english, either, so long as it is understandable and not painful to read. I guess you, like me, aren't sure where to comment on this since the Reputation System thread was locked for I don't know what reason. I guess it makes sense to talk about it in the thread where questionable ratings are occurring.

Is it because of a time issue that you don't read? If so, I like the way Kelly wrote his book, each chapter is only 2 or 3 pages and can therefore be easily set down to come back to later....a good book for the bathroom if ya know what I mean.

Ill be finishing up my current book, "Better" by Dr. Atul Gawande, any day now and am looking for a solid book for my next read. I'd like to read something related to EMS. Have any suggestions?

... just when I thought I had heard it all ...