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And that's why the U.S. continues to have low wages in EMS. Why pay well, when people will do it for free. New Alberta provincial wage starts at $29/hr for Paramedic ($40 after 8 yrs), $5 shift differentials on weekends/evenings, 2X Overtime..... must I go on.

You mean you guys don't eat while you work? It really just shows how rude some patients are. How dare he interrupt a medic singing about breakfast. Patients are all about themselves these days.

I think you handled this patient very well. Although I probably would have considered an anti-emetic, I can understand your line of thinking with not wanting to stop his body from throwing up a potential poison. But considering you did not have a strong suspicion of an oral medication or illicit drug OD, his continual vomiting is likely due to being really intoxicated. Besides if the ER doctor decides that his stomach contents really do need to be evacuated, an NG tube will do the job regardless. His continuous vomiting is a threat to his airway, and remember that is your priority. Break out the suction and do the best you can. Roll him on his side and keep his airway clear. Remember that as a newer generation paramedic you should not be relying on intubation as much as in the past. Expect some differences in opinion with the old-school folk. There is much less emphasis on field intubations, because in so many cases the benefits fail to outweigh the risk. Less than 8, intubate is a thing of the past. If you can manage an airway without a tube, do it. If this guy is a simple drunk, control his airway and let him sober up in the ER. He'll go home in a few hours. But if you tube him, you are potentially buying him several days in the hospital maybe even the ICU. He will require sedation (which brings in a whole new set of risks.)He may have problems surrounding extubation and be exposed to dangerous hospital acquired infections, including a potentially fatal ventilator acquired pneumonia. I am not saying not to intubate, because sometimes it is necessary. But remember that it is one of many tools in airway management and every tool has an appropriate usage.

I've had all of the NIMS courses, and twenty other similar FEMA courses, by virtue of a position with municipal emergency management. They're all boring as hell, often redundant, but a necessary speed bump.

Laugh away, but drive by the local fast food joint and see how many ambulances, fire trucks, and police cars you see there. Then wonder why so many of us die from heart disease. Commericials have a nasty habit of providing a social mirror, don't they?

I really intended to stay out of this one, and it looks like a consensus has already been reached. But after reading all the replies, I think this issue is A. being blown way out of proportion (MATEO !) and B. Being made way too complicated. Take it from a 20-something year old female, the population I believe that you are most likely to encounter with ob/gyn emergencies and the least likely to be educated about what exactly is going on. Pelvic/vaginal examinations, be they visualization or palpation, should be done a very strictly need-to-know basis. It will not and should not change our treatment, and spare me the 12 lead argument. There is just too much risk in this highly litigious society, especially for male providers, without any real proximate benefit. All we really need to be assessing for down there is excessive bleeding or presentation of a baby's head. If your patient is pregnant, a lot of that modesty is probably out the window anyway and a visual check for crowning is acceptable but should be done discreetly. If there is excessive bleeding you are probably going to see it. And even if you don't, you can ask in a way that even the stupidest chromosomal deficient piece of trailer trash can understand. A simple, how many times in the last 30 minutes have you had to change your pad or tampon question should give you an understanding of what you are dealing with. Some are claiming that we can't take the patient's word for how much they are bleeding and it may not be apparent, (ie we can't treat what we can't see). Well I say that any half-ass decent paramedic should be very closely monitoring any patient with vaginal bleeding, regardless of how much they claim it is or even what they see. Like Spenac said, they could be compensating with normal vitals. We should be prepared to aggressively treat hemorrhagic shock in these patients and checking out their crotch isn't going to be able make us any better prepared to do that than we already should be.

Hmm, your comments made me think of something else. (I need to stop thinking here!) This is a TEENAGER and as no one saw what happened (and even if they did you can't trust their word) there is a high risk of a traumatic injury including spinal injury if he possibly was diving into the pool or slipped on the edge of it. You should use spinal precautions for any drowning victim even if friends say they weren't diving etc. I saw an episode of one of the reality shows where the friends all denied any kind of trauma with a drowning victim at the beach. He ended up with a devastating spinal injury and they HAD been playing around and hit his head on the bottom of the ocean and broke his neck. I dealt with a lot of pediatric drownings in the PICU in CA. Majority of the little ones rarely had spinal injuries but there was a few of the older ones who did from diving into pools and rivers, lakes etc. One kid hit his head on the side of the diving board and ended up with a spinal injury on top of the drowning. Besides a BB is a nice hard surface for doing CPR on if needed and a c-collar helps keep an airway aligned better (midline) and keeps an airway device more secure.