Herbie

Wow. I could go on for hours about some good ones, but many folks here take themselves WAY too seriously. I would hate to be accused of being "unprofessional". Let's just say a few of my favorites involve a fake battery operated rat, a fart machine, an intercom between the cab and the patient compartment area(yes, it was a LONG time ago), the dispatcher and the radio, body bags... Use your imagination.

I guess it depends on where you practice. If you live in a large area, you may be exposed to many different ethnic groups, who each may have very different cultures and practices. First generation immigrants may bring their own homespun remedies which we may find very different, or even downright dangerous. I will never forget the first time I saw the practice of cupping. For those who are not aware, a small glass is heated, the cup is placed on the skin, creating a partial vacuum, and is intended to stimulate blood flow to an area, draw out bad blood, toxins, phlegm in the chest, and many other things. It's an ancient practice and many cultures have used it- China, Hindu nations, Viet Nam, Mexico- very common with old school folks. The first time I saw it, we were called for a congested young patient who had circular type red marks on his chest, and I of course thought it was some type of abuse. My partner had to explain to me what it was all about. Does it work? Apparently not, since they called us for help, but who am I to judge?

LMAO Couldn't tell ya mate, but depending on my mood, "all of above" would probably be appropriate for me.

All good advice. Start with talking to the person. You don't say how long this has been going on- has he always been an a'hole to you, or is this recent? Maybe he is having some personal issues that have nothing to do with you. That said, your personal life should not have such an impact on your job- we all have baggage we must deal with. Grab the bull by the horns and be proactive- this is YOUR education, and your preceptor has a lot to do with molding your career. I think too many folks have been tarnished by bad experiences during the internship phase of their careers, and too many of these folks perpetuate the problem by thinking this type of behavior is "normal", and become a'holes to their students when the time comes. If your talk does not help, then go to the coordinator/instructor and explain the situation. My suspicion is you aren't the first person to have a problem with this person. Too many times a program is desperate for preceptors and they may not be too picky about who they use- especially when there may be no incentive to precept- but let me be clear. Whether or not you get paid, receive continuing education hours, or some other perk, being able to teach is an awesome responsibility that should not be taken lightly. To me, nothing is more important than ensuring new EMS folks learn the right way, and get the most out of their training- regardless of whether you are compensated in some way for your actions. These students may be your partner some day, or work on someone you love, so I will never understand how someone can have such a crappy attitude towards them. Good luck and let us know how this turns out for you.

Yeah- those "Big One" calls are generally the ones where you get a couple mindsets- first, it's "Damn, I missed that." Then- for the especially horrific ones- it's "Damn-too bad I wasn't on vacation- that was no fun." Sure- sometimes it's fun to claim bragging rights among your peers and say "yeah- I was at that big one- pretty f'ed up scene" or to point out that you are either a crap magnet that attracts these type of calls, or the lucky SOB who manages to miss them. (I happen to fall into the former category) Obviously it depends on where you work- the horrific calls you never forget may not be mass disasters with scores of victims, it may be responding to your neighbor who is a DOA or the SIDS call of a family member. Yes, the big incidents garner all the media attention, but depending on what they are, and your particular role in the event, as you say, it may have been nothing but sheer boredom, waiting in the staging area. It's the "other" calls that are not news worthy enough- the types we all see every day-child abuse, a fatal hit and run, domestic violence,etc- that usually have the biggest impact on our lives and careers. All professions have morons, wankers, posers, and lunatics. It's also never pretty to see your peers behaving stupidly- it tends to cast a shadow on us all, but no rational person thinks a single clown represents an entire circus. .

Here's the deal. I have no idea how much time this Mongo has on the job, but today's FF is nothing like 30- or even 20 years ago. I would be extremely frustrated if after spending time, energy, blood, sweat, and tears training for a job I would only be able to do a handful of times each year. For too many of them, their careers become a parody of what they wish their jobs were like. The jealousy I see is from the guys who did not do their homework and never realized the majority of their efforts would be spent doing EMS calls and drilling for the rare occasions they actually get some pump time. I know and work with hundreds of FF's, and most of the old school guys long for the days when they had working fires every single day of their careers, but they also know those times are a distant memory. They also earned every dime they made in those days and then some. Even in the busiest areas now, a guy could go MONTHS(and sometimes years) where the only real fire they see is under their dinner pots. Some adapt and move on, many retire, and yes, some are bitter about what their jobs have become. When they DO catch a fire, it's a scary thing because so many guys may have tons of training but little hands on experience. No amount of book knowledge or training evolutions can ever prepare you for the insanity of a fireground scene. Many of these guys move up the career ladder, becoming chief officers with very little fire experience. Not much you can do about that when fires are down, but it also makes a very dangerous profession even more risky. I also see too many guys who have their daddy's time on the job, live vicariously throught them and the old timers, and somehow think that experience, bravado, and knowledge automatically transfers to them once they get the job- even before they ever get their boots dirty. I hear them talk about fires they only heard or read about as if they were first in and leading out the first line. Look- there are hand jobs in any profession- EMS included. I also am reminded of the old saying- it ain't bragging if you can back it up. The guys who turn every conversation into a BS session about how they "beat back the beast" and brag about the fires they claim to have seen are generally the ones who haven't seen jack shit. The ones I respect are the ones who quietly do their job and take pride in it- whatever it may be.

Exactly. Years ago I was on a trip to Vegas with my then girlfriend, having a good time and a couple drinks. About 2 hours into the flight, I heard that exact announcement. I looked around but could not see what was going on. About 5 minutes later, they repeated the announcement. I was utterly stunned- I thought every flight had some type of doctor on board- OB/Gyn, podiatrist- ANYTHING. Nope. Not on my flight. So I wandered to the back of the aircraft and explained I was a paramedic. They damn near dragged me to the back of the plane. I found an approximately 30 year old female, writhing around the floor in the galley. To make a long story short, I surmised that at worst, she may have had a bad polish sausage and had a bit of diarrhea, nausea, and a WHOLE bunch of drama. Vitals were better than mine, completely benign exam, no PMH, etc. Apparently she also just had a spat with her boyfriend according to the passengers near her, and I think this was mostly about getting some attention. My patient? She was fine. After a few minutes she returned to her seat, calmed down, and the rest of the flight was uneventful. When we landed, EMS entered the plane, I gave them a report, they evaluated her, and apparently the patient eventually refused transport. Hero status? Hardly- just a bunch of passengers- myself included- who were grateful we did not need to divert and delay our vacations. The airline was also happy since they did not need to spend tens of thousands on a diversion, which would have caused missed connections, wasted fuel, and rebooking hassles.

Agree with what is said. If we suspect something- as in the injuries do not coincide with the story we get about what happened- we can call the PD to investigate further. There are certain mechanisms of injury and situations where police automatically respond besides with the obvious(gunshots, stabbings, beatings, etc). Someone who falls on a city street, the police need to make a report. If there is a possibility of litigation, they need to make a report. Good luck.

Interesting article. The drug has been around for a long time, but apparently someone figured out another use for it. It certainly sounds like it would have value in certain situations-stopping uncontrolled bleeding is important, but we still need a solution to replace blood that already has been lost. Clearly we we would need very specific protocols to determine the best use of the product, but I do see potential here.

Dentists ARE included as part of the NIMS response. As doc mentions, they can be valuable assets in a mass disaster, but I would not classify them as emergency responders in any sense of the word. Yes, dentists are "doctors" but when is the last time a doctor needed to treat a fractured bone, a cardiac issue, or anything else below the mouth? I've responded to dental offices for things like allergic reactions to anesthetics, syncope, or excessive bleeding and they really are out of their element in an emergency situation. Things like identifying bodies via dental records is vital- albeit a secondary action in terms of mitigating a disaster. Obviously they ARE medically trained, and in a pinch they are certainly better than a bystander who is a carpenter. As the article says, this is about getting federal funding for Dental schools: "The bill doesn't cost anything, but according to Stupak and Miller, denying dentists the emergency-response provider designation has meant that dental schools have at times been refused federal public health and medical response training funds." I see no harm in the declaration, unless dentists will be providing front line medical care in an emergency situation. I doubt such a declaration will change their roles in a NIMS governed MCI.

Well, since the church was probably there first, then I propose that anyone who builds a family planning center near a church is asking for trouble. Second, let's extend your premise. A hospital or doctors office that promotes birth control should not be located anywhere near a Catholic church. After all, strict Roman Catholics should not be using any form of contraception, right? No vasectomy or tubal ligation procedures should be conducted anywhere near there either. Where does it stop? Yep, these Muslims probably are US citizens. Good for them, and if they are, then they should understand WHY so many people are opposed to their plan. Like I said, if this really is about building bridges between cultures, acceptance, and honoring those who died that day, then there is no way they- as compassionate and tolerant US citizens- should even be considering this idea.

Richard- I tell my students the same thing about treating the patient and family with respect. Like I said before, when we are new to the business, it's all about procedures, skills, practice, getting a "good" call, but I constantly remind them the things people remember are simple human kindness. I also tell them that the family will remember what you did long after you have forgotten the call. What's routine for us may be a life changing incident for them.

LMAO You must be a better provider than I. Apparently I've been doing it wrong for the past 25 years. Textbook vs reality, sir.

Ah- the age old question- "stay and play" or "throw and go". Our business is still evolving, although it has come a long way. Before the advent of Trauma systems and Level One trauma centers, a seriously injured person was likely to die from what are now seen as very "fixable" injuries. We learned about the golden hour and that a couple large bore IVs were NOT going to fix someone who had 3 or 4 GSW's to their chest- they needed an OR suite ASAP. Needle decompressions enroute, stop the bleeding, assist ventilations, advanced airways if warranted, or anything else you are capable of doing as needed, and fly. Is treatment enroute optimum- of course not, but you would be amazed at what you can do when pressed. We used to use the MAST on everything from GI bleeds(messy) to routine cardiac arrests(useless), but we all know how long this can take to apply. Clearly, the conventional wisdom in that has also changed over the years. In our system, we are encouraged to do as much as possible enroute with a trauma patient. For sick medical/cardiac patients, such as bad CHF'ers who can literally die in front of you, the more you do prehospital, the better chance they have. I have ALWAYS been aggressive with these patients- this is what we are trained for, but you also need to weigh the possibilities. ETA to hospital, how busy the ER may be(how quickly they can mobilize and give the care needed, etc. I've had ER docs tell me that for bad cardiacs, our initial treatment is essentially the same as theirs and can mean all the difference in the world, so stay and play is totally appropriate in most situations. (Yes, sitting in the ER driveway would be an exception to that rule) Point being, we should all know our limitations, but someone said it above: Unless we use the skills we learned, we are simply ambulance drivers.

The bag comes in with every call- a finger lac or a cardiac arrest. First line in this case(without the monitor, non cardiac) would mean things like Epi for a status asthma, Valium for a status seizure, Narcan for an OD, Albuterol, the Ambu bag, and usually O2, etc. We also have enough for a couple rounds of epi/atropine, lido, adenosine, etc but obviously we need to monitor too. Sorry, but traveling light in this case(high rises) is a must. Truth be told, in most project calls, the elevators are unreliable at best and usually dangerous, so humping 17+ floors is pretty much the standard. In a high rise housing project(or any high rise call), everything depends on the type of call and if it's a suspected/potential cardiac, everything comes in. Thankfully though, most of the high rise projects here have been torn down.