captainstandup

Perhaps part of the answer you seek, young Jedi, rests in this question. From a purely hemodynamic perspective, why could it be important to have an early indication of right ventricular involvement?

In the history of EMS there has never been a truer statement scaramedic. Ford has historically been of poor quality but since introduction of the 6.0 its utter junk. I have never seen or heard of a chassis that was worse than the 6.0 Fords. The four we have have literally spent more time on the shop than on the road! Problems have ranged from constant failure of seals below the turbo, which are a real problem to repair, to a total of four engine replacements. Virtually all of these repairs have been warranty but who cares? Having so many vehicles constantly out of service has been a real nightmare. And now their better idea is to add a two stage turbo charger. Just remember its virtually impossible to make chicken salad out of chicken sh*&. In America we have become so accustomed to large ambulances instead of spending our dollars wisely. Now the trend is to purchase these huge critical care trucks with four door cabs and a $221,000 price tag and rarely use them to transport the critically ill. Now it seems more important to show off the toys than to deliver good care.

The one I test drove was very stable, had great power and the ride along with crew comfort (in the cab) was great. Engine and transmission are Mercedes, and had a suprising warranty. If I remember correctly fuel economy was on the order of 16 mpg which was incredible. I should have bought a couple of them.

How many isolation carts are other providers noticing in the hospital hallways? There is apparently an initiative JCAHO for nasal colonization of MRSA which has resulted in routine screening of all patients for MRSA in the nares.

Hey Novisen, have you had any bad experiences with propofol admin? The reason I asked is virtually every time I have occasion to initiate a drip in the field or during interfacility transfers I have notice rather severe hemodynamic effects even with dosing @ a paltry 15 ug/kg/min. Perhaps I have just been treating really sick patients but I have found going lightly on the propofol and utilizing versed and MS in conjunction with propofol resulted in less negative effects.

I agree with spenac it did get way out of hand and it was my fault. I apologize to the OP and have sent Asysin2leads an apology as well. I love spirited debate, but not at the expense of someone else. I lost sight of the fact that he an I have different ideas on certain issues but these should not have resulted personal attacks. I'll remember to attack issues instead of individual in the future.

How many providers would prefer to have thumb screws applied or eat sheep eyes than to sit through the annual infection control update? We prepare, plan, legislate and punish those not in compliance. Most of us laugh at the prospect of the dreaded "pandemic" and continue happily along our apathetic path of self destruction. Its really a shame that health care is largely responsible for this mess. As an earlier post mentioned, overuse of antibiotics and filthy conditions within the institutions have made naturally occurring pathogens deadly. Add to this completion of mapping of the genome and a few million towel clad zealots with money and you have a recipe for destruction. No we can't wear level 1 PPE on every UTI call to or from a nursing home, but we can take progressive steps to literally clean up our act. Hospitals are constantly at or beyond capacity, often denying admission for days due to lack of bed space or staffing shortages. Try adding a surge of 100,000 additional patients nationwide over a three day period. How about 500,000 or a million? Pandemic anything, be it MRSA, the flu (avian or 1918), small pox etc, would tax the healthcare industry to the breaking point. We can barely meet the current need as is. EMS role in patient to patient transmission of disease is arguably minimal. Furthermore, to the best of my knowledge there is no data regarding healthcare worker contraction of disease while attending to those infected. Hospitals do all they can to manipulate data to minimize three things 1) The impact of recordable illnesses / injuries on workers compensation insurance rates 2) Negative effects of high infection rates on JCAHO accreditation 3) Negative impact on revenue stream. So who takes the lead? I really don’t know the answers, but I think most of us agree these are real issues and if, perhaps when things go badly, each patient that isn't in the hospital will be another bed available for someone seriously ill. I personally don't believe the hospitals can or want to operate with even one bed in reserve capacity as an empty room generates no money, needs no nurses, no labs, no support services, etc until filled. Perhaps 4cmk6 is right, we can’t wear tyvek suits and minimal contact is simply going to happen. All I'm saying is that our success in not being a part of disease transmission may be as simple as being more attentive to hand washing and keeping the rig clean. No, it likely will not be measurable and if so meaningful data is years away, but we must begin somewhere.

I can't believe someone hasn’t mentioned "killer asteroids". I've already had my shots for those. Oh and I almost forgot comets, remember the mess they caused in the movie, Maximum Overdrive. I personally do not relish the thoughts of being attacked by soda machines, lawn mowers, Emilio Estevez acting, and worst of all driverless semi trucks, considering how bad they are WITH drivers! I have to go with RidRyder911 on this one. Although a bit light hearted in this thread, nosocomial infections are common to every "health care institution". All of us respond to nursing homes or rest homes which we consider to be unclean or even nasty. You know the ones where the aroma of urine, ammonia and excrement blend in the air to create that special ambiance that keeps you coming back, or is that dispatch? How diligent are we in terms of PPE, hand washing and perish the thought of donning gown and face shields for patients with "routine" infections. I understand these facilities attract the upper crust (pun intended) of health care workers, who always have a good clinical picture and impeccable patient report ready for you. The reality is we often provide the most competent evaluation for this patient population. We, of course, do not have laboratory services immediately but we certainly possess the good judgment to think outside the box and utilize proper infection control procedures. "Proper infection control procedures" aren’t just words! We have a duty to our families, our co-workers and the next patient and the next, to utilize infection control techniques every day. Not only is the filthiest of nursing homes, but in the nicest upscale homes, ugly microbes are waiting for you. No, they probably aren’t filoviruses or plague, but to you or one of your family members they are potentially just as deadly. The next time your lazy "mutt" partner is burning up the remote control instead of studying or reading a trade journal, anything that would have improved the quality of his care! Get his/her ass out of the recliner and wipe down the rig. Try cleaning the grab rail or sanitizing the patient care area. How long has it been since the cot was truly decontaminated and clean? You may save a life or improve the quality of someone's life by killing the bug that would have harmed them. No you won’t get to tell war stories about it like the triple axle intubation, but it's still important work. -Standup-

I'm not sure I understand what you were trying to say. Airway management is dynamic and our most sacred of skill in EMS. What manuvers actually "cross the minds" of 90% of your providers? This is the first time I have heard of a situation that requires a patient to be in respiratory arrest before aggressive ALS airway manuvers are employed. The only exception I am aware of is in services without paramedic level care. If what you are saying is true I would really hate to be in acute CHF, or respiratory failure in your response area. "Snowing" a patient for the purpose of intubation may be the only option available to EMS agencies where RSI isnt permitted. RSI is completely appropriate in certain situations, provided the person performing this skill is competent and has a back up plan and a backup to the backup. Succinylcholine is a very safe and appropriate medication used in the proper setting. There are medications that would serve us better such as rocuronium which is a "medium duration" paralytic, but as I said in an earlier post, there exists' a reversal agent for rocuronium, that isnt available for Sux. A failing airway / respiratory system is in my opinion "more important" than one which has already failed. By the time a person has deteriorated to a state of respiratory arrest, there is often little we can do to resuscitate them.

What a great training resource! Thanks

I started to buy one of the first Sprinters offered in NC, at the time American LaFrance was gluing their label on them. The only significant difference in the one I test drove was single versus dual rear wheels. I really liked the Sprinter, it had plenty of power, acceleration was great and stability was surprising for tall narrow platform. As far as being cramped, perhaps they could install a McDonald’s avoidance system into this platform. EMT's and Paramedics are too darn fat in the US, and yes I resemble that remark.

Unfortunately this happened early in my career, you know back when God's dog was a puppy. "Back in the day" (early 1990's) when this happened we weren't even permitted to utilize drug assisted intubation and RSI was unheard of. Didn't have enough valium to make a difference and versed wasn't on the trucks. We couldn't even spell succinylcholine. The worst part of this situation was the only rescue airway technique we had available was the horribly useless needle cric. My how we have improved since then.

I wonder of any of the services represented on this thread utilize full EMD with the "Omega" option?

Not that it matters, but not only are manhole covers round but the city had to tac weld them in place because thieves were stealing them and selling them to scrap vendors. A few really nasty MVC's resulted. I wonder if square ones would have been less attractive? Oh well, back to the OP thread...

OK how did you answer spenac? You should have told them that the tiger from my scenario came into yours and ate everyone, except you. Therefore you can hop into a QRV and dent have to work with any of them............. Standup

The MI is a no brainier, plan and prepare for the worst hope for the best but always let assessment and response to treatment direct your actions while maintaining that cautious little voice in the back of your mind that asks "could I be wrong" or "what am I missing". This will keep you sharp and help you learn and improve as you become a true clinician instead of someone who just sits in the captain’s chair during transport. I understand your not really being allowed the time to ask detailed questions / assess your convalescent home patient limited your responses. Please always bear in mind there are a few other questions that would really help in field differentiation between pneumonia and perhaps CHF, COPD, Asthma etc. Its also important to remember concomitant conditions may present especially in the elderly patient. For example; the elderly patient may have been suffering from septic shock from a bad UTI leading to fever. Sepsis can lead to widespread vasodilatation overworking an older heart leading to pump failure and congestive failure. BP, skin color, effort of breathing, certainly breath sounds and the presence of or absence of orthopnea are really good pieces of information among many others. The MVA was completely directed toward assessing your critical thinking skills. In your mind the issue came down to, do I treat an airway problem in the adult accident victim or life threatening hemorrhage in the child? Suddenly you are conflicted; the palms are sweaty as you weigh the options. Child vs. adult, adult vs. child, airway vs. hemorrhage, emotionally the child trumps the older person, EMT training teases you into believing the older persons airway is more imminently life threatening that hemorrhage in the child. They wanted to hear you say you would immediately employ hemorrhage control measure to the child and if possible simply tilt the older patients head back to determine if they were viable. Dust is right; the older person may not need your help. My point is not to say you were wrong, but is to inspire you to grab each and every "molecule" of information in assessing patients. Then when you reassess and reassess and reassess during care you will develop a clearer clinical picture and can direct treatment accordingly. You are already taking the first best step possible. Asking questions is huge regardless of whether you are a new EMT or a seasoned Paramedic. By the way, the worst question I was ever asked in a promotional interview was "if you were an animal, which animal would you be?" Again this was intended to evaluate critical thinking, and communication skills given the fact it was entirely foreign to all other medical and managerial questions asked.

Pay no attention to the parasitic black liberal behind the curtain, for he/she is/are the great and powerful OZ, and they will retaliate with a force or is that farce (finger pointing, race card tossing, headline grabbing silliness) so powerful, mere mortals quake in their boots. This is oddly symbolic of the reason emergency services personnel will continue to endure claims of racism. When faced with an opportunity to gain understanding and learn from each other, the perpetually offended find it easier and certainly less labor intense (in an intellectual sense) to simply be mad and point their finger as this has been their harbor for decades. And so ends my journey in this thread, having traveled so far yet nowhere. Perhaps I can withdraw to my "upper-class, intellectual, a--ho-l- friends, you know those with a dictionary and a thesaurus. How dare I be sold bold as to attempt abstract thought when emotion and hate serve Mr, Mrs or Ms. 2leads so well? Mr,Mrs or even Ms. 2 leads, I leave you to carry forth your doctrine of self pity and hate having taught that damn white "boy" a lesson. Bask in the multicolored light streaming from the rainbow coalition, but never, ever look behind the curtain! You may find those in your own race, you know the same ones who actually sold your ancestors into slavery, are still pulling the levers. Sure the names have changed and perhaps they are of different tribal lineage, but the faces are the same, but now they have the REV. prefix and they continue to enslave you today. Finally, two definitions for you: Ignorance = A lack of knowledge. Stupidity = An unwillingness to learn. Which category do you fit into?

Who is the artist?

I wasn't trying to offend anyone, just to examine the basis for the question in the first place. "Has anyone been called a racist?" This isn't a closed ended question in my opinion. Race discussions are always emotional and unless I sing the the politically correct tune of the modern age I will be perceived as a racist, bigot or what ever label folks like Asysin2leads wish to apply. I have been called a racist, I have heard others called racist without cause. Sometimes alcohol or drugs were a component sometimes it was simply an issue of heightened emotions during chaotic or violent situations. I have never witnessed anyone being accused of being a racist by anyone from all of the other races except black people. Spenac is exactly right I strayed way off topic in an effort to broaden the discussion to include causative factors and tried to open discussion that might lead to better understanding in our little EMT City corner of the world, who knows we could have learned something? Unfortunately I allowed emotion to get the better part of me in trying to prove a point with Asysin2leads. Instead of trying to have a meaningful discussion with me he/she quickly threw down their version of the digital race card and began attacking the things he/she assumed were important to me, instead of discussing the core content of things I had brought up. Perhaps I do have issues as Asysin2leads accused me of having, but there are key differences between us. I am willing to have a forthright, intellectual discussion with the objective of answering the greater questions; why were we perceived as racists, what were the circumstances surrounding the incident and what can we do to improve the way we are percieved? Culture and race are important issues to EMS in ways separate from the emotional, headline grabbing nonense that folks like Asysin2leads want us to focus on. Differences in interpretation of specific words, slang, pain tolerance levels and reluctance for certain races to seek help early in an emergency are crucial aspects in terms of patient assessment. These directly affect our index of suspicion (thats a medical term Asysin2leads) and in developing an accurate "clinical picture". Understanding differences in how families of different cultures perceive an emergency, react to that emergency and effect emergency response are important to not only emergency responders, but to those we serve. Our efforts as EMS providers in responding to calls involving the minority population must include meaningful efforts to understand their perspective without our employees or ourselves feeling as though we have been forced into doing so. This will not happen until folks like Asysin2leads can check Political Correctness and their state of being perpetually offended at the door.

Here is an example, 52 year old semi-homeless man riding a bicycle near the Middle School. 16 year old kid in dads blazer didn't see the bicycle rider until just before impact estimated to be 35 - 40 mph. Upon our arrival the patient is unconscious with obvious s/s closed head injury but is technically breathing on his own @ 24. Teeth clenched and impossible to open his mouth. Bleeding from nose and to a lesser extent from his mouth as evidenced by blood being forced through his teeth during expiration.

Sorry about that, I was initially trying to expand the dialogue to include the reason for the question in the first place and I let it get a little out of hand, perhaps a lot out of hand.

Our million man march involves us taking ourselves to work every day to enable us to pay the tab your liberal pals run up. As far as guns or Jesus, there’s a great example of how the country would look if the citizenry were disarmed or matters of faith restricted; it’s a little place you may have heard of called China. These folks enjoy freedom of speech, a robust economy, the safest working conditions on the planet, especially in the coal mines, high wages, great retirement and an environmental stewardship that is second to none OR perhaps NOT SO MUCH! Your ideas of conditional conservatism are impressive but terribly misguided. Personal freedom and liberty are all or nothing concepts. You espouse to hold conservative ideas then just like every good liberal you bitch about guns, religious freedom and disrespect the military. One only has to look at the jewel of gun control, the greater Washington DC area, which reported 409 murders in 2005, to see how successful gun control is. You and your pals have the notion that when a criminal strikes, the police will magically appear to rescue you. Does the concept of response time completely elude you or what? Perhaps you can show the murder or rapist family photos or mesmerize them with tales of how your ancestors fought for their civil rights. I really don’t care what you believe in; in terms of faith, but I have to wonder who or what you would be praying to if you or your child were entrapped in burning wreckage? You and your liberal "colorblind" Neil Young worshiping pals scoff at anyone of Christian Faith yet celebrate the diversity of all other faiths, especially the favorite faith of the black man in trouble, Islam, another double standard. You are only colorblind when it suits your agenda and when the discussion benefits your perspective otherwise the race cards take wing. Let’s add another "star" or your precious civil right stage to the discussion. The totally honorable crack head whoremongering political superhero of Washington DC Marion Berry. You should be so proud, as should the pitiful souls who have consciously walked into a voting booth and elected this looser to two mayoral terms and continue to allow him to serve as a councilman to this day. Now that’s a legacy for all black Americans to be proud of. As for Jesse “the illegitimate baby daddy” Jackson, he like so many of your so called leaders hide or assume credibility behind the “Rev” that implies they too worship the deity you seem to despise. If you want an honest examination of these leaders get a copy of the truly Rev. Jesse Lee Peterson’s book entitled Scam. In his book Rev. Peterson exposes Jesse Jackson, Louis Farrakhan, Al Sharpton, and Maxine Waters, among others-claiming they are nothing more than scam artists profiting off the hatred and disorder they foster in the black community. It's impossible make meaningful progress in civil rights when folks like you are so filled with hate and double standards none can approach sensitive issues without being labeled a racist or bigot. Instead of addressing many of the issues I brought up pertaining to the minority community, you instantly resort to injecting hot button issues such as the war, gun control or religion. My suspicion is that you do this because you cant figure out a way to blame the real issues on someone else.

I'm trying to reach out to this fellow, dont think its working though.............. Oh well I have been hated for being white all of my life, why should it change now? Perhaps if he would add the other 10 leads things would be a little clearer.

Tell you what, lets you and i have a meaningful dialogue based on positive changes we could make to help EMS in terms of racial issues. I'll skip my "long winded posts and wont tell you I'm not a racist anymore, it doesn't change the fact I actually do have several friends that just happen to be black but of if make you feel better just assume this isn't true either. You in turn take a look at the content of what I have said minus the emotion arousing comments about the parasites and liberals. Perhaps this would be better suited for a non-EMS thread, but I sincerely would like to hear your unemotional perspective on these issues. Perhaps we could start with my suggestions regarding public assistance and ways to improve the end product of a currently failed concept that has led to despair and hopelessness for many minorities. I am realistic enough to understand that our conversation probably wont change the world and may have very little to do with EMS but who knows, perhaps I can learn something. Oh and by the way, the phrase "True colors" was originally frequently utilized by whites as a negative connotation toward blacks in the original slave days, as it inferred they couldn't rise above their true color.

We are expected to be professional and treat everyone with respect. I say treat them as nice as they will allow you to be. By virtue of the fact we are in public service doesn’t mean we are their door mats. It sickens me that everyone dances around the issue of race like it was a cobra preparing to strike. This is the result of all of the wonderful liberal liars and self-righteous do-gooders that have been able to poison the workplace and academia with this crap. We need a hero, black or white and completely unlike and unaffiliated with charlatan liars like Al Sharpton or Jesse (the illegitimate baby daddy Jackson) and pretty much anyone in the Democratic Party to have an open, honest dialogue. We have a lot of common ground but the opportunist and lazy ner do wells get all of the press and interfere with real progress. I'll tell you who could fix this, my friend Kevin, who just happens to be Black. This fellow is hard working, college educated and spends not one second of his life pissing and moaning about how he has been treated unfairly by white people. He doesn’t give a damn for the term "African American" and told me that he couldn’t speak a single syllable of any of the native dialects and added that he has no interest in traveling to Africa because it wasn’t his native home, America is........ We can continue to hide behind the truth, legislate and sue our way to utopian racial equality but this only galvanizes the opposing forces and results in their withdrawing to an out of sight but not out of action position. The alternative is to acknowledge our cultural differences, even celebrate them, the positive aspects that is. We must stop electing the parasitic liberals that continue to enslave those less fortunate in the name of diversity. If there were a magical way to make public assistance work the way it is supposed to, (support people while they are down and not punish them for making a decent living or kick them out of public housing based on marital status) I believe this would be a huge step in making your next EMS call in the projects a little less dangerous, dismal and hopeless. Perhaps those on public assistance could be required to attend classes that would help with financial planning, and offer incentives to them for finishing high school. Consider extending the amount of time they are permitted to remain on welfare provided they continue their education, but require transcripts and base the amount of assistance on successes instead of punishing them for achievement. On the other hand those on public assistance should be put into the street when they are convicted of felony drug offenses or violent crimes. No public aid whatsoever, not only would they loose the right to vote and own firearms, they wouldnt receive one red cent of assistance money and wouldn’t be permitted to spend one day in public housing. Another step in the right direction would be meaningful programs to attract minorities to EMS. How many black or Latino EMT's and Paramedics do you know? I'll bet it's not many. One of the things that damage these efforts is that upon attracting even one black employee into the business the HR folks are foaming at the mouth to fast track this person to a leadership role in an effort to meet a multitude of quotas. This often means resorting to reverse racism against seasoned personnel that have worked in an agency for 10 or 15 years only to be passed over in the interest of having a diverse workforce. In the most egregious cases they will use different scoring standards one for black, one for white and offer the promotion to the lesser qualified black employee. This breeds hate and contempt and does a tremendous disservice to the black employee as they will never be respected based on ability.