captainstandup

And, and one time at band camp we joined hands of all races, well most of them, and surrounded the camp fire and sang kum ba yah as we sacrificed an evil white man over the flames.

Please re-read my recent post, you "guys" relpied so quickly I didnt have time to correct a couple mistakes. Spenac, I had the same experience in a predominantly black community when we responded to a shooting where half of a young black kid's head was blown off. The very large group of blacks that had surrounded us became so angry when we wouldnt work this kid that police eventually had to get out shotguns and pepper spray to get us out of there.

I didn't say anything about you or your single mom, but since you brought the issue up. The last statistics I read indicated that 70% of black children grow up without the father in the home. It probably just a coincidence that prisons in the US are filled with young black men that more often than not had no father in the home. I'm sure this too is the fault of white men in some abstract manner or wait Its Pat Robertson’s fault! Where did the whole religion rant come from anyway? I don’t like any of the TV Preachers that allege to sell God’s word but give you their address to send the check to. Like I said I'm a realist, not a racist. All of the self-righteous liberals scream diversity from the highest peaks and the public stage then return home to gated communities. Consider, for example, the opportunistic criminal liars Hillary and Bill Clinton. It's easy to be so diverse when you have multi-million dollar Secret Service Protection 24/7 for the rest of your life. Hell with this level of security I could live in the “Pork and Beans” neighborhood in Miami. It's unfortunate that the minorities have fought so hard for civil rights only to be enslaved by liberal politicians who knowingly perpetuate their "dependant class" status in society to ensure a continued constituency. The liberals tax the hell out of the rest of us and create welfare programs that instantly cut benefits if dad returns home (unlikely) and low rent public housing that is taken away if the folks living there get a job which reports income to the state and feds. Once these folks are in the system they are slaves of the very system that purports to be their benefactor. Their only alternative is illegal enterprises such as high yield drug trade, prostitution, theft etc. There are of course those who do not choose this alternative but, when times are desperate and they are by design prevented from working hard to improve their situation legally, what are they going to do? If my family were hungry or sick, and I was in this situation, I would resort to almost any measure to take care of them. This is where EMS most often enters the equation. In a group of people that, by liberal public policy is relegated to wait for the handouts from “the man”. This often results sedentary lifestyle and along comes morbid obesity, diabetes, heart disease, hypertension, renal failure, stroke etc. This is accompanied by extraordinary crime rates, especially violent crimes often against those of their own race. In these situations emotions are high, even on otherwise routine medical calls (C/P, SOB, etc). Enter stage left, the whitest of white paramedic crews. If the crew is in any manner inattentive to "cultural differences" such as when they are trying to get the 5 screaming relatives out of the room to allow proper assessment of the patient, an entire deck of race cards take flight. Then there are the opportunistic parasites of the black race, The Rev. Al Sharpton and The "Rev" Jesse (the illegitimate baby daddy) Jackson leaping in front of TV cameras to cry about how their people are being treated unfairly because they are black. One might note both of these losers are wealthy charlatan liberals that wouldn't be able to buy lunch if it weren't for their disenfranchised followers. Oh and do you think these guys live in the "hood" among their people? In every situation where Sharpton and Jackson show up to raise hell, as soon as the TV cameras pack up and leave these idiots are drafting off the rear bumper of the satellite truck as it leaves town. My point is this, minority children, and we are really speaking of black children, (how many Asians, Chinese, Latino’s have thrown down the race card? NOT MANY) are indoctrinated into the belief they are being treated unfairly from a very early age? This message is reinforced by the "black leaders" in mass media along with the liberal mouthpiece of mass-media dba. CNN, rap music and certainly the liberal print media.. All of these folks have a financial interest in keeping black Americans subservient to them in one way or another. The OP asked if anyone had been called a racist. In my opinion the objective was to begin a broader discussion of how race issues impact EMS and not simply a yes/no question. The race issue in public service is much larger and more complex than can be addressed with sensitivity training or little pink diversity policy books in EMS, Fire LE. Until we as a society can agree to be different while not using this as a basis for hate ON EITHER SIDE of the equation, this issue will remain at a low boil ready to spill over without warning.

There is a huge difference between being a racist and a realist. And really what you are asking is has anyone ever thrown down the "black card" on us. In our world of political correctness if anyone mentions an undeniable truth that involves someone other than a white person then we are considered racist. As far as this "respecting everyone" vomitus, the way you truly respect others is to admit we are culturally different, have different value systems and life experiences. This isnt an opportunity to dislike someone simply based on race, its an admission of the truth and a basis for learning and respect to develop in the proper setting. Have you ever noticed the liberals are always screaming the loudest about "diversity". They have pimped and whored the word and the minorities out for political gain since this country began. Now ask yourself if you or they are so culturally sensitive why will you not take the step of moving your family into a more "diverse community" Wouldnt this be an incredible statement of your dedication to the cause of diversity; for you to live among those so disenfranchised by white man. Just imagine your little girl walking alone to the bus stop at 7 am near the housing project. You could be so proud of the diverse classrooms and good grades that all of the children have because they make sure the tests arent too challenging and never hurt anyone's feelings. All of their pissing and moaning and tossing out the race card when they get into trouble simply serves to galvanize those opposed to diversity. How do we fix this? Beats me but I can tell you the friends I have who are black are educated, articulate, hardworking and would never think of throwing down the race card. They dont need to as their personality, values, ethics and professionalism speaks for itself. We have had numerous conversations about race and guess what? We agreed that black and white folks are different in many ways but we also agreed not to be too serious about our differences and just enjoy learning from each others perspective. Oh and did I mention that every single one of them has a mother and FATHER in the home helping raise the children. We decided to celebrate our differences and to laugh a lot insead of being mad.

Please if you know of even one of these piss palaces that actually has one single skilled staff member not including maintenance tell me where it is and I will travel there to see it for myself.

Our hospital based service sucks ass, the benefits are crap and we have awful insurance but the money is is incredible. The hospital politics are just short of the third chamber of hell and the backstabbing, mean spirited folks are always trying to screw a coworker both literally and figuratively, but the money is incredible. The CCEMTP's here make more than starting nurses so we hold on hoping things will improve.................

Come on, you know exactly what I am referring to. The emergency lanes and easing around stalled traffic, the median if its dry and safe. Im not talking about reckless foolishness but I am saying that sitting in the back of a piece of crap ambulance with shitty AC for 2 or three hours is cruel and if there is any safe manner of escaping this situation through utilizing the warning lights and siren perhaps its the better choice.

Patient or crew comfort becomes an issue when you are sitting on the 5 in California or on I-77 in NC every day for 2 or 3 hours just because a bunch of dumbasses cant drive and have a fender bender. The little old lady with a stable hip fracture on your cot deserves better than this. I'm not saying to abuse Lights and Siren but there are situations where even a non-emergency transport to the hospital isn't so routine anymore. And what a waste of resources to sit in traffic. As far your point of an urgent call waiting that makes no sense. We are expected to maintain a state of readiness since EMS is important at the time of need and much less important 20 minutes after the fact. Perhaps it ok to leave a kid choking a a nearby school while the ambulances sit in traffic and obey the traffic rules. There has to be some common sense in this equation but until agencies are properly funded, staffed and deployed we will often find ourselves in a state of crisis. I vividly remember an article, i think it was in popular science, that warned of future traffic nightmares. Well sportsfans we have arrived in the future they warned of. Even in less populated portions of NC its not uncommon to sit in traffic on the interstates for 40 minutes or longer. We have even resorted to aeromedical at certain times of the day for less severe patients than we would have flown in the past due to gridlock. But unfortunately there are scarce air resources and they are very expensive for the patients.

As an EMS Director the issue of providing and ambulance for youth league sporting events was a political aggravation and a real pain in the ass due to the number of weekly events. We finally stopped doing them and told the officials to call 911 if they needed help. At one point the athletic associations attempted to apply pressure to us politically by implementing a rule that if an ambulance wasn't standing by they had to stop the games. Considering the fact there were at times seven different locations where games were being played on Saturday, this wasn't happening. The local rescue squad was horrible and wouldn't assist as were the volunteer FD's. I finally told the youth league sports "administration" that we were no longer providing standby services due to negative impact on response times. In my opinion if youth league sports are so inherently dangerous (and my sons play football) that an ambulance is required to stand by, then it's likely theses activities are too dangerous for participation by children. What's next, perhaps we will become so limpwristed and whiney that we will call 911 and request a standby at our homes each time our kids and their friends play on the swings or jump on a trampoline. Come to think of it my lawn is really steep in places, what if my tractor overturns? I know, I'll have EMS, Fire, Rescue and a local aeromedical chopper stand by in my yard.

In our service L&S rarely used during transport to hospital. Exceptions include Penetrating trauma, S&S AMI needing interventional cath, Stroke, any life threatening or quality of life threatening condition that cant be managed by the crew. I must admit I can understand the rationale for running emergency in California traffic though. Traffic around Raleigh, Durham, Greensboro and for sure on I-77 around charlotte has reached a point that easily delays transports for an hour and sometimes three unless you take measures to get around it. Even a BLS to the hospital can be "urgent" simply due to limited resources, patient and crew comfort and the need to return crews to service as quickly as possible.

In North Carolina the ER's would stroke if we brought this patient back to them having intubated and medicated. Eight hour waits for care are common as it is. The real problem is vultures in our own midst that are waiting for a reason to get you in a jam. I agree with the folks in this thread that you call medical control for direction after having completely explaining the situation. Of the thirty ER doc's I know personnaly there isnt one of them that would have you work this patient. If you have no medical control (cant imagine that!) I think the best option is to ensure the discharge planners have done their job in terms of COMPLETING all of the paperwork including the DNR before you load the patient onto your stretcher. In absence of the proper documents simply deny transport as you are accepting care of a patient likely to be in need of ALS services and are unable to provide it to them. All things considered I wonder if this could be considered an EMTALA violation on the sending facilitys part?

The problem is there is no standard of care in the US, and for that matter there certainly isnt a international standard of care. Medical Directors are afforded a great deal of power in determining which skills are worthy of his / her risk. Since the day the white paper was released there hasnt been enough continuity in pre-hospital care to fill a paragraph,

Now were ready for that "state" to break off and simply float away.

I'm confused, can a basic there admin lasix? Whats his heart rate and rhythm? If this isnt the problem he needs dopamine or dobutrex now! Depending on the degree of chf he may be able to o He is screaming for CPAP and perhaps intubation soon. I hope he already has a NRB on at about a million liters per min.

Are you saying they do not intubate pediatrics in LA county?

Ditto to Dust! What is the annual budget and how many personnel / stations do they have? Surely they cover areas outside the municipality. By the way dust, what do you think of my new "tag line"?

The age old problem with RSI has been when things don't go as planned. Unusual anatomy, morbid obesity etc are some of the complicating factors with any intubation. Paralyzed patients and and unmanageable airway make for an ugly combination. On the horizon is the possibility of switching from Succinylcholine and Vecuronium to Rocuronium and backing this up with Suggamadex which is a very fast acting reversal agent capable of completely restoring the patient to exactly the state they were in prior to administration of the paralytic, and this in roughly 90 seconds. Advantages of using a single, medium duration agent as opposed to multiple agents include decreased confusion with dosages, reduced expense and most importantly the clinician will be able to revere the effects of the medication if things get ugly.

I havent seen a "shock position" in protocols for years. You eluded to different circumstances to which i would add the following: Remember to consider the effects of the spine feet high position due to possible complications. This is especially true in late third trimester females who connot tolerate supine positoning due to vascular compression and discomfort. CHF patients generally will not lie flat and certainly wont allow elevation of lower extremities.

We too are allowed to RSI and do so without physician orders and even carry diprivan and a host of other really cool meds and you know what? We rarely use even half of this stuff. How many of us give even a second thought to the value of the "stuff we do"? Its really nice to be able to reach into our bag of tricks and pull out things that no EMS service in the region gets to use, and to hear the oohh and aahhhh, but is this truly science based medicine? I feel we have reached a point to where we can’t see the forest due to the trees in the way. There exists painfully little research to prove the value of RSI or even intubation in the field. I haven’t read the other threads on this subject but they are likely filled with this and other redundant claims both for and against RSI. Like myself many would probably loose their mind if the “Excalibur of paramedicine” (our laryngoscope) was taken away in favor of a less invasive device. Now, before you folks start slamming me on this please read on as I am not giving up my laryngoscope willingly. At some point during the evolution of paramedics, perhaps during the Pre-Cambrian period, we became competitive and fault finding with others perceived as less skilled. The focus became a matter of successful skills completed as opposed to appropriate patient care that was evidence based. I too, was a training officer before moving to admin and am guilty of tallysheet measurement of a paramedic or EMT-I's ability. They say with age comes wisdom and I now possess the former, hopefully I possess the latter as well. Instead of focusing on successful skills completed and berating those with poor rates we should have been looking at the whole picture. This isn’t one of those touchy feely everyone can do this posts, because I have seen those who were much better suited on the fry maker at Burger King and I sent them there. In terms of airway there are a few undeniable truths 1) Oxygen is good (I know, I know the research about free radicals in stroke patients, but we will save that one for another time) 2) Blue is bad 3) Air goes in and out. That’s where the "truths" end and the lines blur. If we listen to the American Heart Association (for $ale to the highe$t pharmaceutical or airway adjunct vendor) the LMA is just as good as the endotracheal tube in cardiac arrest, is easier to utilize, can be utilized by a broader group of providers with less training and less complications. Now you ask could this be? To that I reply possibly, but there is no data to prove this. Just like the "science" behind vasopressin which was absurd and failed to proved its value yet guess who gets invited to the algorhythm. The point I’m trying to make is that we simply must begin a process of putting forth the effort to prove our skills, procedures and medications have intrinsic value to the patients. With few exceptions there is little pre hospital based research that is actually based on field conditions. Unlike the power brokers and fraudulent research that exists in the AHA for the sake of money, our research must be real world, down in the ditch, nursing home floor, along the roadside, in the back of a truck designed for hauling freight as opposed to people; realistic research that either proves or disproves the value of what we do. In absence of the research we can skip the silly recriminations and tallysheet nonsense and truly evaluate skill success on a case by case basis. If we can’t get the patient intubated or RSI isn’t successful then is ok to go to a backup airway such as the LMA or combiube or are we to draw and quarter those failing to complete the precious skill. Our focus must be only one thing; did the patient receive appropriate care? Were they successfully ventilated by appropriate means which may mean only a BVM with OPA and supplemental oxygen or it may include devices such as the LMA or Combitube. This isn’t to imply we accept "good enough" and excuse those poorly skilled as clinicians, but I do feel we need to instill in all of our personnel to have a backup plan and a backup plan to the backup and so on. Then when things don’t go well our folks are able to adapt and overcome. In the days before RSI I vividly remember patients that would clearly have benefited from this skill and in retrospect I really wish I had it then. I think RSI is now merely a component or tool that we have to accomplish appropriate airway management in certain situations. Not everyone should be armed with this skill, but I believe if we gain the necessary education then training and support both with good recurrent training accompanied by QA/QI that is patient care centered RSI and many other skills procedures and medications will remain available to our prehospital patients. Oh and by the way if any of you have trouble getting and airway on me I'll expect a nice vertical scar somewhere around the cricoid cartilage, I'll wear it with pride!

Brock8024, I really appreciate the fact that you can engage in this discussion with an unemotional and apparently honest perspective. Nothing I have said in this thread has been intended to be defamatory or disrespectful to anyone. I just think it's important to attempt to gain understanding. In order to do that we must first understand the perspective of the other regardless of how open minded or myopic it may seem at the time. I believe you understand this and thats what makes the thread interesting and now 10 pages in length.

How did I fight dirty? I simply stated the facts, if this guy and members of the community hated this guy and the fact he was gay I felt like they should put their money where their mouth is. I didn't care if this guy was straight or gay. As an administrator it was strictly business. He was a great clinician and kept his personal life out of EMS. This redneck fire chief was an idiot and was trying to terrorize me into firing the employee through political and community pressure. Under federal and state laws how could I have acquiesced? As an employer it was simply the wrong thing to do anyway.

Add cold extremities and associated vasoconstriction to the list although an earlier post mentioned "things affecting skin perfusion". If the patient is intubated then its rather moot since the gold standard is continuous EtCO2 if its available.

I had a paramedic working for me who was openly gay. This was well known throughout our rural community and it being a rural community in the southeast one would expect some opposition to this guy's lifestyle. We had a Fire Chief that was livid about the fact that this guys was "allowed" to take care of patients. He proceeded to call friends in his community who called other friends who, you get the point. My phone rang of the hook for almost two weeks with citizens raising hell about this guy and how they didn't want him taking care of their children. These folks were calling the town board members and manager it was a mess. From a fair labor standard, civil rights etc perspective there was nothing I could do about this guy possibly responding to these folks residence. I failed to mention this guy was an outstanding employee, educated and probably the most skilled in the service. I finally got fed up with this mess and called the Fire Chief and asked him for his mailing address and that of the town. He inquired as to why to which I replied that this employee was preparing to file a federal civil rights lawsuit against our service, his fire department and town and him as an individual. I also used this tactic when citizens called in, and you know after about another week I didn't receive another call..... If the clinician provided inappropriate care file the appropriate WRITTEN complaints. If this doesn't work hire an attorney. I would also include the medical director in this situation as he/she is likely more capable of stopping this guy from practicing than the town or county HR folks.

FINALLY! Someone that can discuss this subject scientifically. Although I am a bit suspicious of research that set out to prove a particular result as opposed to openly examining the issue. By the way I too had anthropology and psychological anthropology in college. I was hoping to provoke this kind of discussion by my earlier threads on this subject. We keep getting the same emotional psychobabble about folks being born with homosexuality in their genetic structure. I would really like to hear your perspective on this, so is it choice or a "genetic destiny"?

This isn't a spelling bee, its a spirited discussion between folks with varying opinions on an often emotional subject. What I am saying is the homosexual community shouldn't attempt to gain assumed credibility by hijacking the legacy of african slavery in america, the civil rights movement, world war II or those already dead in what is shaping up to be world war III against psycho muslims. It's quite a stretch to attempt to equate your "struggle" with the above for the following reasons: I, and arguably the majority of people on earth, view homosexual behavior to be based on deviant sexual behavior with no biological or procreative purpose. Now I realize you will respond by saying that most heterosexual sex is non-procreative. To this I would reply that the basis for sex, at least from a biological perspective, is pro creative and for perpetuation of the species. Homosexual sex lacks this basis. Is there any other species on the planet that engages in homosexual sex? Cattle, squirrels, rabbits, fish, birds. The only animal I am aware of, other than humans, that engage in an act of homosexual sex is the manatee and this is apparently by happenstance instead of an overt sexual act. As I see it the biggest hurdle you have is political correctness. On the surface it appears to be your ally in the workplace and society at large. The "word police" feverishly seek out those expressing views even remotely opposed to homosexuals. People of faith christians and others who oppose total acceptance of homosexual behavior are censored, fired, and ridiculed in the main stream media as backward or ignorant. The problem with this is that for all of their hell raising and political activism they simply galvanize others against them. Politically homosexuals are seen as a huge nuisance that must be handled carefully due to their influence in hollywood and as I mentioned above the main stream media. I'm sure this isn't how you wish to be perceived. In order to gain credibility it will take time, spirited discussion, understanding of BOTH SIDES not just yours or mine and finally a more peaceful approach by the homosexual community as opposed to the semi-terrorist posture that exists now.