captainstandup

I didn't know and hey, I read, attend classes and teach all of the time. Perhaps I need new books or to go back to college. I must admit really enjoying getting put in my place by some of the folks on EMT City though. Just when I think I am smart enough to actually participate in the discussions on here someone mentions something I have never heard of and makes me feel like a green rookie. Oh well I'll keep trying...............

Yeah it didnt really make much sense to me at first but, I resisted common sense and posted it anyway. It's sad how the liberals want us (civilians and public safety folks) to remain helpless sheep headed for the slaughter and then they rush to defend the scumbag criminals! I only wish the crimes would happen to the liberals, of course they would no longer be liberals then would they?

Years ago a friend of mine was fueling his vehicle when confronted by a thug threatening him with a knife. My friend yanked the hose out of the car and gave this idiot a nice soaking with unleaded in the face and chest. Thug fall back and my friend pulls out a lighter and tells this guy if he moves he's going to light him up. Cops arrive and take the smelly looser to jail. There will be no crack (narcotically speaking that is) for him that night. Sometimes the simplest solutions are the best.

We must stop operating from the perspective of our worst and instead plan and tool for the best among us. It's completely unreasonable to discount an effective solution to a problem or therapy simply based on the fact that a dumbass in the service will misuse it. Clear policies, good training and a screening process to determine who should be allowed to be armed will minimize risk. Tazers are a great idea, I personally want an airweight 38 with glaser safety slugs.

Although not related to field care, I'm curious as to what her labs were? Specifically ALT, AST, BUN, Creatnine, Amylase and Lipase, GGT. LDH. Bilirubin.

I notice a comment you (Spenac) made in another thread about "a sux pen" or something of the sort. I realize nothing like this really exists (ok perhaps it exists at Langley) but not in EMS. This caused me to wonder if it would even be possible to deliver an instantly paralyzing or debilitating IM injection with a combination of the meds carried on an EMS or Critical Care unit?

There are many threads on EMT City that discuss self defense or response to violent situations. Other discussions have centered on defensive tactics and a common sense approach to scene safety. All of these discussions are important and many aspects worth consideration by EMS policy makers. Our goal in EMS is to help, to provide comfort and minimize suffering and to provide safe transport to definitive care. As a paramedic I'm all about accomplishing these things, but more important than anything is my goal to return home safely and in one piece. What I hope to accomplish with this discussion is to identify items routinely carried on our units and in our jumpbags that can be utilized to disable or if necessary kill an attacker. I'm referring to a "worst case scenario" where it's us against them and we are in a situation where law enforcement is otherwise occupied. This isn't intended to spawn a Dirty Harry like discussion among those simply desiring to hurt someone but is instead intended to provide useful intelligent information. It's important to remember whatever tactics we use must later be defended. Clearly, the best defense is avoiding to the greatest possible degree getting into a situation that has a high likelihood of violence or unreasonable risk, but as we all know this isn't always possible to predict. Now, with all of the disclaimers out of the way let’s discuss how we can use the things commonly carried to escape the worst possible situation in terms of a single or multiple attackers.

I wonder, if it were possible to have a concotion of drugs that would instantly paralyze an attacker? The challenge would be in the variability of administration methods that could occur in a defensive situation . Sub q, IM, and inadvertent IV admin.

http://www.whonamedit.com/synd.cfm/3050.html

I would love to pretend I knew what Hoffman's Sign was prior to your post, but honestly, I had no clue. As to your question regarding its use in the field. I believe any information that can be gained as early as possible is worthy of the effort. With this said we must remain cognizant of the need for "economy of time" and attend to rapid triage and transport when indicated. Finally to utilize a "test" such as that to elicit Hoffman's Sign it is necessary to have some practical application of the process and expected results along with a clear understanding of the implications of positive and negative results. Many prehosital providers will not have this opportunity.

Although she is afebrile I would be curious regarding some type of nosocomial infection or peritonitis as related to her surgery. Based on your assessment it could be as simple as an unusually painful menstruation cycle, Mittelschmerz, ectopic pregnancy. Another consideration would be gastritis which is fairly common following surgery, trauma, burns etc.

I believe that Fire and EMS should remain separate. The political reality of the situation is, in my opinion, that once combined one discipline or the other will suffer when it comes to allocating scarce budget dollars. To me only two things are worse than fire/ems combo departments 1) Public safety departments that include law enforcement into this ridiculous mix 2) Private EMS (The employees always loose, ALWAYS loose in either benefits or salary and the community often looses in quality of service delivered.

It seems as though the Chief violated if not the spirit of HIPAA, then he certainly violated public trust. Isn't it interesting the Chief would be "grabassing" around with his cameraphone instead of doing his job? This begs the question, was his presence even needed on-scene, since he obviously didn't make any meaningful contribution to the rescue effort? This is another case demonstrative of the need for very clear agency policies regarding release of information, regardless of the specific manner of release. One must consider whether photos of this woman were considered "personally identifiable health information" One of the driving forces behind promulgation of the HIPAA standards was the fact that personally identifiable health information was being sold. A variety of companies used this information for the purposes of direct marketing of therapies, medications, devices or services to specific persons based on specific conditions; based on unethically obtained information. The HIPAA standard is also intended to prevent anyone with access to private medical information to profit from release that information. This takes us back to "Chief Paparazzi", as I asked before, was the information personally identifiable, did through virtue of his position did the chief have specialized access and finally was there any manner he could profit from its release? I doubt the Department of Justice would charge him with a HIPAA violation but I would be willing to wager he and the Fire Department would loose a civil suit brought by the woman’s family. Regardless of the criminal aspect of this case I can assure you there will be a civil action against them and they will try to settle out of court. Although not related to HIPAA, OJ Simpson got away with killing two people in cold blood, but a civil jury essentially convicted him anyway and awarded the families tens of millions in damages.

What are orders? I thought this concept died with the dinosaurs 20 million years ago, or was it 1992? No more mother may I for us. Medical control is available if we need to chat about an unusual situation, but our medical director expects us to conduct an educated assessment and apply the appropriate treatment. I cringe at the thought of returning to the dark ages. We had an MICN that was so worthless, we would call in with a report of a patient with 10 / 10 chest pain and every conceivable symptom of an MI and she would being the "silly dance." The dance began by her asking if we had the patient on oxygen, then she wanted the vitals again, then she wanted the patients color and skin condition AGAIN then she would give us "permission" to administer 1 mg of MS "slow IVP" and included "recheck patient's BP immediately after MS admin" Thankfully this insulting idiot retired and the OEMS vastly altered the rules to allow an immense degree of autonomy among EMS providers. I wonder if we overdosed anyone with such a high dose of MS back then?

One of our local hospitals actually hired a guy as an RN and failed to check his credentials. This guy worked in the ER for 14 months as an RN before a "routine audit" (is 14 months routine?) of credentials exposed the fact that he had never taken the NCLEX. So this looser quits the hospital and begins working in a nursing home which is in the same town and only a few miles away as what? That’s right an RN! It wasn't long before rumor of his fraudulent status in the ER filtered out to the EMS crews who instantly mentioned to the ER Director the fact this guy was working in the SNF. The ER Director calls the SNF, who confronts this guy who promises "I'll bring my credentials in tomorrow morning" The next morning this psycho brings not his credentials in, but instead two gallons of gasoline, which he summarily proceeds to pour over his head in the dining room and attempts to light with a match. Fortunately for the SNF the gasoline damaged the striking plate on the matchbook. This prevented him from getting the necessary ignition source that would have secured his place in the next Darwin Awards book and probably have killed or injured a significant portion of the SNF's 160 residents. Fire and LE shows up, staff struggling with this idiot, quick thinking fire department foamed his ass and the entire dining room. There will be no fire or lunch in there this day! After proper decon the cops hauled this guy of to the "who who farm" This is but one example of how a fraudulent individual with enough cunning and wit can game the system for an extended period of time. There are a few things we can do to help minimize the risk of acquiring these folks within our ranks: 1) Competent HR folks would be really nice! 2) Thorough background checks (must be very careful until a conditional offer of employment is made) 3) During background checks require the applicant to provide their ORIGINAL state or or Federal credential. Do not accept a copy and don't be fooled by a color copy. You make the "official copy" and initial same as a copy of the original. 3) Actual verification of the applicant’s licensure status and investigation to the greatest possible extent as to whether the applicant has ever been convicted of misconduct in any state. It’s very important to ensure they have never been charged with Medicare or Medicaid fraud. 4) Comprehensive pre-employment competency exam and skills assessment. No, simply presenting a shiny RN or Paramedic License isn't good enough! This should include agency specific considerations that, while examining competency, provide latitude if the specific discipline is new for the applicant. Finally, at the end of the day there remains a great deal of unknowns with employees however, if you can show good faith in hiring practices you will essentially remain above reproach if a clever criminal invades you organization.

There are tremendous risks to mother and fetus including unexplainable in utero death, hypoglycemic newborns that are also heavily exposed to ketones along with really large babies > 90th percentile are common. A myriad of problems during the birthing process for the child and certainly for the mom.Please note this only scratches the surface of a much broader discussion of the ill effects of (GDM) gestational diabetes mellitus.

Here is a nice read that deals with a little more physiology by adding another dynamic to the discussion. http://bjr.birjournals.org/cgi/content/full/74/877/86

Thanks Asysin2leads, I've looked for those words for a long time. This kid was a friend to my oldest son and best friends to my nephew. I can still smell the gas and antifreeze from that night. We all took a great deal of risk to try to save him and busted our asses for over 40 minutes to get him out of a bad situation and had hope for his survival which seemed to be squandered by a misguided mother. There have been literally hundreds of fatality MVAs, to which I hae responded since then, but this one certainly galvanized in me for some reason and bothers me to this day. I too share your opinion regarding Government involvement in anything and especially matters of faith and wow do they spend far too much time in my wallet these days. My quest for understanding continues, perhaps a little more knowledgable and a little less emotional, wish me luck for I will certainly need it........................

I began this thread hoping to learn and as always have spirited discussion. My point is never to offend or be harmful. I have strong beliefs, but an inquisitive mind. It fascinates me that this discussion has lasted as long, and with as many posts as there have been. I haven't wavered in my belief that allowing the teenage MVA victim (that I described in the original post) to bleed to death, with a proven solution literally feet away, was wrong regardless of which God one worships. I tried to admire the JW's level of commitment to their faith, but alas I have failed on this one too. In my opinion any faith that sanctions neglect of the young or those mentally or physically incapable of making informed life and death decisions, as demonstration of PARENTAL obedience to their God is in my opinion suspect at best. What do I do with what I've learned from this thread? The only rational answer I have at this point is to continue being as active as possible in political and legal circles to prevent further occurrences of what happened to my patient.

Has there been other threads regarding opportunities for Paramedics in other allied health fields? If not I was hoping to begin a discussion focused on employment opportunities sharing ideas for disciplines, common and not so common, that capitalize on paramedic education and experience.

I reviewed all of the earlier posts again and must admit I was a few miles over the top on my last post, sorry about that. I still have flashbacks to a time when a few really bad employees caused me and our service a great deal of embarrassment and as you can see even now perhaps I'm still a bit too sensitive regarding these issues. I certainly didn't mean to throw cold water on the fun. One of the most embarrassing things I ever did occurred during a massive forest fire. I had been up for almost 48 hours and was the IC for night shift when the ops chief called me on the radio. He inquired as to what I was doing? Like an idiot I picked up the mic and simply stated "I'm in the command post CP,ing" This was interpreted as CPEEEING by everyone that heard the transmission. It’s been over 15 years since this happened and I still occasionally get crap from some of the folks that heard me back then. Thankfully it was around 2AM and the media never picked up on it. Since then I've been to Paramedic School and College and hopefully am at least a little more skilled than I was back then, but I sure was tired and we have enjoyed a great deal of fun over the years, related to my slip of the lip .

You kill me dust! I couldnt stop laughing!!

I was trying further my earlier point that the rule of law is all we have to protect the weak and young and those who cant protect themselves from harm, be it at the hands of their "loving" zealot parents or by a criminal. Protection from harm is the issue and it must be evenly distributed to all members of a society before all other emotional / religious considerations. If we simply discount what is in my opinion criminal neglect by the JW's for refusing to allow every conceivable therapy possible to save a Childs life then why should drug abusers that allow children to be filthy and undernourished be charged. They cant help it, right! Perhaps they are simply trying to achieve enlightenment and get closer to God thorough use of mind altering substances. Many in the public scream like a little girl at the prospect of a child being punished by spanking as this is a form of torture. A bruise or welt on a child’s legs has DSS and law enforcement sliding sideways into a school parking lot. How is this possible as the bible clearly says spare the rod spoil the child? If that same child were instead to suffer a ruptured spleen or lacerated liver in a school bus accident and the family deny lifesaving blood to be administered this same school staff wouldn't even conceive of calling DSS or law enforcement as the child lay dying. Which is more harmful, Corporal punishment, denied lifesaving care or the entire idea of the flawed concept of religious freedom, which has clearly run amuck

From a societal perspective the "holy spirit" is not a static entity, its variable based on a myriad of different faith's and cultures. Its virtually impossible to write laws that protect personal choice and religious freedom without by default offering sanctuary to criminals and psychos or abandoning the young and those mentally or physically incapable of articulating their desires from an informed perspective. It seems "interesting" that life and death decisions are being made on what is by many accounts an incomplete book. In 1885 the Archbishop of Canterbury recognized only 66 of the 73 books as valid. This is what is now referred to as teh "King James Version" of the Bible. What if the remaining instructions for life were in the missing chapters? Point is; human decisions are based on either emotion, money, power, sex or a combination thereof. These are the reasons we need consistent laws that protect those who cannot protect themselves.

I was the Director at the time in a service vastly smaller than NYC EMS. In any event, there is no professional organization that permits rank in file employees to speak to the media at will. The very basis of ICS requires an organized flow of information that has at least been approved by by the IC. There are political realities and operational considerations that most rank in file staff are not privy to. One misspoken word or phrase at a minor MVC can come back to haunt an entire organization. Failing to acknowledge the assistance of everyone involved while not insulting those that weren't is a big challenge. Attending to the ego's of those holding the purse strings without being overzealous is an incredibly important consideration. Of course there are HIPAA concerns and God forbid we forget the ambulance chasing bastard lawyers. Misstatements that can be distorted by one party or another can be a real problem for a public organization. I frequently allowed employees to be interviewed, however this had to be approved by their immediate supervisor who had a higher understanding of the policies and my directives regarding the release of information. At the end-of-the-day I was responsible for the impact good or bad from the release of information. There were many more considerations than simply permitting those you describe as having gotten their hands dirty to claim their 15 minutes of fame by being interviewed. Improperly released information could result in terrible fallout in the form of reduced funding, poor or absent response from mutual aid agencies , and even loss of jobs within our agency. In times of disaster release of information by those with a limited understanding of the "big picture" can result in lost lives. Getting your hands dirty, as you describe it, is the most important part of the job. I earned my position of administrator through 11 years of getting my hands dirty and through education, training and experience. Before you infer that those on the ground should be allowed to speak without the benefit of knowledge consider the impact when things are poorly received or the news isn't good. It seems everyone wants the spotlight when they can assume the role of hero but only the administrators are worthy of the spotlight when things are bad. You cannot possibly hope to engage in recklessly releasing information without the associated responsibility. Fortunately it wasn't a democratic process and voting on adhering to the policies wasn't an option.