captainstandup

Just wait until you are an administrator! For five years it seemed as though I spent more time with the media than with my family or the folks that worked for me. Now I simply go to work, do my job and go home. "Living large and loving life again" I suppose...........

Without laws to protect the young, or those without the capacity to make informed decisions, charlatans such as Jim Jones, David Keresh, Marshall Herff Applewhite, Elizabeth Clare Prophet, Sun Myung Moon, Victor Paul Wierwille, can operate with impunity. Under the veil of religious freedom cults or sects can practice aberrant rituals regardless of the risk or actual harm done to some or all of their followers. This is certainly not intended not to infer that JW's are members of a cult, but is instead; intended to illustrate the need for civilized society to have rules (laws) that are representative of the will of the greatest number of its members. If society establishes laws that accept an isolationist or hands off approach allowing one religion to deny life saving treatment to children then by default this approach must be equally applied to White Supremacists, Aryans, the New Black Panther Party, Satan Worshipers, muslims, Christians, Jews, Atheists, Pagans and Witches, etc, regardless of socially aberrant practices that are harmful to others. Perhaps this would include mutilation of young girls as practiced in some foreign cultures or even virgin sacrifice. Any activity would be ok and out of society's reach provided it was protected by the curtain of religious freedom. Due to their irreversible consequences, matters of life and death cannot subjective. If there exists even one "micron" of doubt or conjecture then life must be the default choice. Once a person has the ability to comprehend the gravity of life and death decisions, as related to themselves, it would seem logical they be afforded the right to choose.

ABC news is hardly more than an infomercial for the Democrat party anyway, therefore their opinion and horse dung are of equal value to me. Come to think of it horse dung has the ability to help things grow and ABC's liberal vomit poisons and demoralizes everything it "touches."

First evaluate all risks. Traffic flow, hazmat, fire, criminal event, power lines or other hazards. If you have children or other people in the car with you, you have a responsibility to keep them safe. The roadside at at accident scene is hardly a safe place for loved ones to wait on you. (I've had two law enforcement friends killed while on duty by being run over on the side of the highway, and they weren't out in the travel lanes) If you have small children then you aren't a paramedic or an EMT you are simply a mom or dad and your responsibility to them certainly supersedes any ethical requirement to assist. Would you ask a stranger to watch your two year old while you assist? Perhaps that really nice pedophile would be happy to assist, he would be thrilled to take little Johnny for ice cream while you assist at the accident. Emergency services work, even life in general comes with risk. All of us that have been in this business for very long have likely stopped to help in this type situation. By our nature we want to help those in need. A good friend always used this phrase when teaching: "When much is to be gained, much is to be risked; when little is to be gained, little is to be risked" On the surface this may seem self-evident but, the point is to give pause and consider all of the risks in any situation, then make an educated decision regarding risk/ benefit. Make sure you, your family and anyone involved can live with the results of a bad outcome. In situations on or near highways the risk is so variable and unpredictable due to sleepy, stupid, intoxicated or enraged drivers with no concern for anyone other than themselves I often find it too high to stop outside my home jurisdiction. This isnt to say you should allow fear to rule your decision making, actually the contrary is true. If you are making good decisions based on educated analysis of the risk versus benefit you need not fear anything and will be an asset to your family, patients and community.

Let's consider another twist to this discussion. Would healthcare providers that are of the JW faith refuse to initiate, continue or assist in any manner with the administration of blood products? If involved in any manner wouldn't they be complicit in "denying the patient eternal life" This seemingly would exclude JW's from all positions within healthcare that in any conceivable manner is involved in the administration of blood to another human. Obviously critical care nurses and paramedics, air and ground, are routinely required to initiate and continue blood administration. On a religious note: I ask these questions out of curiosity and not of disrespect. I'm curious as to how the consumption of blood has been paralleled with blood transfusions in the JW faith? The passages repeatedly cited in this thread were clearly written before anyone could remotely conceive of a day when blood transfusions would be possible. I realize this is a matter of faith and interpretation for those in the JW faith but I wonder if these passages were meant to alter human behavior of the day and time of their writing? Was cannibalism practiced or were there rituals that involved the consumption of human blood that needed to be addressed?

The children haven't the capacity to understand the risk of refusing or accepting treatment. In the United States they generally do not have the right to choose regarding acceptance of treatment in the setting of life threatening situations until they are eighteen. I haven't intended to offend spenac or anyone else with this discussion and he is welcome to continue the inference that I am uneducated, ignorant or stupid because of my position on this topic. To me it’s more a matter of law and the right for a child to be given every possible chance in experiencing the wonders of life. If the child is robbed of that life or the quality of their life is altered due to parental religious practice denying them appropriate treatment I feel it should be criminal under the law of our land. How is it that simply hiding behind religion (of any kind) excuses child neglect in many folks mind? We had a rather unusual church locally that practiced snake handling and the drinking of poison as a demonstration of faith. They had boxes of timber rattlers and copperhead snakes and usually drank strychnine, or at least what they claimed was strychnine. The "ring leader of this group suffered a couple of bites from a copperhead and apparently actually consumed the poison. This guy died because he believed his faith was strong enough and that God wouldn't let him die. Alas, he was way wrong. Had these idiots been exposing children to this practice they would have been arrested and charged with child endangerment. Who is being served by religious practices that deny proven therapies? The parents, the church, the friends and parrisioneers, the minister, everyone is looking out for their interest and seemingly no concern for the child.

Perhaps my 17 year old MVC patient's mom didn’t kill him. She simply interfered with his being given every chance available to live. This kid was lying in a level 2 Trauma Center and died from hemorrhagic shock and DIC with a proven therapy literally 10 yards away. How is this OK? I've spent most of my adult life being educated and trained to provide care for those in harm's way and to "witness" narrow minded superstition and see the harm it causes to those who are helpless and without voice or ability to articulate their wishes sickens me. Practice whatever religion you wish as an adult, worship goats, cows, the sun, the moon each other, everything, or nothing. Civilized society simply must intervene when parents are making decisions that are clearly not in a child's best interest. I'm surprised my earlier comments regarding the hypothetical 5 year old with burns didn’t garner any direct comments. Emotionally I feel there are vivid parallels between the hypothetical patient and my 17 year old MVC patient. In both "cases" the patient succumbs due to parental religious practice with absolutely no chance to speak for themselves. Thankfully only one of these patients is real, unfortunately he has been dead for just over four years now and the world will never know what his contribution to mankind would have been. He deserved better in a nation that has seemingly unlimited scientific ability.

We replaced ammonia inhalants with thumb screws five years ago, that will teach those faking bastards.

I realize religion is touchy but for the sake of discussion, lets say the parents of a five year old practice a hypothetical religion which prevents them from accepting medical care for any reason, under the guise that whatever happens is "Gods will". Now let’s say, again for the sake of discussion, this child suffers 20% second and 10% third degree burns and is in intense pain with possible airway complications. Instead of calling 911 the family summons church members and they hold vigil praying around the child as it lays suffering and dying, but they continue in their belief that this incident is a result of "God's will" and do not call for help. Later in the evening the child finally succumbs to injuries and airway edema. The family and church members accept this again as "God's will" or rationalize the Childs death in the belief their faith was not strong enough to save them. 1) How is their refusal to call for help different than the Jehovah’s Witness refusal to allow potentially life saving therapy for their child? 2) How do you suppose the Sheriff's Office will react to the child's death when they are notified? 3) How many children grow up and choose a different religion than their parents? Perhaps this hypothetical child would have chosen a different faith and one that would have saved their life? 4) Muslim extremists believe it to be honorable and perfectly within "God's, or Allah's, law to strap a bomb on twelve year old and send them into a crowded market to kill the Infidel. (You can’t preach cultural understanding of one religion without wholesale acceptance of all religions, regardless of their psychosis) The point I'm trying to make is that in my opinion this is an area of human existence that simply requires intercession on the behalf of those too young to assert their religious beliefs. We as pre hospital providers often intercede on behalf of those who cannot assert their wishes under the law of implied consent. It seems elementary that in spite of parental religious practice a child would choose to live instead of suffer and die. Once they are eighteen they should be able to decide entirely regarding acceptance of any therapy.

First, if this has been addressed in an earlier thread please block it and direct me to the previous discussion. How many providers have seen parental interference in caring for critical patients by family members of the Jehovah’s Witness "Faith"? I have personally been involved in at least three cases where pediatric patients were in my opinion killed through parental refusal to accept potentially life saving blood administration therapy. The most recent was a seventeen year old male MVC victim. It took us almost 40 minutes to get this kid out of what was left of his car and all his mother was concerned about was that he not receive blood products. Trauma surgeons told her and the father he would die without blood, yet they refused and consequently killed him. I know that some state supreme courts have held the Childs constitutional right to life trumps the parents "right" to freedom of religious practice. I have heard of cases where healthcare providers have been successful in obtaining emergency protective custody orders allowing them to proceed with necessary therapy against parental wishes. I'm curious as to how this is addressed in various EMT City Members response areas.

Belligerent silliness ruins careers! Yet another example of providers with a self appointed "God Complex", meaning they feel the need to exact some degree of revenge against a person they feel is unworthy of their time. Healthcare providers must resist this with every molecule of their being. Professional competent assessment and treatment is what you are paid to do, your job is to provide the best customer service possible including empathy and compassion even if the patient is "faking" or "malingering". If patient assessment reveals the patient to be "unconscious" then treat them as unconscious including admin O2 (consider orotracheal or nasotracheal intubation to secure airway) IV + Blood Glucose check, assess for toxic exposure or envenomation, ?CO poisoning or hypoxia, hypo or hyperthermia, stroke or MI, trauma, spinal injury, seizure then reassess. If they "wake up" treat them accordingly. Perhaps it is merely a psychological emergency but I assure you that being judgmental or cruel to those folks doesn't solve anything. Remember in an hour you'll be fortunate to be clear of the call but the person you cared for is left to heal physically and mentally and we certainly shouldn't make that process any more difficult. Being fortunate enough to be entrusted with another persons care is sacred and those who violate this trust and resort to cruelty and malpractice should do the world and healthcare a favor and shoot themselves in the face!

Dust, are you saying that education and cultural understanding are useful in patient care? Surely you can’t mean that broader understanding of different cultures from an anthropological AND cultural perspective is useful in caring for them? We have a significant American Indian population in North Carolina and I find their presentation more unique than any other ethnic group. They are very proud and very suspicious of white healthcare providers. Diabetes and associated disease processes are common in epidemic proportions. Many of these folks are non-compliant with medications and diet restrictions ordered by their physicians. In addition to a high tolerance for pain, "diabetic neuropathy" further complicates assessment. Assumption or poor education and judgment by care providers lead to inappropriate treatment or patient refusal of transport leading to deterioration and return calls for help by the family. Not to mention idiosyncrasies of the Indian population in response to certain medications. More on that later.

Nope, I just don't give pain meds to anyone, I hate everybody and think they should all suffer! Now seriously, investigate the motive behind the author of the article, the magazine or newspaper, if the story were from ABC or CNN of course its a white against black thing. I have never administered or withheld medication from anyone based on anything other than clinical presentation. To do otherwise is damnable (is that a word dust?) How many providers make "value judgments" about frequent fliers or "drunks" labeling them as drug seekers? I don't give a damn if I have transported a patient 59 times for the same complaint, if their presentation qualifies them for narcotics, I'm administering narcotics. It's up to physicians and social workers to sort out the details regarding suspected abuse of the system or "drug seeking" I've seen patients receive inappropriate care by other crews simply based on value judgments that distorted their clinical judgment and led to errors. A really good example of this is a young black man who we frequently transport for sickle cell crisis. This fellow lives in a really bad area, has a history or marijuana use and has had a few "encounters" with law enforcement. As most of you know one of the most common presentations in sickle cell crisis is unbearable groin or abdominal pain. I found the only effective treatment for this patient to be NRB o2 @ 15 LPM, Saline IV and 15 mg doses IV Morphine. I have seen other crews bring tis guy in without even as much as an IV. These are the same medics that never pick up a book of trade journal and sleep through inservice. We cannot teach empathy, caring or kindness. Medics who develop the idea that they get to decide the value of another person must be helped to find other new and exciting career opportnities. Perhaps the garbage collection industry or fast food would be a nice fit. Finally, DING! Fries are done!

Two to three week waits to see a primary care MD and insurance with idiosyncracies that I couldn't begin to explain have placed me among those that use the ER as a primary MD. The copay is lower, lab, x-ray, and other associated support services are instantly available and I don't have to go to three or four places to have different tests done. The physicians are competent and professional. The downside is I am sometimes 10th in line behind mostly illegal mexicans.

Assumption is the mother of all screwups my friend. The public is better educated regarding different aspects of EMS and patient care than ever before. Hollywood and networks like discovery, science and health networks have conditioned people to expect a great deal more than just a ride to the hospital.

Please dont get the idea that I am opposed to new people riding along, we encouraged local first reponders to schedule ride alongs with our agency to build relationships and give them much needed patient care experience. We have permitted high school health occupations students to ride along also, but thse kids all have been immunized against Hepatitis B and have a rudimentary understanding of infecton control and patient privacy. We added what amounted to a contract that the riders, and if they aere under 18, their parents had to sign. This document was not only a waiver of liability but also was a contract that held them and the parents responsible for breaches of patient confidentiality committed by the student. I refused to allow anyone that was simply "interested in an EMS career" to ride along. This was based on aforementioned risk to the individual, agency, patients and taxpayers. There is simply no good reason to allow this activity. We dare not discourage those considering EMS as a career (God love them!) but we have an immense responsibility to our patients, staff members and the community to minimize risk to its lowest possible level.

Of course your state and local medical authority will have the final say in this however, if you are going to offer what amounts to a higher level of care you must, in my opinion, offer that level 24/7 X 365. It will be a political and funding nightmare if you folks offer an inconsistent level of service and with only three or four providers trained to do this it will be very difficult to cover 24/7. Your agency would likely be much better served if the three of you follow the process of upgrading the level of service for the entire organization by being involved in lobbying local and state authorities to allow the increase in service and then by being instrumental in training / educating your folks. It is very bad form to respond to a call where you offer a higher level of care, then the next day respond to the neighbors house and offer only BLS services. Imagine how this may be perceived by; bystanders that happened to be present at both calls.

Contrary to popular belief in some areas, EMS is a service industry and not a club. We have a legal, moral and ethical responsibility to work efficiently, competently, safely,and clearly we have a federally decreed responsibility to maintain privacy. Uncertified people with no reason to be in the patient care environment present a myriad of risks including 1) Risk of violating the patients right to privacy 2) Risk of interfering with patient care and potentially resulting in harm 3) Risk of exposure to blood borne pathogens 4) Risk of being involved in an MVC 5) Risk inherent to the rescue / EMS scene 6) Risk of having their ass kicked of they in any manner harm, endanger, insult, offend, violate the privacy of or in any manner bother my patient 7) Risk of being left on a street corner in the hood. All jokes aside, if there is no valid reason for someone to be riding along then they must be prevented from doing so. Its the responsibility of the highest credentialed provider to set forth the barriers and establish the overall tone for a given patient care situation. This must be backed up with clear policies regarding riders and associated privacy / environment of care issues.

My primary objective is to get a sense of what its like to live and work in an area where these parasites are common. I also want to gain understanding of the gang culture. I offered the opening post to the thread to provide insight into the culture where I live, not to provoke an argument. Perhaps Asysin2leads is right and I do need to look in the mirror. I suppose it is a matter of perspective but the folks I referred to differ from gangs in many ways. Unlike gang members these people are hard working honest people that would rather die than steal from others or harm someone without provocation. They don't use drugs, sell drugs aren't involved in prostitution or racketeering and I don't believe a single one of them has ever carjacked anyone. These folks are at work every day, pay their bills and taxes, hunt and fish and enjoy life without bothering another person. Many are highly educated and some are not and; are of meager means. They will however, never walk away from a fight, and they have virtually no concept of fear when it comes to defending those they love. "Sidebar" In the "racism" thread I threw some ugly remarks at Asysin2leads which were unnecessary and childish. I was wrong for making comments in that thread that were personal against him. He is obviously very bright and professional and apparently shares the same passion for spirited discussion that I do. Thats the reason he "said he didn't want to start a fight" I read everything he posts on EMT City and agree with him 99.8% of the time.

Being from semi-rural North Carolina and an area where EVERYONE is armed and not easily intimidated by thugs, I have never been exposed to gang violence or responded to those types of calls. The culture and topography make our area much less inviting to those with bad intentions and there exists a sense of community that wouldn't tolerate outside trouble. When it occurs people here will respond with frightening violence and absolutely no restraint to gang intimidation. I believe this sense of community spans the court system and Law Enforcement to an extent that would make it particularly uncomfortable for gangs and would be very forgiving of locals protecting themselves. I understand Gangs are simply another form of organized crime, with money and power being the motivating factor for the leadership, and a sense of identity for the gang members. I am curious about several things though: 1) Is there any meaningful effort in curbing this behavior or is it simply political BS and the areas where gang activity is high have simply been "written off?" 2) Does your response to these areas differ from normal scene safety? 3) Are there special considerations regarding treating these patients, ie: not damaging their "colors" or gang specific things that would provoke them to lash out against EMS? 4) Is there other information on gangs you feel would be helpful to A) EMS providers and B)Parents

Aren't travel papers or a passport required for travel into the People's Republic of California? I know they have comrade Schwarzenegger, the demopublicancommunist liberal liar for governor. Californians better be careful, Maria's Chappaquiddickennedy DNA could rear its ugly head and start drowning people.

I believe I would shoot myself..................in the ER or something along those lines..........

The problem isn't with the quality of books, its with the idiots permitted to "teach" the subject matter and the political "stuff" that surrounds learning. In North Carolina the Association of Rescue and EMS has lobbied and bribed its way to credibility. They oppose virtually every advancement in educational requirements or in raising the bar for "instructors" The company line is " you cant increase the educational requirements, it would destroy our volunteer organizations" The government coalesces and nothing changes. A single book simply will not do. Anatomy and Physiology is poorly addressed, if at all in most EMS textbooks. The reason is that it cannot be effectively covered in a section of a book since it is at least a two semester course with labs. (OK perhaps its not everywhere, but it should be) This is the very foundation of caring for others and must be given the appropriate attention instead of being an aside or nuisance.

I think I would rather burn to death slowly than finish my days in one of those "piss holes" At least you would know the end was near and perhaps a wonderful medic with fentanyl or dilaudid would stop your suffering. How horrible it must be to be treated terribly and charged five grand a month for it! I am certain there is a special place in hell for bad nursing home employees such as the ones you encountered!

Isn't the objective of the Military Medic to "preserve the fighting force"? I, by no means, claim to be a Military Medic however I have several friends who are and they have transitioned into civilian practice nicely. I can assure you these guys NEVER complain about how hot or cold the weather is and they never make excuses for half-assed work because they are mission driven and never fail to accomplish their mission, never! Our terrain and environment can provide really difficult situations in terms of being required to hike 7 or 8 miles into the woods to the patient and then carry them out. We have even been forced to stay overnight on the trail with an injured patient due to safety issues (fog completely eliminating visibility and in an area with 800 foot sheer drops) The Military guys never uttered a syllable of complaint.