Steve Whitehead

Everyone's rules will be a little bit different. You're already on the right road. You are being open about what happened and you are establishing a credible work history. Don't give up on EMS until you make some phone calls. Just take it one step at a time. Call the state and tell them you are an active duty soldier returning from duty and you have a previous dui (give the date). Find out the process to get your license in order. Each employer and job opportunity will look at your dui differently depending on a bunch of different factors from insurance to existing policy to personal preferences and their need to hire. Starting with an ER tech or event medical job is a good idea. (Actually there are a ton of non-ambulance opportunities.) Then approach employers with your solid work history and honorable service since your dui event. Be willing to talk openly about your dui. What happened, what you learned and what it has meant in your life. If you can do any kind of community service involving alcohol, drug or dui education, that would look very good on your resume. It's also nice to be able to talk about your previous dui from the standpoint of an awareness /educator who learned from the experience. If you hold your head high and move in the direction of your goals, I bet someone will give you a break.

I appreciate that feedback Bernhard. Well thought out. Cogent. Non-polarizing. Experiential. Thank you.

After my response to this string passed 1,000 words, I made it into a blog post. Here's the meat of it. Some of the ideas are great. There’s always plenty of insightful, well thought out input. But there are also a lot of EMS solution myths that rise to the surface when these discussions get rolling. Many of our ideas for how to fix all that ails us are shrouded in false beliefs and oversimplified analogies. Here are six EMS fit-it myths that find their way into so many of our EMS rants. How many do you fall for? 1) The myth of solution by committee In this delusion, we convince ourselves that even the most complex and pressing problems could be solved if only we just got the people closest to the issues to come together and talk. If that were to happen, we believe that the right solution would emerge from the dialogue and then we would ll agree and implement those solutions. This idea is flawed on many fronts. First it places its faith on the myth of the single solution. (See below) It also disregards how difficult true dialogue becomes in these situations. Committees are notoriously awful at producing worthwhile solutions. The old axiom that a mule is a thoroughbred designed by committee is true. When we elevate groups of individuals to the level of “problem solvers” we interject ego, turf wars, personality conflict, competing interests, inter agency politics and the interloping of millions of stakeholders all looking for a piece of the influence. If you think problem solving within your organization is difficult, doing the same thing at the national level is monumental. (Literally…if it were to work, we would build a monument.) 2) The Myth of the single solution. This one is endemic to conversations about the woes of our EMS nation. It’s the belief that a single solution could be applied to EMS systems across America and they would work universally. Our EMS systems are unfathomably diverse. We have fire based EMS systems, private EMS industry, public service EMS delivery, hospital based EMS providers and combination systems. Add to this the fact that we serve diverse populations from rural areas where EMS response can take hours (or longer and call volumes are measured in calls per week to busy urban systems over-run with system abuse, overtaxed hospitals and annual declining budgets. Don’t forget that over half of us are volunteers and most of us are under-trained and the idea that a single panacea idea or movement could solve the issue of modern EMS becomes extremely unlikely. 3) The Myth that nothing is being done. Here’s a shocker that most of the arm-chair EMS quarterbacks will have a hard time wrapping their brains around. Most every problem endemic to EMS in America and around the world is already being addressed and worked on by some organization or group of people. And here’s the really sad thing. Most of them are begging for your support and you don’t even know they exist. That’s right. While you’re angry about the lack of national representation of EMS, the NAEMT is working hard every day to fix that. (And you’re still not a member.) Movements like EMS on the Hill Day are taking place every year and you aren’t present. Worried about EMS education? NEMSA is working hard day and night to raise the standards of pay, recognition and political clout of EMT's and paramedics both publc and private. NREMT is fighting for a minimum national standard of EMS education as well with one of the most advanced testing processes available to anyone ever. (Even though you bash the test every time you take it.) And online education groups like CenterLearn and The EMS Web Summit are striving to bring real, cutting edge EMS education to your desktop. Upset about system abuse? Agencies like West Eagle County EMS and Colorado Springs Fire are experimenting with community paramedic models to try to head off the call before it comes. Progressive EMS organizations are partnering with community service agencies to identify repeated 911 abusers to find more long term solutions to their ongoing problems. And that idea of a national committee? Groups like FRN-TV are working on creative ways to create that national dialogue you’re talking about. You should watch…and comment. Instead of trying to launch a movement, find where the movement is and join it. Champion the EMS champions who are already working hard to solve the problems of EMS. 4) The myth of EMS ineffectiveness For folks who subscribe to the myth of ineffectiveness, EMS doesn’t do any good because so few of our interventions or actions are truly lifesaving. It’s as if providing medical care that falls short of life-or-death interventions is beneath us. By this same logic, urgent care clinics should close their doors. I mean really, how many of their interventions are lifesaving? If someone has a true emergency they have to call 911. They should feel so ineffective. Of course, that’s ridiculous. They practice medicine. So do we. We listen, we question, we evaluate and then we give people advice. We also apply medical treatments and, yes, we take people to the hospital. We make a difference. We make a difference to the people we serve. If you need someone’s life to hang in the balance before you can feel like your work is important, you may want to switch jobs. 5) The myth that only field EMS providers know the real answers to the problems. This myth rears its ugly head with a rant that sounds something like this, “The problem with EMS is that the people implementing changes have been riding a desk for the last 20 years and don’t know a thing about real EMS. These jokers would be more likely to find Jesus in their morning toast than find a real solution to a real EMS problem.” We’re convinced that real system solutions are only found behind the windshield of an ambulance. Anyone outside of direct patient contact is an idiot. Here’s the thing…I only hear this opinion from people who don’t spend any time with nationally recognized EMS leadership. Sit in a room for a while with creative EMS managers and consultants like Chris Montera, Mike Taigman and Skip Kirkwood and your head will swim. You may find yourself overwhelmed with their creativity and the depth of their understanding of EMS operational challenges. (With all things truly considered.) Let them give you an eye opening perspective of what EMS looks like from 30,000 feet in the air. Suddenly, your ground level, overly simplistic EMS solutions might seem a little naive. If you spent less than 30 minutes trying to solve our nations EMS woes you may leave feeling a little foolish (or enlightened). 6) The myth of instant results. While the myth of instant results is present in every industry, it is particularly endemic to EMS. We don’t just want solutions; we want solutions that present themselves fast. We are results oriented people. If an idea works, then it should work now. If it hasn’t created results in six months scrap it and do something else. Here’s the thing we so often forget. Today’s problems are the result of yesterday’s solutions. Emergency services are in-and-of-themselves solutions to yesterday’s problems. Fifty years ago, getting sick people to life saving interventions in a timely manner was a real problem. It isn’t much of a problem anymore. We created a system where anyone call a simple number and get bedside delivery of our most time-sensitive medical interventions. But the way we designed the system created a bunch of new problems today. Those problems are what we’re talking about now. Yesterday’s solution = todays new problem. The better we design our solutions today, the fewer problems they will create for the next generation. But slow implementation solutions don’t win managers awards. Creative solutions that solve problems ten years from now aren’t that popular in an immediate gratification society. We want sloppy, fast answers that show immediate results. With any luck, but the time the new problems emerge, we’ll be on to our next promotion and some other poor sap will have to solve the new problems we created. 7) The myth of the perfect solution We are also deeply intolerant of answers that only partially solve the problem we are trying to address. Even when the problem is death itself, we demand changes that produce dramatic results. If our cardiac arrest save rate is 4% before the implementation of continuous compressions CPR and it’s 7% after, we deem the intervention a failure. Death happens to be a remarkably difficult process to reverse, and yet a 3% decrease in this troublesome disorder is apparently nothing worth celebrating. We are apparently in search of an intervention that will definitively reverse death. Nothing else will do. It seems ridiculous, but this is how we measure positive change in emergency services. Unfortunately, this isn’t how positive change tends to happen. It happens slowly over many years, backed by the hard work of a whole bunch of really smart people. And yet, when new EMTs enter the field they find that people don’t always call 911 for appropriate reasons and more often than not, the people who die stay dead. In a few short years (or less) they are frustrated and angry. They write angry blogs dedicated to EMS rants and adopt the affect of the burned out old-timer. (Not realizing that we’ve seen this all before.) There’s a much better way to go about all this. If you’d like to work towards positive change in EMS, instead of adding one more angry rant to the pile, here are a few possibilities that would be far more productive. A.) Embrace the imperfection. Life isn’t perfect. Neither is any job…anywhere. Life is about solving problems. When we’re done solving these problems, we get more. That’s the way it works. B.) Join the fight. You don’t need to start a movement. (There are already several.) You need to look into the long list of groups and organizations already working to advance the cause of improving EMS. They could all use your support. C.) Champion the people who are doing good work. There are a bunch of them. EMS doesn’t need another rant. Rants are easy. Use your voice to talk about everything that’s right with EMS. If you can’t see it, you aren’t looking hard enough. When you do see it, help other people see it. D.) Be patient. Do the right things because they are the right things to do. If you don’t see immediate results, be patient. EMS isn’t going to change overnight, but it will change. It’s been slowly improving for the past 50 years and it will continue to improve. You could be a part of it. E.) Respect the folks who have invested their lifetimes working in EMS. Just because you don’t understand why they are moving in the direction they are moving doesn’t mean they are wrong. Ask them. You may learn something. F.) Keep your eyes open. The next brilliant idea is around the corner, but you’re going to miss it if you’re too caught up in your “everything sucks” mentality. People who explain what’s wrong are a dime a dozen. People who see what’s going to happen next and move in anticipation are rare and valuable. Be valuable. Thanks for the question.

And again Herbie...the question wasn't, "Is it legal to exclude women?" It wasn't, "Are women being harmed?" It wasn't, "Are they entitled to make their own rules?" It wasn't, "Are their examples of similar discrimination against men?" (Your own offered definition of discrimination does not hinge on any of these factors.) Just because they are legally entitled to exclude women doesn't make their decision just, or non-prejudicial or non-discriminatory. They are free and legally entitled to be as unjust, prejudicial and discriminatory as they want to be in their private club. Should they do away with their unjust, prejudicial, discriminatory policy? Yes...yes they should. The fact that I have no association with they Augusta Country Club has no bearing on my opinion about racial, gender, ethnic or spiritual discrimination. It is wrong in every context. (the fact that I'm male has no bearing either.) Look ya'll. Here's where we are just not going to come to terms. Some folks here on this thread believe that discrimination is OK and appropriate in some contexts and other believe that it is not OK in any context. I fall on the side of not ok in any context. We can disagree on this one.

Mobey, your initial response gave me a huge smile. i probably would have openly laughed if I hadn't been in a room full of people. Thanks for that. I'd love to hear what people who are using serum lactate as an early indicator. I'm using it in my rig (in the context of septic shock) and I'm finding it very relevant and useful. I was wondering how quick mentation changes would come up. I don't personally feel that true confusion is an early sign of shock but I certainly agree with Asys on the weakness, malaise and generalized dizziness / instability. I've seen some folks in fairly profound shock who were still able to speak in context and oriented. (Slow, sluggish and weak...but oriented.) I'd like more input here. Pallor... good one. How many times have you seen compensated shock that wasn't pale? (With the exception of anaphylactic shock.) Come to think of it, I've seen some pretty pale anaphylactics too. Mobey, last thing. Research is great, but I don't mind hearing subjective opinion here as well. The science of what we do is critically important. If you find relevant research, please pass it on to us all. But our personal experiences touch in the art of what we do. I know a lot of people dismiss the art. I don't. Now I should be quiet for a while and let this develop without my intrusive nonsense.

In truth, there is no difference. I think it's both discriminatory and immoral to exclude people solely based on race, sex, ethnicity or spirituality. I don't apply these rules to my home and if you do, you are, by definition discriminatory. Make peace with it. If someone says, "People who are black can't come in my home. I don't care who they are. I exclude them from my home because they are black." They are racist. If they make the distinction because they are female they are gender biased. (By definition.) I exclude people from my home for more appropriate and morally sound reasons. Reasons like..."I don't know you." This is a judgement I can apply even handedly to anyone who shows up at my door. If you'd like to make a case that I discriminate against strangers...OK. I'm at peace with that. I couldn't agree with you more. I don't know if bigoted is the right word but it is an unacceptable contradiction. If we say that this is the minimum physical standard at the time of hiring, it should remain the physical standard for as long as you do the job. The service should remain biased against people who are unfit to do the job from the time of hiring to the time of retirement. It's part of the job. There's no excuse for 300 lb. fat firefighters. They are a danger to themselves and others. It shouldn't be allowed to happen. (And yes, I am biased against them for what I feel are morally sound reasons.) If it was my choice, I would exclude them from the fire service until they met the same minimum standard applied to all new hires. Then we are simply at a theological road block Dwayne. We just fundamentally believe in different core values. That's OK. We were all meant to believe things in lock step. I believe that it is morally unjustifiable to use race, gender, ethnicity or spirituality as a means to select or admit people...anywhere. These aren't morally appropriate measuring sticks. Clearly, many, many people disagree with me. (Including the board of directors of the Augusta Country Club.) We may just need to agree to disagree on this one.

I came up with this idea while reading some of the feedback in the "Shock Index" thread I posted last week. The previous thread brought forward a lot of good discussion about recognition of shock and what indicators were thought to be reliable and unreliable. Another theme was early vs late indicators of shock states. It reminded me of years back when I learned about analyzing stocks and predicting their movements. Some signs were considered reliable and others were considered unreliable. Some indicators were considered "leading indicators" meaning they appeared early and others were considered "trailing indicators" meaning that they appeared late in the stocks movement. (These are sometimes referred to as confirming indicators.) As you might guess, leading indicators were less reliable that trailing indicators. (Had less predictive value.) I imagine that, between the folks who frequent this forum, we've collectively assessed and treated shock presentations in the six figure patient range. I'd like to know, what do you all feel are the most reliable early indicators of shock? What are the most unreliable indicators? If you had to make a list of the best assessment findings or symptom constellations to identify shock early in the compensated phase, what would they be? Two disclaimers: 1) I understand that they type of shock will change the constellations of symptoms, especially when we're considering skin signs. 2) If I get a bunch of good feedback, I may make this into a blog post. If you'd like your input excluded from the blog post, please say so.

I agree that MAP has great assessment value. I've shied away from teaching it at the EMT level because of the complexity of the calculation itself. But (if I could get over that hurdle without eating up too much class time) it may be a better concept. Regarding perfusion being a simple concept, many of the concepts that we teach at the EMT level are simple, yet we still need to teach them, just like someone needed to teach it to you. I think it's valid to consider how best to teach these concepts, regardless of how "simple" they may be now. Regarding getting stepped on...hummm. I think there are some folks on the city who are prepared to give good, cogent feedback that is useful and helpful. And there are some folks who are...less prepared to do so. I feel like I can pick the good stuff out. You do have to come to a forum with thick skin for sure. My time is limited and I'd prefer to not invest too much time in the folks who aren't here for the community.

Thanks for all the input everyone. There are a bunch of really good observations here. I'm surprised to see that the shock index appears to be relatively unknown to this group. I'd never heard of it before I encountered it recently. I'm still on the fence about using it as a teaching tool. I think most fo the folks who are advising not to teach it seem to infer that I'd teach it as an actual assessment tool to be calculated and used in the clinical setting. That's not my intention. Actually, that's the one big minus I referenced in the original post. I don't want EMT's thinking they should calculate this on the fly. I'm still wondering if the concept has merit to try to illustrate that vital signs don't live in a compartment. They are associated with each other and the rest of the assessment. And every patient assessment needs to be considered in the context of that patient and the rest of the exam. This is a really difficult concept to teach new EMTs. Once upon a time I thought the Glasgow was crap. Unitll I started teaching it. I teach it regularly. For new EMT students it is a great was to explain the different elements that need to be considered when assessing the patients responsiveness and how significant they should consider different levels of responsiveness. It also has fairly good predictive value for multi-system trauma mortality as well as the need for advanced airway intervention. Having said that, I never calculate it in the middle of patient care. I assess and I act. I don't teach my students to calculate it in the midst of patient assessment. It's just not appropriate. But to a new EMT learning how to figure out what it means when the patient doesn't respond normally, it has tremendous value. Someone said it was crap because they had never heard of it. There are plenty of valuable assessment tools that I've not yet heard of. I haven't reached a point in my career where I consider my absence of awareness of a technique or concept as evidence of its uselessness. That's why when I heard about this I decided to explore it instead of reject it. I've learned a lot of great stuff over the years by being honest about my own knowledge shortcomings. I agree that a single vital sign like blood pressure cannot be used as a definitive sign of shock (or any other abnormality). That's the exact reason I kinda like this concept. It's simple, but it shows the association between to major vital signs. I also think it would have greater predictive value for shock states that are blunted by pharmacology. For our beta blocker patients I suspect that the shock index would rise as they entered decompensated shock even in the presence of a normal heart rate. For our patients on multiple anti-hypertensives like ACE Inhibitors, I think this dynamic might still play out. I'm wondering if we should teach the shock index as a concept for the very reasons your saying it's worthless. I agree that tracking any single vital sign is worthless. That's the exact reason I like this concept.

I'm considering whether I should teach the concept of the "shock index" to new EMT's. I like the concept for several reasons. I also think it has some failings. Plus: 1) Good demonstration of the relationship between pulse and blood pressure in identifying shock. (New students like to compartmentalize information.) 2) Would help newer EMTs recognize early decompensation when complicating factors (like beta-blocker use) affect the complete vital sign picture. 3) MIght help recognition of occult bleeding. 4) Good platform to lead into teaching about putting the vitals signs in context for the patient. (Diffcult to teach new EMTs) Minus: 1) Might give new EMT's the idea that they should be puling out a calculator and doing math while they are involved in patient care. Is this concept worthwhile in prehospital care? Should we be learning it at the EMT basic level?

Well done. Glad to hear that you're doing things that scare you. It's a good sign that you're pushing against your boundaries. It's a fantastic career. Don't ever feel like you have to apologize for being a firefighter. Wear your uniform with pride. Show up and do a good job. Good luck Iowa

I'm currently using Zofran (Ondansetron) 4mg SIVP which I prefer over Reglan (Metclopramide). I'm presonally a huge fan of Inapsine and I used it frequently both as an anti-emetic and a chemical restraint for years without any issues. Inapsine was black boxed about ten years ago but I've heard talk that it might get released for use again in the near future. That would be a good day. 1.25mg of Inapsine was like turning off the vomit button. I don't care if I have to put a cardiac monitor on every patient I give Inapsine to, it would be worth it.

It was never my intention to make you think you needed to apologize Dwayne. I didn't feel your response was out of line. I only wished to point out that I felt your transitions of logic weren't representitive of my input. No harm, no foul. We're good. And your response illustrates that leap perfectly. So give me a chance to elaborate. Here you reiterate my thought which I feel you represtent correctly: Absoloutely. OK, right there. HUGE leap of logic. Do you see what I'm saying? This is our "straw-man-fallacy. Instead of addressing my true argument, the argument that gender should not be used as a measuring point to determine if someone should or should not be admitted to a private establishment, we've jumped to everyone should be allowed everywhere all the time. And were discussing an absurd statement instead of my original statement. You've created a straw-man, and once you defeat that straw-man, my orginal thought is declared equally absurd. ...but it's not Dwayne. It's not absurd to think that using gender as a basis of admission is unacceptable. Here's an example of why the two are not the same. Let's take the fire service for instance. I work with very few females. Maybe... one in ten firefighters at my organization are female. (And we are pretty diverse comparatively.) Some folks will tell you that our testing process is discriminatory. We have a challenging physical agility test that is difficult for anyone to pass but it's exceptionally hard on many of our female candidates. (It's also an accurate mirror of some of the physical demands of the job.) This test is indeed biased. It's biased against people who are not physically fit enough to do the job. In a selection process, this is a perfectly acceptable bias. It's acceptable because it pertains to an actual standard of the expected job performance and because it can be applied to every human being who shows up to be tested. Now let's relate this to your example. There are several standards that apply to whom I allow in my home. If I made a list it might include, 1) I need to know you or be familiar with you. 2) I need to have invited you or been expecting you. 3) If a football game is on, you need to be carrying beer. 4) You need to be not-stinky (or I will turn you away) All of these rules are my preferences and none of them are discriminatory because I apply them to every human being who approaches my door. If I made a rule that said 1) you can't be black 2) You can't be female 3) You can't be jewish 4) You can't be Muslim. Now I'm being discriminatory. I'm applying a rule unilaterally. (and based on an inappropriate or even immoral standard) I'm refusing you because of who you are. This is the difference between personal preference and bigotry. It's a huge difference. And people have been trying to dress up bigotry to look like personal preference for a long, long time. You make an excellent point. It's something I'll consider if a posted question raises a desire in me to be flippant. Perhaps I should have just left this one alone. OK, then my next question would be "Should black people be allowed in the Augusta, GA country club?" (Note: I'm not asking "are they" and I'm not talking about law or freedom or status quo or even choice. I'm just asking on a moral...right and wrong level...should they?) Yes or no? This is a really....really good point. It doesn't change the issue. It doesn't speak to the rightness or wrongness of the issue. (In fact, one might argue that it's an easy way to do an end-run around any topic with non-global implications) But it does put the issue in perspective.

I would offer that the two are unrelated. We can't reasonably compare racial / ethnic / gender discrimination with scientific / social / fashion discrimination. Having discriminating tase in clothing is not related to excluding members from a club based on their race / ethnicity / gender. The acceptability on one does not justify the other. I don't intend to be insulting or shallow when I offer my input. I thought my post reflected my feelings on the subject perfectly. If I had posted a direct question, "Should X be allowed?" and I recieved a direct "No" answer, I would accept that input as meaningful and complete. I've seen yourself and other folks on the board become upset over brief responses in the past and it's certainly possible that I've tripped over a forum etiquette issue that I'm unfamiliar with, but I would suggest that the length of a post is not directly related to the validity of the input. I can offer a very long, pseudo-intellectual rant and add very little value to the discussion. I can also put a lot of thought and experience into very few words. (I've been known to do both.) Sometimes I wish we were more tolerant of brevity and less tolerant of long winded nonsense. Socialism is used to collectively define a fairly diverse group of political concepts. (Most of them being economic not social.) I'd need you to draw a stonger parallel to the political construct of 'socialism" before I could agree or disagree. If, in using the term "socialism", you intended to imply that I was being un-American (my word not yours) I would suggest that you are overlooking some very important moments in American history including the Cilil Rights Act of 1964 and Brown vs. Board of Education Topeka. Having said that, the OP was not asking about rights or law, he was simply asking if we thought a private country club in Georgia should refuse membership to women. And it makes no sense to me either. I'm glad I never said or suggested such a non-sensical thing. I made a statement of belief about whether or not a private country club and golf course should refuse membership to females. Honestly Dwayne, you've made such a gigantic leap from specific gender discrimination to this argument that I can't really put the pieces back together. You've piled straw-man fallacy on top of straw-man fallacy to misrepresent the spirit and meaning of my statement. On this point we can agree. The world will never be free of racial / ethnic or gender biases. We can only recognize them for what they are and do our best to minimize their influence. I don't claim to be free of any of it. There are parts of me that are racist and sexist and bigoted. We can only accept those parts of us as flawed and reject them. The world is not utopian. There will be theft but it doesn't make it right. There will be violence but that doesn't mean that it is acceptable. There will be discrimination...but that doesn't mean that there should be. Augusta National does discriminate against women, but they should not. Sometimes membership, by design, is exclusive. That means that some are included and some are excluded. When we are trying to make a decision about inclusion into a group or organization, there are many acceptable ways that we can measure an evaluate a human being. Gender is not one of them. "Should women be allowed in the Augusta Country Club?" ...Yes Dwayne I'm curious if you were to simply address the OPs question with a direct yes or no answer, what would it be?

The act of discrimination is hurtful. You can argue that if there is no specific victim then there is no wrong doing but I stongly disagree. Arguments like these were used to justify post civil rights "seperate but equal" segregation for years. We can demonstrate our discriminatory bias through seperation but we'll keep everything nice and equal. What you have, we have. Look...that's fair. No harm, no wrong doing right? You drink from your fountain labeled "black" and I'll drink from my fountain labeled "white" and everything will be just fine. Segregation is discrimination. I don't see this as one of those gray areas where it's OK in some situations and not in others. Gender based discrimination is wrong. The harm is not validated by identifying victims. The harm is recognized when we realize that the ideology is hurtful in-and-of-itself. As a side note - those "total woman gym" places that refuse membership to men are every bit as discriminatory as Augusta. If it's wrong for men to exclude women from a country club, it's wrong for women to exclude men from a workout facility. (I'm not a big fan of gender specific education either.) Respect, Steve