HERBIE1

I know. You're not supposed to feed a troll, but when I see ridiculous statements that are blatantly false, I have a hard time biting my tongue. I just get sick and tired of the victim mentality.

Truly fascinating stuff, but also common sense when you think about it. Think about how many people grew up with buttery fly band aids from mom(now Steri Strips) to close wounds that could easily have needed sutures. As long as the wound was cleaned, none of us died from that lack of sterile technique. Granted, a few of us may be sporting interesting scars from our escapades, but I never expected to be in a beauty pageant either. LOL

I guess I missed the part where I should WANT to be someone else. ANYONE else, for that matter. That type of mentality makes no sense to me. How about being the best person YOU can be and not worrying about being someone or something you are not? Stop celebrating victimhood, crochity. It's not noble, you don't get points for being a martyr, nor does it ever help you get ahead in life. I am who I am- for better or worse. If I have flaws or problems I work to change them and improve myself. I think it's ridiculous to spend your life wanting to be someone else. Envy and jealousy are very ugly and nonproductive traits. Get off the damn pity pot already. That act has long since gotten stale and old.

I just looked up that word and it must be a translation issue- I could not find it. I did find these alternative words: copremesis and stercoraceous. Never really wanted to know the actual medical terms- hopefully I will never see this again. Feces should NOT be coming out of someone's mouth. I guess everyone has their own tricks to deal with nasty smells. I had an old police wagon guy who told me to put a generous hunk of Carmex (A highly mentholated lip balm) under their nose. Works pretty well. I also developed a breathing trick- I simply breathe through my mouth and for some reason, the aroma simply is not bad. I guess it all depends on how sensitive your nose- and stomach happen to be. I've gagged a few times but never lost my lunch over a smell. The only time I threw up at work was years ago when I was young, single, and stupid, I came into work fairly hung over. Of course the first call was for a young guy with the flu- N/V/D. The guy warned me he may vomit- and I said I may join him if he did. He did- and I did. Not something I'm proud of, but it was also the last time I came to work in that condition.

Tough times, firemedicchick. I am quite familiar with the asthma issue- from my wife. She's been pretty severe her entire life. She was tugging on the albuterol q 4 hrs- more often if seasons were changing or during allergy season. If she got sick, add the nebulizer to the mix, and a couple times she still ended up in the hospital for a couple days because she was so hypoxic. She was always tethered to that inhaler and had one at work, in the car, at home, in her purse- she could never chance not having one nearby. Enter Advair. Literally a life saver. She takes it twice a day, and since then, now uses her Proventil pump MAYBE 1-2 a YEAR- when she gets a URI. I cannot recall the last time I saw her use her rescue inhaler. As for frustrated- I get that. Anything that alters your routine, keeps you from doing what you want, or changes your lifestyle- sucks. I don't know what the answer is, but maybe see the doctor to find out if a medication change is in order. I think many of us- especially the old timers- have chronic health issues. Backs, shoulders, knees, heart, GERD, it sucks to be "old". This profession will also prematurely age a person. I see more younger folks with issues generally reserved for retirees. It's simple the nature of the beast. Yes, you have a medical condition, but do NOT let it define who or what you are. Deal with it as needed and move on. The more you dwell on it, the more it will get you down. Trust me- been there with my heart.

Did you happen to miss the part where I mentioned that a black professor was hired to write this test, and who's specialty is writing race neutral, unbiased tests? So tell me again about how the test was rigged. Here's a link, if you don't believe me: http://overlawyered.com/2005/03/chicago-firefighters-exam/ Would you like an example of the type of question that was asked on that exam? A picture was shown of a building on fire- people in windows, firefighters performing various tasks, bystanders, cars, hoses, ladders, fire hydrants- anything you would expect to see with a building on fire. The applicants were shown the picture for awhile, and then were asked a series of questions pertaining to that picture. Where was the smoke coming from on that building? Which floors were on fire? Was the fire coming from the front or rear of the structure? How many people did you see in windows? How many ladders did you see on the building? How many people were waving for help? How many fire hydrants did you see? How many fire engines were in the picture? Any of that sound unfair, inappropriate, unrelated to the job, or biased to you? Explain to me how such a question can be biased, discriminatory, or unfair to anyone? Explain to me why a minority would be at a disadvantage when taking that test? Explain to me how the racist educational system would be responsible for a black doing poorly on such an exam. Explain to me how slavery from the 1800's would keep someone from being able to look at a picture and answer questions such as these. Short of giving out crayons and having someone trace a large X on an "exam" sheet, how can this be made any easier? It's a friggin picture, for gawd sakes. A 1st grader could handle that. Should there be ANY standards at all?

Think institutional racism, doc. It's a fancy way of essentially saying- "Even though we cannot cite a specific example of a bias, the entire system(ie educational system failure, history of slavery, civil rights violations, etc) must be at fault- because any other explanation would be too messy, unPC, and would certainly not celebrate being a victim." Seriously- if you ever get a chance, look up the concept of institutional racism. The term was invented back in the 60's by a black activist. It goes through these convoluted explanations and justifications, but it is actually quite clever at it's core. . Essentially, anything that adversely impacts a minority can be classified under this term- regardless of the intent of the "offender". That is exactly why that Chicago lawsuit was won.

First, I'll address the nerve you struck with some in regards to your FF/EMS thing. I am not as militant about pro EMS and anti- Fire dept. To me, fire/EMS combination is a necessary evil in many places. The highest pay will be on fire departments and while there are some single role EMS providers on fire departments, most places are cross trained. In most cases. even the single role EMS folks on fire make far more than the private counterparts. It's a matter of what you really want. Cross training gives you the best of both worlds. Bottom line- even as a FF, over 80% of your calls will be EMS related, which means you had better be on top of your game. THAT is your bread and butter. As to your question about death. Everyone is different. Every death is different. Is it a child, or an elderly person who quietly slips away in their bed? Is it a young child who is struck by a stray bullet, or a baby who is a victim of child abuse? Is it a chronic alcoholic who has abused their body for so long that their liver finally gave out? Is it a teenager who succumbs to cancer in the prime of their life? Remember, with nearly every death, someone will be mourning the loss of a loved one or a friend. Be mindful of this fact in your approach, your demeanor, and your actions. Some deaths WILL affect you. Sometimes a lot, and generally you will be surprised at when it may hit you.. You simply need to be empathetic. Understand how grief works, think about how you would want to be treated in the same situation. Think about how you would want your loved ones to be dealt with by a provider if you are the one who passes away. It also depends on where you plan on working. In a busy system, you may be looking at the grim reaper's handiwork multiple times each day, in a variety of situations. In a slower area, you may be lucky to see one cardiac arrest or DOA in an entire year. Like anything, the more exposure you get, the easier it becomes to handle it. Best of luck. Melena is a smell that is certainly immediately recognizable- from across the room. LOL The ones that get me- burnt flesh and decomposition. The number one most hideous sight and smell- someone who had an obstructed bowel and actually vomited fecal matter. I will never forget that as long as I live.

Been awhile for me here and the first topic I post on is one of crochity's infamous racism topics. And I just had to bite... LOL Oh well. Lots has happened in recent weeks- none of it good. Looking for a diversion, so we'll see how it goes. Hope all is well with everyone here.

The devil is in the details. Discrimination did NOT occur. Minorities were adversely represented in the results of the exam. BIG DIFFERENCE, but for the purposes of the lawsuit, it's "racism", which means lotto payout time. That exam was race neutral, written at a 5th grade reading level, and created by a black professor who specializes in making race neutral, unbiased tests, but if it makes crochity feel better, then let's call it racism and file a lawsuit. It's lotto time! Much easier than trying to figure out how to play with the test results to get the numbers they need.

No question. By far the worst call I have ever had- Responded to a long time friend and coworkers home. Last call of a long 24 hour shift- did not realize this was their apartment. Supposedly a sick person- very sketchy- no other information. Walked in and found mom sitting on the couch in a darkened room, with her back to us, holding her 4 month old unresponsive daughter. I grabbed the baby and ran to the rig and told mom to follow-we did not have our Peds bag since we were told our PT was an adult. Gave a couple breaths and started compressions when I realized the baby was cold and in the light, I see the baby is mottled and long gone. This was a SIDS. As we were confirming asytole on the monitor, mom was trying to get in the back of the rig and I said "Hang on for a second, mom". I look up and noticed this was someone who was my friend, a mentor and my preceptor 20 years earlier. I was speechless. Mom knew what was going on, but we explained it anyway. We transported to the hospital, and brought in the baby. I had radioed in the details and said we would be transporting as a courtesy- no further TX. As we arrived at the ER, calmly walking in with the baby and mom, one of the doctors approached me, looked at the baby, and said quite loudly in an obnoxious tone- "This baby is dead! Why are you bringing it here!??" It took every ounce of self control I had to not punch this doctor's lights out. (I'm still getting furious all over again as I am typing this, 20 years after the fact) I managed to grab the doctors arm, and dragged him into an exam room where I explained the situation. He was still being an ignorant a'hole and I had to walk away. A nurse stepped between us and pulled the doctor out of the room because she honestly thought I was going to kill this guy. The rest of the day was a blur. I helped make notifications- the father, the chaplain, friends, family, etc and I finally went home around noon, physically and emotionally drained. Even worse - the church service for her, seeing this tiny little casket in a big church, and at the end of the service, dad picking the coffin up and carrying his daughter down the aisle and out of the church. Getting chills just thinking about it now. I was depressed for weeks afterwards.

Off duty or on duty- doesn't make a damn bit of difference to me. This guy was an a'hole. Period. In an ER, there are boxes of gloves of every size. No excuses. Unless the patient was covered in blood, or had a gaping chest wound, II see no reason why you can't do simple compressions- the risk of being exposed to anything is essentially nil. Then again, when I started in the business it was a badge of honor to be covered up to your elbows in blood. Yeah, unthinkable now, but we didn't know better. Guess what? Never caught anything from a patient either. This lazy provider would hate to have me as a partner- he would be in for a very long day.

Used to be an issue with us, but now we have automatic door locks, with the key fob on our key chains. NO reason to have the rig unlocked now.

Am I the only one with a sense of humor here? Hysterical belly laugh? No, but pretty funny just the same. It's listed under "Funny stuff". You can laugh or not.

Some locales have more instances that require law enforcement or other agency notification. If a person gets injured in a public area- tripped on a sidewalk, fell on the street, etc- a police report must be filed- of course to combat the probable lawsuit for an improperly maintained street, sidewalk.

HORRIBLE idea.

Horrible news. Condolences to the entire family.

A Liaison would need to be well versed and familiar with not only prehospital and ER protocols, but the actual day to day issues each group deals with. A prehospital provider may not understand bed availability issues, delays in admitting/discharging patients because of slow labs, waiting for a transporter, busy procedure rooms, back ups waiting for Xrays, waiting to give reports, waiting for attendings to call back- the list is endless. Many EMS folks only see that they have no ER beds to transfer their patient to. An ER person may not understand the pressures of being told to get back in service, of the horrible conditions we sometimes see, of the weather extremes, of the difficult scenes, of the frustration of waiting for supplies, of the pressures of missing sleep, meals, the frustration of not having housekeeping to clean up the rig after a particularly messy call, of having no down time, of sometimes having to wrestle/restrain a combative patient with no help around, of performing our jobs in less than ideal conditions.... I would like to say that understanding is a 2 way street. I've been in both settings- field and ER- while I can count on one hand how many ER nurses I interact with can say they have done anything more than a mandatory shift or 2 for their critical care nursing class, trauma nurse specialist, or telemetry nurse class. Thus, if I know what happens in an ER, it does not stop the ER nurse from getting snotty. Yes, we can escalate things and make formal complaints about personality conflicts or nasty behavior, but I prefer to handle it on my own. So who would this liaison be? A staff member of either group that has worked in both capacities. Obviously that would be ideal, but not always possible. Lacking that, the person would need to be actively involved in regular meetings/sessions to discuss the issues of both.

Depends on the transport time. As long as the patient is perfusing well, good BP, O2 sats, pulse, stable EKG, etc) I would NOT start an IO, As for the patient turning their head frequently- place them in a cervical collar if you really feel the need to go jugular.. Let the ER start a central line.

Welcome to the city! So you are talking about a self inflicted cardiac tamponade? Yeah, pretty rare. I worked in a very busy Level One Trauma center for 10 years and only saw a few. I do recall one good one- not self inflicted, but a knife sticking out of a guy's chest, buried in his heart, pulsing with each heartbeat. He survived. Prehospitally- maybe 2-3 that I know of in 30 years.

Courageous? Nah- just apparently following the letter of the law. Interviews with the jurors indicate they believed she was guilty, but the evidence simply did not support that verdict. BIG difference between that and acquitting her. Am I angry at the verdict? Damn right. Based on the evidence we have heard, it would seem the prosecution did not have a strong case. Tons of circumstantial stuff? Absolutely. Too many questions unanswered to convict, I guess- BUT- Why did she lie to the police? Why did she wait 30 days to report her child was missing? Why did she lie about where her child was? Why did she seem so annoyed when someone asked her in a phone conversation about her daughter when she seemed more interested in her own issues? Why was this little girl found with duct tape on her mouth if this was supposed to be an accident? Sorry- I'm not a judge, a lawyer, nor was I on that jury. That;s why I can say without reservation that I think that in some way, this woman was responsible for killing her own daughter. If not- I want someone to give me a plausible alternative explanation for what happened, and who was responsible. Added: The defense's job was to create reasonable doubt, and with their shotgun approach- blast away with all kinds of crazy theories to plant the seed of doubt in the minds of the jury. They didn't disprove anything. They did their job, but in my mind, justice was NOT served for that poor little girl.

I didn't find this particularly funny, but I certainly do not find it offensive.

All good suggestions about solutions here. I'll quibble about the term "customer". We can refer to the people we treat in many different ways- some printable, some not. The trend is to attach cute names to consumers as well as employees in all types of businesses. Clients, consumers, customers, patients, "friends", etc. The buzzwords for employees are even funnier- associates, team members- and my favorite-"partners"- as if some minimum wage guy at Wal Mart makes corporate decisions of any kind. Anyway- It doesn't really matter the moniker we hang on the people we care for, it's how we treat them- physically and psychologically. In most cases, those we care for ARE customers- the service we provide is not free. They pay up front, are billed, or the service is included in assessments and taxes. So yes, this is about customer service, although in our case the consequences for a poor encounter are a bit more serious than a poorly made espresso or chicken sandwich. If a person is a a'hole to a patient or family member, odds are they would have a similar attitude in any job they would perform. Tough nut to crack, but you need to set up specific behavioral standards that must be adhered to, as well as outlining consequences for violating those standards. Specifics are difficult in such cases, so you need to tailor any approach to your providers and the specific problems you are seeing. I have found that management/leadership/HR training is vital in order to fairly deal with personnel issues such as these- especially if a collective bargaining agreement is involved. I've seen that 4/3 rule in other contexts, but it's indeed accurate. I had forgotten about it, so thanks for bringing it up.

Maybe a slight detour, but I will back up a bit. Anecdotally, the majority of my full arrest saves have been WITHOUT an ET tube. We've been on a roll lately- the last 3 arrests we had were saves with a ROSC, and so far, 2 of them have survived to discharge with no deficits. All were intubated AFTER ROSC. With proper CPR and good ventilations, I think the ET is superfluous in the initial stages of a resuscitation. .New CPR standards say we need to compress the chest hard and fast and demphasizes ventialtions.. Is an airway and ventilations important? Of course, but here's an example. Last week- call for a person "down" in car. Upon arrival, we see a bystander doing OUTSTANDING CPR with the victim on the sidewalk- compressions ONLY- for about 3-4 minutes per bystanders,.I checked for a pulse, and the patient actually had one, and some preliminary respirations. I profusely thanked the bystander and told him he just saved a life. To make a long story short, we essentially did an ACLS megacode, - multiple defibs, lots of drugs, but the person survived, was making purposeful movements and fighting the tube. Before we left the ER, the patient was enroute to tthe cath lab for his STEMI- unknown outcome. Point being, we make a big deal out of toys, procedures, and forget the point of all this. Simple answer- do NOT interrupt CPR just to intubate. Good, solid BLS care is what saves folks, and the toys and meds we use are what keeps them alive for definitive care.

Why not? There is no such thing as bad publicity, but I reserve judgment until I see the show- IF I see the show. I never saw that FSR training series- Rescue Me. I realize EMS suffers from an identity crisis, but I think more exposure is a good thing. Apparently this new show is a comedy, so unless someone is severely dim witted, folks will understand this is not a documentary or real life account of EMS workers.