HERBIE1

LMAO

Just when I thought I had heard them all...

Thanks for the belly laugh.

These are stories about people who grew up in public housing back in the 50's and 60's. Note the diversity here. Jews, Italians, blacks, whites, immigrants- with common roots. Note what they say about HOW and WHY they succeeded. Note the descriptions of their backgrounds, influences, and role models. Note that not a single one of them blames the "white man" or racism for anything. Note that they all had a desire to change their circumstances and they were willing to put forth an effort to do it.

Selected quotes:

"People did not understand that Jane Addams in the 1940s and 1950s was a safe place where families, many of them of Italian descent like him, gathered in their yards in the summer. Everyone knew one another, and families like his were common -- the men worked two or three jobs to make ends meet while their wives stayed home. Basile, however, always wanted more for himself."

and

"Back then, public housing was not viewed as last-resort housing. When we moved in, it was a big deal. We were moving up from the tenements," said Brady, 60, one of seven children whose father was a postal worker and mother stayed home. "I didn't really understand how poor we were in comparison to other people."

Sounds pretty "middle class" to me.

And this from the CEO of Chicago's Public Housing, who grew up as a resident there...

"I find more times than not, this look of surprise when people talk about where they came from and what they have achieved," Jordan said. "It is important to tell these stories so others can know that by working hard, having good people around you and a whole lot of luck, anything can be accomplished."

From Dick Portillo, founder of a nationwide chain of fast food places:

For most of his young life, Dick Portillo's universe consisted of row houses on Mohawk Street known then as the Mother Frances Cabrini housing project, later called Cabrini-Green.

"We didn't have material things. We never went on vacation," said Portillo, 69, whose father did everything from selling insurance to working in factories while his mother raised him and two siblings. "I don't remember being sad. We didn't have steak or fast food, but we ate. We didn't know we were poor because nobody in the projects had any money."

from a playwright and founder of a black theater group:

"It's not about where you are from, it is about how open you are to understanding that there is more to the world around you than you can hear, see or feel."

Taylor said she had all kinds of role models, good and bad, growing up in the 1960s. Her challenge was to decide which she would emulate.

"I had role models who said, 'Let's get pregnant and live in the projects and have a good time.' I had role models who said, 'No, you want to be someone, you want to have things and make it in the world because you have something to offer.' I had both sides, and I think the majority of us have both sides."

According to Taylor, the projects are no different than the rest of the world. Many of the problems that exist there can also be found in communities that have lots of money.

And this is my favorite, taken from his obituary and directly applicable to this forum. I had the pleasure of knowing this man. He was a true gentleman, fair, honest, and ALWAYS willing to help anyone. I have even referenced his textbooks in my teachings.

Mr. Crane grew up in the Ida B. Wells public housing complex on the South Side and graduated from Dunbar High School, where he met his future wife, Lois.

Here is link to his obituary. His resume and accomplishments would make any scholar envious.

www.chicagotribune.com/news/chi-hed-bcranejul08,0,4881774.story

chicagotribune.com

BENNIE L. CRANE 1935-2009

Bennie L. Crane, 1935-2009: Retired Chicago district fire chief

Mentor to fellow firefighters

Thanks for those of you who responded without resulting to attacks and name calling, we can only learn when we are openminded. And to answer all, yes I believe poor parenting is a major factor if not the major factor, but lets look at why that is. Obvioulsy black children are more likely to grow up in a single-family household, which isnt necessarily a bad thing (before all you single parents jump down my throat), but basically the last generation of black kids have grown up without a father.

You may not want to hear it, but racism does play a role. The inequity in pay for those who have jobs, and the inability to get jobs, moves minorities to the lower end of the socio-economic scale -- which puts them in worse neighborhoods and schools.

First. a previous poster did a nice job looking at the links you provided. I read them as well but have nothing significant to add.

As for the above passage...

How is it that racism forced fathers to abandon their parental responsibilities? Before the Civil Rights movement, the prevalence of single parent homes was essentially the same as for any other group-it was rare. I read a study about this and need to find it again, but I promise you it is true. This isn't a racial problem, it's about abdicating your responsibilities, and that is a problem endemic to the community, not an external issue.

You need to back up a bit with the inequity in pay issue here. WHY is there an inequity in pay? Claiming racism is the easy cop out but... Could it be that the high school drop out rate for blacks is astronomical? It's pretty hard to make a a decent living and support a family without a basic high school diploma or GED, much less a 6 figure income. The change has to start somewhere, and with all the incentives, special programs, mentoring, tutoring, affirmative action, and other race based initiatives available, even in an economically depressed area, it is EASILY possible to elevate yourself and change the status quo for yourself, but the effort must be there. The "barriers" to success are self imposed, not from white folks. It's not easy for ANYONE to succeed these days, and there are no promises for success for anyone except the trust fund kids, and when programs are specifically targeting the black community, what else should be done?

Like Chris Rock said, no matter where you are in America (and note I appreciate the Canadian facts, but they are Canadian not American) if you are on MLK Blvd, you better get the hell out of there quick. Because the white man put all blacks in public housing in the 60s-80s, and then introduced crack cocaine to the population, the result is higher teen pregnancy, more highschool dropouts, and more imprisoned black males.

Again, I know for a fact that many people who grew up in public housing back in the 50's and 60's and it was NOT just for blacks. It was also a family oriented place with working people who were not rich, but were getting by. The people who were successful worked hard, stayed in school, and stayed out of trouble, and they did not have many of the protections and set asides available now. At some point, attitudes changed, and the value of hard work was replaced with a victimization mentality which is a direct result of the set aside movement. People who may not have had the strongest work ethic or morality base realized that thanks to hand outs, they could "survive" just fine without putting forth much of an effort, and that mentality took hold and exploded. As a result, they became marginalized and began to operate independent of the rest of society-do what you have to do to survive. Social engineering ideas that were meant to help or simply to atone for past injustices, have done done nothing but ensure a permanent underclass. After all, it's human nature- most people take the path of least resistance. You seem to be suggesting that poverty automatically begets violence, lawlessness, immorality, and a lack of education. I strongly disagree with that notion. I've worked in poor black areas for my whole career- I know better. Those who are able to "get out" of the ghetto have family support and people who instill values and a work ethic. I suggest the opposite is true- once no value is placed on education, a stable family unit, and a strong work ethic, those societal ills become the norm. It's not the "white man's" fault that a kid decides to drop out and join a gang. They make that decision as soon as they buy into the notion that staying in school, getting a job, staying out of trouble, working your way up, etc- is "acting white", selling out, and is a bad thing.

A teenage black mail today is more likely to die or go to prison than he is to get a white-collar management job. And I fully understand that part of the reason for so many blacks not being able to get into public safety jobs is because they can not pass the criminal background check due to crimes they committed as teens, but that is the viscious circle that whites have put us in --- which I know that you can not believe or see, but it is the truth.

Again- the chicken or the egg here. If a teenage black male drops out of school, what "career" do you think he is qualified for? They make a choice- based on their role models, their family, and their peers. If they attempt to elevate themselves, they are accused of "acting white". You can blame the white man all you want- and clearly you do- but you need to stop blaming everything on the "white man". Laws exist to protect from true racism- and yes it does occur- along with sexism, homophobia, misogyny, xenophobia, nepotism, and all sorts of bias. Get over it, get past it, and stop using it as an excuse.

It is kind of like the problem with illegal aliens. Because they are illegal, they can not go to the police when crimes are committed against them, and they can not get banking accounts (white man's rules). So everyone knows that on any given day, any hispanic looking male who is not speaking english probably has several hundred dollars in his pocket, which makes him an easy target for robbery.

More "white man whining". If you are illegal, you should NOT have a right to anything other than a one way ticket back to where you came from. That means no bank account, no drivers license, no free education, no free health care, no rights reserved for citizens. These aren't white man's rules, this is common sense. Go to Mexico or any other country as a US citizen, decide to stay without becoming a citizen and demand the things we give ILLEGALS here. See how far you get.

I have news for you- illegal aliens work their arses off for low pay, but somehow they are able to survive, make a living, and even send money back home to their families. They don't feel that menial jobs are beneath them, and don't expect to get a "white collar job" because they know they ARE illegal, have limited language skills and are undereducated.

Yes the slaves were freed in the 1800s, but we couldnt get jobs or education until the 1960s (the only major company that was hiring blacks before the 60s was the military --- which is a whole other arguement -- funny how we got to fight for whites freedom when we were being discriminated against in our own country). When you gave us freedom you then put us in a new prison (public housing) which broke apart our families.

Again, at some point, choices are made to either continue the status quo, or try to elevate yourself. These days, there is NO reason why someone has to CHOOSE to stay in a ghetto. Step one is to stay in school. PERIOD. How many gang bangers do you think have HS diplomas or GED's? Step 2- take responsibility for your own actions- meaning if you cannot support yourself, you had better not start spreading your seed and having kids you cannot take care of in any way. After that, the road is wide open. Difficult- yep- and these days, it's difficult for EVERYONE, but when you have special programs that give you opportunities unique to your group, you even have an advantage over everyone else. USE IT. There are no promises of success for ANYONE except an elite few. Always been that way, and always will be.

The Republican (rich white) mantra of pull yourself up by your bootstraps is ironically spoken by people who have not had to pull themselves up by their bootstraps. There are exceptions to every rule, but if most of you look back on your life, you will see that most of you have never had to really pull yourself up by your own bootstraps (sure you have had problems, like everyone else does --- but most of you have never really gone to sleep hungry or cold). Most of you had a great middle-class existence complete with mother, father, nice home, a good education, a car when you were a teen, and college if you wanted it. The black child is more likely to come from a single parent home, with a parent with poor credit (who cant get a college loan for you, or any other loan), poor diet, poor education, and lives in a housing project or in the part of town where drug sales occur within 100 feet of your door every day and night.

Bull. You have a myopic view of "middle class". My "middle class" upbringing:

A father with a high school education, stay at home mom. Public school education for us. (That was the norm) Worked his arse off 12-14 hrs a day, worked his way up to middle management. I stayed in school, stayed out of trouble- mostly- and worked nearly every day after school. Lived in apartments until I was 14 until they could save enough to buy a house. Had 1 family car, and although we always had food on the table, not much left at the end of the month. Took 1 major family vacation- to Disney World-they saved for years for it. I started to work at age 14 at $1/hr. Soon worked 2-3 jobs. Saved my money, bought my my first car at 16. Come college time, there was no money to pay for it. Applied for financial aid- sorry- dad makes "too much" money. It wasn't about net income after expenses, they went by his salary. Sell the family car, they said. Needed to be a minority to be eligible for most of the money. Applied for and received a school loan in my name- cosigned by parents. Graduated and took 10 years to pay off my loans, working on privates and driving a truck for $4/hr. (I still have the contract that is stamped "Paid in Full".

That is "middle class" reality for most people and no different than most people I grew up with. All had parents who instilled a strong work ethic and a "bootstraps" mentality. Nobody was given something for nothing. NOBODY. If you couldn't afford it, you either put in extra hours, got a 2nd job, or you did without it because nobody was standing there with a monthly check to bail you out.It simply was not an option.

I will say it again, if the white race had only had access to this country's educational system for 40 years, you would not do well on written or oral tests either. It will be generations before we as a group can compete evenly in that category with other races who have had 100s of years of education in their family. Its like taking a rich white kid from Boston who is the fifth generation of his family that has graduated from Harvard, and putting him side-by-side with a poor white kid from Mississippi who is the first generation to graduate high school and college ----- If you had to bet $5,000.00 on who would do better on any written/oral test, who are you going to bet on ?

More bull. Except for maybe a Kennedy or Rockefeller family, what someone's great-great great-great grandpa did has NO bearing on their educational performance today. NONE. YOU are the one being educated, NOT an ancestor from centuries ago. YOU make the choice-stay in school, learn, get an education, or drop out.

Explain the success of immigrants like a Korean/Arab/Slavic etc., family who comes here from REAL poverty- growing up in a village with no running water, living in a hut, under an oppressive and violent dictator that kills to keep power. They don't have things like affirmative action, welfare, or set asides. If you don't work, you don't eat. They come here with nothing- and don't even speak the language, yet in a generation or 2, own a grocery store, a cleaner, a restaurant, or some other business. They learn the language, become citizens, and they prosper. Like the "white man", they do not have race based help. They even make enough to send for more family members to get out of their horrible situations.

Tell me again how the evil Republican "white man" denies their success?

Get off the pity pot.

AMR is all about the money. They attempted a hostile takeover here and drove many companies either out of business or forced them to consolidate. They wanted to take over 911 calls but realized a 30% reimbursement rate wasn't going to help their bottom line. They left.

Good luck.

OK, will try once again:

1. Standardized test are not objective, nor are they color or lower-socio-economically blind. As mentioned in a previous thread, a question like "saucer is to plate as wine goblet is to ________ ?" seems to be a fair question, unless you were a poor minority that has never seen a saucer or a wine goblet.

The original topic was a promotional exam for firefighters. Either you know the material or you do not. Everyone has access to the same materials. Firefighting is race neutral, but if you try hard enough, I guess you can insert race into anything. Gawd knows plenty of activists make a nice living doing exactly that.

2. The national registry test did "fail" some unqualified applicants, but it also gave license to many who are not qualified. I would emotionally argue that the medics that passed their respective state tests in the 80s are far superior to medics that pass national registry today, but I can not back that up with fact.

Never took the registry.

3. I said base it on job performance, not supervisor opinion. If you are worth promoting, you should have a concrete record of accomplishment that you can point to. Unfortunately in EMS/Fire, we are typically too lazy (all races) to do any extracurricular projects until the promotional exam is mentioned, so all supervisors have to judge you on is a single "test" score.

As soon as you put a subjective component into anything, bias is a possibility. Is a purely objective exam the perfect solution? Of course not, but it beats all the suspicions of bias and clout when other things are considered. Someone will ALWAYS claim they were treated unfairly.

4. I agree that I would rather not have incompetent supervisors, but I am sure you have also had supervisors who were great medics or firemen but were horrible managers. In your world can an EMT-I or Fireman supervise Paramedics ? Many departments have done this for years, and the EMT or non-medic obviously could not pass a Paramedic skills test -- so how do they manage ? Just because you know human anatomy and physiology backwards and forewards does not mean you can lead people.

Again, training in leadership, management skills should be mandatory for anyone who is a supervisor. The more responsibility someone has, the more training, education they should have.

5. I agree that the best person should be promoted regardless of age, sex, or race, but the current system in most departments discriminates against those of a lower socio-economic background (all races).

No, the current system rewards those who do not adequately prepare for a test by giving them an easy alibi- racism. This USSC ruling is a step in the right direction for true equality. You take a pretty dim view of the intelligence of a race if you assume they cannot compete on a level playing field. Every time you insert racial exceptions into a situation, you diminish the accomplishments of every person of that group who succeeded and/or excelled without any extra help.

I do not often express opinions on the site except the opinion that users have the ability to have spirited debates within the confines of the site rules.

Those opinions that are controversial will either be justified by the debate that follows or proved to be irrelevant or unjustified.

There are sites out there that will only allow people with a certain conforming thought processes to participate. This is not one of those places. I have always believed change and education will happen with free flowing debates.

A lot can be learned from those we do not agree with.

I thought that request for banishment was tongue in cheek, but whatever. Thanks for putting forth a mature and proper opinion on this. This discussion has been testy- even nasty at times, but I don't feel it's crossed the line.

Stats, polls, and surveys. They can be skewed to say anything you wish so you need to always dig a bit deeper than polls and maintain a healthy dose of skepticism. Reinforce those numbers with more data, objective and independent opinions, scientific studies- anything to bolster your argument and corroborate your claims.

It's been said before here, evidence based decisions are the only way we can progress. Data justifies new techniques, new equipment, new protocols, and the improvements we want in the delivery of EMS services. Problem is, unscrupulous people may use corrupt or incomplete data and if it puts forth a popular or positive idea, people tend to suspend logic and believe what they want to believe. We have to be better than that.

Regardless of who was the first to graduate college in your family, your family had access to education since this country was founded. My ancestors were not afforded that opportunity, thanks to your ancestors.

Bull. As for my ancestors, they were in Europe during the time of slavery so neither one of us is responsible for it. A significant number also came over as indentured servants. Get off the pity pot. Ask the Irish, Poles, Italians, and many other groups how easy it was for them when they arrived here. They lived in slums, were treated as 2nd class citizens, and were forced to take jobs that most would not want- police, fire, sanitation workers, etc.

BTW- YOU deserve NOTHING for what your ancestors went through. NOTHING. If you can figure out a way to directly compensate those people for what THEY went through, I'll be first in line to send a check and an apology. Until then, for the good of everyone involved, let this rest.

As far as the Harvard versus the Grenada doctor, statistically the harvard doctors may be smarter as a group, but that does not mean that every individual harvard doctor is better or smarter.

No, but "statistically", those who go off shore do not have the grades and/or MCAT scores to get in to a traditional medical school here. It's not just about being "smart" , it's about the quality of training.

Which is the problem with your logic on promotional exams. Just because the whites have better scores on a written test regarding job knowledge does not necessarily mean they will be great supervisors.

You need a objective method for evaluation. As soon as you bring personal opinions into it, bias will ensue.

I would argue that the things that are often tested, are the things that a manager needs the least knowledge in. Most employees are counseled for policy violations, not patient care or firefighting issues (when was the last time you were written up because you couldnt do a friction-loss equation ?)

In the case of knowledge- or lack thereof, it can indeed mean injury or loss of life. As an officer, you are responsible for the safety of your company as well as that of any civilians. The more you understand about building construction, potential hazards, tactics, etc, the better job you will do and the better the decisions you will make. Any firefighter who has dealt with an incompetent officer knows the possible consequences of a bad decision and/or a poor leader. As for human resource issues, you need to understand leadership/management skills and techniques in order to be an effective supervisor.

Why are you so afraid of having your knowledge tested?

Racism is alive and well -- if you dont believe me just look at this weeks events --- Compare the death of Elvis to the death of Jackson. Both were depressed, drug addicted, child molesters, who destroyed their own bodies, lived weird secluded lives, and basically committed slow suicides. The white guy is a hero, complete with postage stamps of his likeness and a shrine that draws millions of visitors each year; the black guy is a freak. But you guys arent racist.

And out it comes- someone utters a negative syllable about Jackson, thus it must be racism.

Crochity, you have an odd definition of "hero". Icons, certainly, groundbreaking artists, sure, but hero??

Both Elvis and Jackson were celebrities. Both have fans whose adoration goes beyond all sanity, reason and common sense. Both were entertainers. Both were wealthy. Both were addicted and enabled by hangers on. Both died way too young. I'd love to hear you describe all the "odd" behaviors of Elvis. I don't think you can compare eating fried peanut butter and banana sandwiches with making your home into an amusement park, a grown man inviting kids to his house for "sleepovers", perpetual plastic surgeries, sleeping in a hyperbaric chamber, or hanging your kid out a window as a joke. As for Elvis being a "child molester", you need to be careful. In many places the age thing is not a problem.

BTW-I don't call rappers, dancers, athletes, singers, or actors "heroes", and I defy you to cite where Elvis is hailed as a "hero" by anyone.

Oh, where to begin ? I am glad your great-great-great-grandfather and every male descendent in your family was a firefighter. My great-great-great granfather or mother for that matter probably would have loved to have been a firefighter, but blacks were not allowed to enter the profession until the 60's (but we arent disadvantaged that every white male firefighter's son and nephew gets hired regardless of their ability because granddaddy worked there).

Nobody in my family was involved in public safety- fire, EMS or police. I waited 5 years to get my job- training brand new people who got on before me simply because of the color of their skin, and/or because they went to the "right" paramedic school. This particular school had a handshake agreement with the department so they could push the minority quotas. When it was first established, that paramedic program was a 2 year associate degree. They couldn't get enough minorities to pass it, so they made it a certificate program- basic gen ed classes. Still couldn't get the minority numbers, so they made it only the bare essentials- paramedic classes only. Again- I taught brand new medics who jumped over everyone else- not because of qualifications, but die to their skin color. Tell me again how racist and excluding this arrangement sounds to you.

I repeat again, you cant expect a race of people that have only been in the educational system of this country for 30-40 years (as a whole group - not individually) to compete with a race of people who have hundreds of years of education in their family.

Huh? So based on your pretzel logic, because I was the first in my family to get a college degree, much less a graduate degree, I should be expected to fail? Are you claiming there is some type of group-think in the black community that precludes individual success?

As far as promotional tests, I am for dropping them. Why not just promote the best employee ? Written tests were created for the sole purpose of suppressing minority candidates. So a white guy makes a 90 on the test and the black guy makes an 85, are you telling me that in and of itself makes the white candidate better ? If you must have a test (especially in the fire department) why not have a written, practical, oral, and a review of the past year's performance (how often they called out or were late, what special projects or committees have they served on). And if you must "grade" us, we should have an extra 10 points added to our score, for doing all of the work all year long while you white guys are running your side business on fire department time for most of the shift.

Ah- a proponent of the feel good, "new math" mentality. Don't have any standards or measures of progress or success. Don't give out grades, it hurts little junior's self esteem. Don't correct poor grammar or ghetto slang- call it "ebonics" instead. Don't hold everyone to the same standards- it's not "fair". Don;t have the right answer- it's OK- the effort is what matters. Don't worry, the liberals are so riddled with deep seated guilt- and they don't even know why- that we won't have true "fairness" for a long time in this country. BTW- in our department, you already get extra points simply for being born a minority AND special consideration after the results are in. Problem is, it still isn't enough.

Easy solution: Dispense with all the pretense, convolutions, and new math. If you are a minority and want the job or the promotion, it's yours. No need to file lawsuits, no scores, no grades, or worrying about a thing. Everyone else needs to study and fight for the leftovers.

As long as you don't care about standards or results, then I'm sure you would have no problem with a Grenada Medical school doctor removing your brain tumor vs a Harvard trained neurosurgeon. After all, they both have MD's after their names, right?

Congrats on the save. Unfortunately, the ones who return with no deficits and survive to discharge are indeed rare. I've had a few.

One in particular was interesting. A guy- about 50 years old, found on all fours on the sidewalk, unable to stand, and slightly confused, c/o SOB- no pain. Turns out, he was on his way from his MD to get an MRI for some back related problem and became too weak to walk. The first responder fire company thought the guy was a drunk and essentially did nothing but wait for us to arrive. Looking at the guy as we approached, something did not add up- it was one of those gut feelings.

Turns out, he was bradycardic, and hypotensive. We started ALS. We were essentially a block or so from the ER and gave them a quick heads up we were on the way. The doc on the radio just happened to be our medical director, and advised us to treat as much as possible enroute. I agreed- we were literally on the property of a Level One Trauma center- silly to screw around if not necessary. WIthin seconds- before I could even give any meds, he bradyed down, went into V-tach, and arrested. I notified my partner what happened with a very loud "Aw sh*t!" and told him to hurry around the block. I was on my own because the first responder had already left, my partner was already behind the wheel, so I slapped the pads on him, and defibbed x's 2. By the time we hit the ER, the guy was awake, asking me what was going on, asking what horse kicked him in the chest. I briefly explained what happened as we rolled into the ER, and his eyes got as big as saucers. He shook my hand and we turned over care. I pulled the doc aside, told him I decided to ignore his medical orders and said I would await my suspension. I then showed him the EKG strip and he laughed. I insisted on taking a day off, but he declined to give it to me.

The resusitation room was also full of observers- wide eyed, fresh med students, paramedic students, and nursing students. My partner and I shrugged as we left, and he told them it was no biggie- this stuff happens every day. I had everything I could do to keep from a belly laugh. The doc rolled his eyes and threw something at us as we left. I know a bunch of copies of that EKG were made and are probably still making the rounds in education circles. I later learned the guy had an ablation procedure and was fine- no deficits, no muscle damage.

Calls like that are indeed rare and great fun. They make up for all the ones we don't save and all the BS we put up with.

Fascinating stuff. I've never heard of this before. I've always had issues with math as well.

Well, we have plenty of blacks- supervisors and grunts in EMS here. We also have plenty of black FF's, thanks to the games they have played with entrance exam results in years past. Not enough minorities- make the test race neutral. Still not enough- change the standards, reduce the passing score, use race norming, band the scores so that a black guy who gets one point above passing has the same chance as a white guy with a score in the 90's.

Is an entrance exam an indication of someone's ability to perform as a FF- absolutely not. Problem is, what's the point of taking an exam if your score is irrelevant? Make it pass/fail and be done with it, but do NOT adjust the scores any further. No points for being a minoriity, no special scoring practices to ensure more minorities pass the test.

Since the playing field will never be level, this issue will never go away. Kudos to those FF's for having the stones to stand up for a double standard. 2 wrongs do NOT make a right.

Here we go again.

Crotchity- simple questions:

Should the results of a RACE NEUTRAL promotional exam be thrown out simply because no blacks were able to pass it?

I love the ear idea! We're being taught "secure with tape" but no actual technique.

I was never actually officially taught how to to an EJ either- I was shown that method years ago by a mentor. As for the tape, a clear op-site is almost mandatory if you have them available. It's really difficult to adequately secure an EJ with tape alone.

Awesome thanks... the over the ear method sounds likea great idea.

What do you mean by wiggle the catheter?

No problem.

This is one of the reasons I suggested a longer catheter.

After you advance the catheter(and retract the needle), and believe you are in the vein's lumen, you gently wiggle the catheter to see if it is indeed inside the vein and not under, over, or through it. Just a secondary- and certainly not perfect- method to help confirm patency.

If you need a dumbed down version of a standardized test that is already dumbed down enough then you probably need to choose a different line of work.

The vast majority of these tests are written at the level of an average newspaper- around 6th grade. The claim in most of these cases is that the test itself is racially biased somehow. In the case of the listed lawsuit, the test was made race neutral and they still did not get the results they wanted. Short of throwing out the results and simply picking the numbers that make everyone happy, I don't see what else should be done.

We recently had a big uproar when it appeared that the test for our city's police academy was discriminatory against minorities. Yeah, you read that right. I don't understand how a standardized test can be discriminatory, but that's what they said. Anyway, they "dumbed it down" which caused another uproar. The plain and simple is that the test wasn't the problem. The problem was the education these men and women recieved beforehand. By the time you reach the age to enroll in the police academy, you should be able to do basic math. That's the portion that was failing people. If not, take a remedial course and be angry with all teachers you had growing up that didn't bother to make sure you got it. Don't sue the city for making sure it's officers can do at least a minimal amount of math. We aren't talking calculus here. We are talking at most basic algebra, geometry, and statistics/probability. These are skills that can be essential in prefoming the job. Now we have a bunch of officers-to-be that won't be able to figure out distance or speed or anything else requiring any math skills. Not to mention the fact that they weren't willing to work for it in the first place by studying. I think maybe the time has come to put regulations on affirmative action. There are, unfortunately, still situations where it may be warranted. But when the public safety is at risk, no. Sorry, you should be held to the same standards as everyone else, which is still woefully inadequate at times.

What many cities are doing- in ours as well- is that they require 60 hours of college credit(not even necessarily a degree) to even apply for the job in law enforcement. At that point, if a person is able to complete 2 years of college course work, I guess the assumption is the applicants must have at least a minimum level of intelligence, competence, and diligence.

I'm no longer a student but I wanted to ask the veterans how they proceed and are successful in starting an IV in a persons EJ vein.

Any special positioning?

How do you hold tension?

What angle do you insert at?

Do you tamponade?

How do you know you're in?

I had my first on my own the other night and the PT had JVD so it was as big as a finger (hard to miss). But I've noticed it's hard to hold tension and things start moving around on me. I want to find a better way to approach this that is still safe (no poking myself).

-I try to lay the PT flat or with the head down if possible.

-I've been holding tension to the sides of the start site with my other hand using my index and thumb in a c shape.

-My angle is similar to an AC or slightly distal to one.

-I haven't had to hold tamponade yet (little back flow)

-It seems like it's hard to be 100% certain you are in. Is a good flash and no obvious infiltration good enough? Anyone have another method of confirmation at this site?

Thanks for your advice and experience!

Sounds like you have a pretty good technique.

Problem is, because of the variations of anatomy, thick necks, short necks, etc, the angle of entry will vary quite a bit. Sometimes you get a pretty good flash, other times you get nothing. Depends on the patient's underlying condition-ie a person in fluid overload will give you quite a big flow. A dehydrated little old lady in a nursing home will probably take some work to confirm your IV. Wiggle the catheter to see if it's in the vein, and hook up your IV. To secure the catheter, use an op-site membrane, loop the tubing over the ear and tape it down securely. They can be good places to have IV access because the arms and chest area tend to get crowded- cables from Pulse OX, EKG, Defib pads, CPR, etc, so an EJ can be useful.

To confirm a patent line, you can also always drop the IV bag, or even aspirate a bit of blood with a syringe, but sometimes the only way you'll know for sure if it infiltrates.

Also, don't use a short catheter-I'd suggest at least 1.5 inches and the largest bore you think the vein can handle- the sturdier the better.

Great story. doc. Glad to see your grandfather is doing well.

Personally, I think the thank you's from families like that make all the other BS we deal with worthwhile. Far more satisfying than a bonus, but I'd never turn that down, either. LOL

Hello,

Interesting call.

Incompleted spinal injury? I am not 100% but it could be Anterior Cord Syndrome. Too much cervical flexation during the crash (pain at base of skull) caused the loss of motor control below the waist.

Or, Causa Equine from an abcess? Maybe his immune system was compromised due to his HIV?

Just a few guesses made during coffee break....

Cheers

Interesting theories.

I'm assuming the problem was due to a hyperflexion type injury. Twisting, torquing- gawd only knows what position he was in at impact? He was struck from behind, spun out, and then hit the guardrail.

Here's some links to case studies on Goolgle.Scholar.

http://scholar.google.com

http://scholar.google.com/scholar?hl=en&am...rognosis+adults

Alot will depend on whether the injury is partial, complete or central.

Here are SCI classifications:

http://www3.umdnj.edu/stlibweb/dpts5312/maynard.pdf

I believe there is an updated version but the info is basically the same.

Intuitively

Thanks. I will read these in detail.

Based on his loss of function, the problem was probably in the lower thoracic/upper lumbar area.

I'm also thinking his HIV may have something to do with this, but I'm at a loss to explain how.

Based on anecdotal evidence, what outcomes have you seen with cases such as these?

Eccymosis from a seat belt may not be visible for awhile. I'm curious as to whether any developed and, if so, where. Is it possible that he had the lap belt on, either properly or improperly, but had placed the shoulder belt behind him as people often do? This could cause spinal damage lower than if he'd had on the shoulder belt.

No visible injuries at all- chest or otherwise except for the slightly bloody gums from the airbag deployment, and he was still restrained when we arrived. Even at the hospital, he still didn't have a mark on his body.

The state police officer found him in the same position and didn't touch him because the victim told the trooper the same thing he told us- he couldn't move his legs. The belts appeared to be correctly applied when we found him.

Spinal cord injury without radiographic abnormality (SCIWORA)

SCIWORA is most common in children but definitely not that unheard of in adults and may be in the thoracic region.

Being a spinal cord center we do see this occasionally and extensive testing may need to be done since the injury is not visible on regular X-Ray or CT Scan. An MRI has a better chance of spotting most injuries but even with that the integrity of white matter tracts within the spinal cord are not well demonstrated. Thus additional steps in MRI are done if this is suspected.

On another note, it is sad to again see the numbers of the new HIV cases among the young.

Thanks for the info.

I had no idea this was common enough to have a syndrome. Obviously there was some type of cord disruption- a small tear in a single fiber, swelling- whatever. I've seen a fair number of cases attributed to cord shock but generally the deficits began to subside fairly quickly after steroids. I want to follow up to see what happened in this case.

What is the prognosis of such cases- SCIWORA?

I'm not really sure what you are asking.

Maybe I'm stating the obvious here but I don't think anyone would omit spinal immobilization for the patient you described, who has mechanism, pain, and neurological deficits. That's three strikes when you really only need one....

I was asking about similar cases- unsuspected spinal injuries, not if the person needed to be immobilized.

Just my observation, but I've found that front airbags very frequently will cause cracks in windshields. Not that I think it should be assumed that such was the case here, but just for the sake of argument...

Agreed. It obviously depends on where the airbags are deployed from, and when the bags are located on top of the dash, the compartment doors usually crack the windshield when they open. Since airbags are deployed at well over 100MPH, damage to the windshield is logical. The damage in these cases is located at the level of those doors- the bottom portion of the windshield.

I see the same flaws in this study as are mentioned above. In a stable ER setting, an automatic cuff is perfectly acceptable, although there have been many times when I questioned the readings and performed a manual BP to verify what the machine tells me. Sometimes they are right, and sometimes they are dead wrong. Personally, I trust my ears before a machine, and in the back of a rough riding ambulance, I question the accuracy of a machine. I think the bottom line here with either method is to chart a trend. Is the BP going up, down, or all over the place? The numbers are important, but I think the more important issue is what those numbers are doing and what does that tell you. Is the patient responding to treatment, are they decompensating, is the pulse pressure changing, are the numbers remaining the same?

Obviously you need to correlate the readings- however they are obtained- with the patient's condition. Just like we generally do not treat an EKG rhythm without checking the patient, if you get a BP that says the patient is not perfusing and is ready to code, and the person is busy telling you a joke, you might double check that BP reading.

Bottom line- like any of the toys we have, nothing can replace your skills, training, and experience. An automatic BP cuff can be a useful tool in the proper setting.

Depends heavily on which group you pose that question to.

City managers look at the bottom line. Does it generate money for us? Does it make the voters happy and gets us reelected?

Tax paying citizens generally support EMS but are probably ambivalent and/or ignorant about the details of how their service operates until they need it. They certainly do not know about the problems the system may have in providing EMS care.

Frequent flyers simply look at it as a taxi to bail them out of their latest self induced tragedy.

Abusers- those who do NOT need an ambulance, much less an ER visit- look at it simply as another service they "deserve"- regardless of it's original intent.

Fire service looks at it as a necessary evil/red-headed step child which generates revenue for them and saves FF jobs.

Herbie- Not arguing with you... you may very well be right. I just felt like defining my comment so nobody thought I had some sort of partisan agenda. And nothing is dependent on political ideology (now I'm arguing with you). Politics is something that human kind invented. Intrigue and deception and promises not kept to gain advantage... those we created as a species. Social ideology on the other hand... you are correct about that one. Social classes exist in all live beings, have since the beginning of life itself. If the current state of politics actually affects your view of "right & wrong," then you are a very lost soul indeed. Those should be developed through personal contemplation and careful understanding of "social" norms, not political ones.

Oh, and I didn't mean to say that I agree with John McCain about his policies... I only meant to say that he is a bad-ass... and I like it.

Agreed about someone whose ideas of right and wrong is governed by the current political wind. Like I said though, these days, it is tough to find a candidate who agrees with your own ideas- ESPECIALLY if you are not a dyed in the wool republican or democrat. Personally, I have mostly conservative ideas-along with a couple that definitely do NOT align with a Republican ideology. As such, presidential campaigns are tough for me.

Thus, my perpetual candidate always seems to be named "None of the above". LOL