Dustdevil

Im being intolerant of intolerance and ignorance whats wrong with that?

That's an ignorant question. Do you really need to ask it?

I don't tolerate intolerance from anyone, including you.

I would insist that my people respond and treat the caller as any other patient. If the ER talks them into staying there, my medics will need to get the patient to sign a witnessed refusal. Period. You cannot make any assumptions about the relationship between the patient and the ER, or the appropriateness of their treatment. The ER may not hold them against their will. And if you would normally transport this patient, then you will also do so in this scenario. You may not refuse them, unless you would be justified refusing the same patient at a scene.

But this being homosexual is a mental illness is just flat wrong dude, its 2011 not 1950 time to open your mind a little bit. I do not know where you were trained at but that is no attitude to have in EMS, weather it be because of religion of just plain ignorance its wrong and unprofessional.

Being a little judgemental here, aren't you? Oh, the irony!

A lot of people here would say that YOUR intolerant attitude has no place in EMS either. What do you think about that?

This is really not a significant problem for you, Bro. Your honesty and academic history, along with a positive interviewing experience, will make up for any doubts. Of course, that is assuming that you interview well. Look 'em straight in the eye when you answer questions, if they should ask. But I really doubt they will. This is your first EMS job, and to them, that may as well be your first job ever.

But, as Spenac said, SoCal is pumping out basics at a rate at least four times what the job market will bear. If your school didn't tell you that, then I would definitely look elsewhere for paramedic school; someplace with more integrity. And yes, you will want to start paramedic school as soon as absolutely possible, regardless of what anyone else tells you.

Good luck!

That would be correct. A violation of departmental privacy rules probably but not a HIPAA violation

There is no acceptable reason to be posting on any type of social media site any information on calls you are part of.

This ^

This is one of the many, many reasons that we say that EMS is not a hobby, a " calling", or "lifestyle". It's just a job, Don't take it home with you.

I've never slept with someone my own race....crap does that mean I hate myself?

Trust me, I made up for it for you.

But he was the type of medic that didnt think about BLS because he tested for his basic like a month before his paramedic. So he always jumped into ALS mode rather than think BLS first

I can't really claim to know you, but from your writings, it does not appear that you have either the education or experience to make that determination. It's a little presumptuous for you to speculate on the intricacies of a process that you have yet to personally undergo. In my thirty-eight years in medicine, it has been my overwhelming observation that, for the most part, you are dead wrong, no pun intended. In fact, most medics with half my experience will tell you that the best partners they ever had, had zero EMT experience prior to paramedic school. I will tell you as a long time instructor, my best medic students are usually those with the least basic experience. If you are seeing something different, it is a very negative reflection on the quality of your system locally.

To re-quote from page 3 of this thread:

When you get to paramedic school, you will notice that there exist a peculiar sub-species of student. S/he is the one who wastes everyone's time with frequent interruptions to either argue with the instructor, or to dazzle us all with war stories that are usually irrelevant and ninety-percent bullshyte. These students usually graduate (if at all) with much less knowledge than their unexperienced fellow students because they think their experience gave them such a "leg up" on education, that they cannot be convinced that they still have much more to learn. They spend a lot of time tuning out the instructor when he covers pathophysiology and other complicated topics that he is convinced you don't really have to know just to start an IV or hit a tube. To them, it's all about skills, because for the last few years, that is all he has seen of the medics' practice. He is SO wrong.

If your eyes are open, and you stay in EMS long enough to call yourself an experienced medic, you will come to see this yourself. It would behove you to listen up and understand it now, rather than being "that guy" -- just like the one who got fired -- for the next decade.

As earlier stated, if a paramedic sucks, it has everything to do with his paramedic educational process, and very little else. With this moronic line of thought of yours, you sound like Critchitymedic claiming that blacks can't be successful today because someone held slaves 150 years ago. It's nonsense.

Ones attitude towards the age of consent changes when you have children.

Not if you're not a hypocrite.

Maybe he can help you with your EMS schoolwork and you can help him get a boy haircut..We'll all be better off for it!

Yeah, if you still have access, he could definitely use a trip to the nearest military base for a haircut!

Nod Dust..Hopefully you know I wasn't really curious if an arrest was hypoglycemic but as to the criteria that the poster may have used to determine that, 'cause I'm confident that it wasn't anchored in A&P.

Yeah, sorry for being unclear who I was directing my reply to. It certainly wasn't you. No worries.

Well, I have dear friends who author that book, so I hate to say this, but...

With three (3 that we know of) wars going on right now, the body of knowledge in tactical medicine is changing at a rapid pace. Consequently, unless you are taking or teaching the corresponding course with the text, I don't think I'd spend fifty bucks on a dust gatherer. Not that it's not a fine book. It is. But if you are a serious consumer of information, it's all available online (the info, not the book). And you will stay more informed and up to date with current literature reviews. After all, that's where they get the info to write textbooks with!

I remember hearing somewhere (which means don't quote me on this) that the physical agitation of the skin was effective as well as the actual compound used... that's been rattling around my head for a while but I'm not sure if it's true or even where I got it. I probably heard it on a television commercial for soap for all I can remember...

I heard it in nursing school. And RT school. And I taught it in medic school.

We teach you to SCRUB your hands before surgery, not just soak them. So yes, you have a very valid point.

And yeah, patting that girl down wasn't about being able to prevent a terrorist plot, it was about making sure that there were plenty of white numbers when the "Random" selections are evaluated to make sure that "minoritis" are not being targeted.

LOL... true. And beyond that, let's not just pick white people, lets pick out little white people so it doesn't take as long.

Seriously, I've never seen them groping a 300 pounder. Just sayin...

Another factor to consider is what exactly is becoming rigid. Organs? Skin? Fluid? When you break a femur, what happens? Muscle spasm. You strain your back, and what happens? Muscle spasm. Sensing the irritation within the abdominal cavity, the abd musculature would logically tighten up in a protective reflex. If you have bled enough into your abdominal cavity for the sheer volume to cause rigidity, you are probably already dead.

Well, I can seriously recommend going AF after nursing school. You'll get speciality training and good educational incentives, even if you just go reserve. And the uniforms look better than Army uniforms too.

EMT before nursing school is helpful, so long as you don't get corrupted by a bunch of bad experience (which most EMT experience is). But nursing school is always better BEFORE paramedic, not after, so don't let the sirens derail your nursing school plans. You'd regret it.

Good luck!

Her boyfriend could be a child prodegy and in school at 16. Likely not but it could happen.

LOL! That's true. I'm no genius, but I still graduated high school at 16, and a lot of people do. It is the norm across the world, as is the 16 year age of consent.

I don't disagree with the need. What I disagree with is the policies and methods they specifically utilise, which are expensive, ineffective, and ignorantly administrated. I don't have a problem with invasive security, so long as it is deployed intelligently. And that is where the US TSA falls dreadfully short. It's just another expensive, unwieldy bureaucracy that simply does not achieve what they were designed to achieve. They are idiots from the top down. What are they preventing? A hijack or bomb in the sky? Tests constantly show them missing explosives and weapons in security screening, so that's still a risk. So would you feel better if the terrorists just blew you up in the screening line? Dead is dead. And the TSA does nothing to prevent that. They just create the problem by building long lines of sitting ducks waiting to be groped. So how are we safer, remind me again?

I liken the TSA to the president. I believe we need one, just not the one we have!

On another track about this call. You have a child that is knocked up at 16 yo and still having sex with her boyfriend who if he's in collage is probably at least 18 yo.

In most places this could be considered statutory rape of a minor.

Most places? Actually, 16 is the legal age of consent in "most places". Look it up.

Texas Legislature is in the process of passing a state law criminalising TSA patdowns in our state, haha! I think that's awesome. They've already screwed it up though. Originally, it was going to be classified as Sexual Assault, a registrable felony. But they've cut it down to simple misdemeanour assault. Still funny though!

Cardiac arrest victims are almost always hypoglycaemic, regardless of the cause of arrest. Anyone who has taken A&P knows that, as well as why.

Giving the victim dextrose was almost certainly a good idea, diabetic or not. But again, you would learn that in any good paramedic programme whether you ever worked a single day as a medic or not, so the story is not particularly relevant to this discussion. It only suggests that you work with poor medics. And the solution to poor medics is not better EMTs. It's better medics.

But asking to do a DRUG test is WAY over the top ... does the kid LOOK like a Crack addict ?

I don't believe the TSA has the capacity to test for drugs, even if they wanted to. The kid was getting an explosives residue swab, not a drug test. Not that I agree with either move.

Side bar .. my best friend is a CAPTAIN with Air Canada (official ID around his neck) that's like 4 bars on his flight uniform epaulettes and a sub contracted security moron that could NOT speak English (btw he could not have got a job at Walmart as a greeter due lack of language skills)

BUT took his nail clippers away ! My friend looked at him and asked what are you fucking thinking I am going to Hi Jack my OWN airplane ? The crowd gathered watching ripped the moron security goof a new asshole .... PRICELESS.

When going to Japan last time, they took the nail file from me -- the wheelchair bound disabled veteran with US passport and military ID. Then I get onto the plan, only to be sat next to a third country national, who clearly had four or five foot-long metal knitting needles sticking out of her bag. WTF, over?

If we were still on scene, and it wasn't a time sensitive injury, I'd call PD and hand the weapon off to them. If we needed to book it for the sake of the patient's wellbeing, or if we were already en route, I'd put it in the lockbox with our narcs and advise PD to meet us at the receiving facility.

Excellent reply.

As a police officer, I was once in an MVA in my personal vehicle off-duty. Being very close to home, both the responding fire and EMS crews were friends of mine. I didn't know the cop though, and although he had my driver licence, I had not ID'd myself as an officer to him. As they were beginning to extricate me, I told the fire crew that I had a gun under my jacket. The fire lieutenant -- a good friend -- asked if I'd like him to just take it back to his station and lock it up for me, rather than the hassle of retrieving it from the police property room. Sounded good to me, so I handed it to him and told him there were three more in the trunk. It was priceless watching the look on the cop's face as the fire lieutenant started pulling an M-16 and a shotgun from my trunk! FD explained it to him, and he confirmed with me that it was okay with me, and all was good.

But the point is, if there is a competent adult that the patient is comfortable releasing his weapon to, licensed or unlicensed, then I would certainly allow my patient that option, not insisting on police involvement. Even cops do that with cars in order to spare someone towing charges after an arrest. So, unless you have a specific law or policy prohibiting it, that's an option to consider. But regardless of policy or laws, don't let yourself be talked into anything you are seriously uncomfortable with.

I guess the question I am getting at is does anyone wish they had changed the decision they made as far as training/experience?

Absolutely! Unfortunately, there weren't any better options back in the Stone Age, when I started. The 90 and 180-day wonder medic schools were all there was, as we were all still under the impression that Johnny and Roy knew wtf they were doing. Boy, were we wrong!

By the time I went to paramedic school, I had already been an EMT and military medic for 5 years. I thought I was hot shit. I could hit any tube or IV in my sleep, and recite protocols backwards and forewards. Life was good! Then I went to school for my biology and psychology degrees. Every day of class, I found myself learning something that made me think, "Wow! I can't believe they let us practise EMS without knowing this!" I started to realise just how inadequate EMS education really was for the procedures we were practising.

So, then I went to Respiratory Therapy school and quickly learned that what I had learned in medic school was not only dangerously inadequate, but much of it was just plain wrong. Again I found myself saying, "Wow! I can't believe they let us practise EMS without knowing this!"

Then I went to nursing school, and as you may guess, I each day caught myself saying, "Wow! I can't believe they let us practise EMS without knowing this!"

Now, again, I had at least five years of EMT practice before going advanced, yet I was still so dangerously ignorant of the physiological (and psychological) basis of our therapeutics that I am quite sure that it contributed to the death of many patients, even though I was technically -- by protocol -- doing everything right. So the question is, what did I gain in that five years of EMT practice? The answer is, very damn little.

Experience without a proper foundation to build upon is worse than useless. It is counterproductive, and it retards your educational progress.

When you get to paramedic school, you will notice that there exist a peculiar sub-species of student. S/he is the one who wastes everyone's time with frequent interruptions to either argue with the instructor, or to dazzle us all with war stories that are usually irrelevant and ninety-percent bullshyte. These students usually graduate (if at all) with much less knowledge than their unexperienced fellow students because they think their experience gave them such a "leg up" on education, that they cannot be convinced that they still have much more to learn. They spend a lot of time tuning out the instructor when he covers pathophysiology and other complicated topics that he is convinced you don't really have to know just to start an IV or hit a tube. To them, it's all about skills, because for the last few years, that is all he has seen of the medics' practice. He is SO wrong.

There is nothing of benefit to you or your patient that is learned from basic EMT practice that cannot be learned better and faster as a paramedic student, with the only exception being driving. But I for one didn't become a paramedic just to be an ambulance driver, did you?

Oh, and of course, if EMS turns out to not really be your cup of Joe, then of course there is some small chance that you might conclude that during EMT practice, which would certainly be nice to know before spending two years in college. But that rarely happens, because even unhappy EMTs usually just assume things get a lot better when you become a medic. They don't.

If you just have to make a living while attending paramedic school, and you are so without skills or attributes that being an EMT-B is the only job you can get to do so, then sure, do it. We all have to eat. Just don't put off paramedic school for any time under the mistaken belief that doing so will benefit you. It won't.

Pretty much what Ruffems said above.

Uterine prolapse in an otherwise healthy, nulliparous adolescent is extremely unlikely. And placenta praevia would generally present much later and with more associated symptoms.

This is almost certainly a premature delivery, but without labour. The cause may be anything from simple spontaneous AB to cervical incompetence. If it is the former, then it is an unfortunate, but otherwise normal tragedy that can be neither prevented nor fixed. If it is the latter, it will most likely happen again, so future pregnancies need to be closely monitored by an OB. Either way, the chances of survival of a 22 week foetus are abysmal. And those who do survive will almost certainly suffer from serious, disabling developmental abnormalities.

You did everything right, medically speaking. Very nice job. The only other thing I would emphasise would be the paramount importance of maintaining your composure, and imparting a calm and reassuring attitude to your patient. Getting her further adrenalised with fear or emotions cannot be helpful. And it can be difficult to strike a balance between panic and concern, and compassion and pity. Like I always say about paramedic education, there is really only one course that you will look back to on each and every patient, and that course is psychology.

I'm the one who voted iodine only. Military aid bags include only iodine. It's been more than two decades since I took microbiology, so I'm going to make the mistake of speaking without the benefit of recent research here (which I always caution others not to do). So I certainly do not submit this as authoritative, just historically observational.

The problem with double swabbing is that neither solution is left in place long enough to achieve antimicrobial competency. You may achieve the appearance of "clean" skin, but you won't achieve disinfected skin, which is your ultimate goal. Consequently, unless you are leaving both on long enough to dry, you are being less effective, not more.

Iodine has a better spectral advantage than isopropyl alcohol against pathogenic bacteria. I proved that to myself in the lab, as have others for decades. But both come with potential problems. Iodine sensitivity is not unheard of. And isopropyl alcohol is too flammable for OR use. Electrocautery and a flashpoint of 53f is a very bad mix. Same reason we don't use flammable anaesthetics anymore, even if they are effective. Hell, we used alcohol hand sanitiser gel as a fuel for heating food and drink in Iraq. It burns like crazy.

So, if those are your only two choices, then it is my opinion that iodine is the better way to go, and just hope for no local sensitivity reactions.

As already mentioned, chlorhexadine solutions are quickly starting to spread in non-OR use. This is a good thing, and long overdue. It is a notably superior antimicrobial to both of the previous choices, is not flammable, and has a lower incidence of sensitivity. Unfortunately, this has been a long time coming into common use for several reasons.

A little history: Before chlorhexadine came hexachlorophene. It was a popular OTC skin cleanser in the 60s, used primarily as an anti-acne face scrub, and for bathing children, who are typically germ ridden from normal child behaviour. Problem was that it turned out to be quite neurotoxic, and possibly carcinogenic. I blame it for my short stature [sarcasm]. It was yanked from the shelves, the concentration lowered, and made prescription-only, and few docs would even prescribe it. So then the expensive and bureaucratically hindered process of developing a safe alternative begins.

Sometime in the late 70s, chlorhehadine began showing up in hospitals as Hibiclens. But it was very slow to catch on because of the high price as compared to iodine, the lack of evidence indicating efficacy, and the bad memories left over from the hexachlorophene fiasco. Consequently, chlorhexadine becoming popular and trusted enough to come into enough use to get both literature and price point behind it has taken thirty years. We didn't even have chlorhexadine swabs when I retired three years ago. I expect them to become the solution of choice in the near future. Until then, iodine remains the solution of choice. And using both iodine and alcohol together offers no benefit over the use of any single solution, as well as it doubling the cost of prepping every IV you start.