Bieber

First of all, having an attitude with people who are trying to give you advice isn't the way to make friends. Secondly, it's not mandatory. You're free to pursue employment elsewhere at any time. Did you complain about having to take a physical agility test to make sure you could safely perform the physical labors of the job? The employer sets the requisites for employment, you're under no obligation to fulfill any of them--unless, of course, you want the job. Like I said, you're arguing for the sake of arguing. You say you have no problem getting the test, but damned if you're going to let someone TELL you to get the test done. How dare they tell you to do what you already know you should do and were going to do anyway! Do you see how silly that sounds? Are you going to be pissed off with them if they tell you to come to work prepared to run calls as well? Finally, like AK has said, it doesn't sound like the test is required by the law, however employers are free to set their own employment requirements. Such as, you have to have your EMT. Or your paramedic. Or whatever level of training they require. Or you have to have CEVO, or PALS, so on and so forth. Just because it's not required by the law doesn't mean the employer doesn't require it. EDIT: Added the final paragraph. Enjoy.

If you've got a problem being told what to do, you're in the wrong profession, man, because EMS is pretty far down the line on the totem pole, and you're going to find out that while we have a lot of autonomy it's all granted to us by someone else, and that someone else can pretty much tell you step by step exactly what you can do and exactly what you can't do and you've got little choice but to say, "Sir, thank you, sir!" There should be no conflict with you on this issue. TB testing saves lives. I was just reading the other day about a paramedic in one of the neighboring counties who found out he had encapsulated TB and discovered it thanks to routine TB testing. Now he's taking antibiotics for the next nine months, but that's a hell of a lot better than the alternative. It's not just about patient safety, it's about your own safety. Because I can guarantee you that's you're going to be LOVING your employers for mandating regular TB testing if you ever turn up positive, because it's going to save you from finding out the hard way. We all live under somebody else's rules, every single one of us. There isn't a man alive who doesn't answer to someone. Fighting against your employers on principle alone will only get you so far, and you've got to pick your battles and choose the ones that are really worth fighting for. And fighting against mandatory TB testing on principle is not a fight worth undertaking. If you want to start a conflict, it had better be over something worth fighting for, otherwise you're just throwing a fit for the sake of throwing a fit.

What chbare said. If you want my medical opinion, you gotta be in my area and dial 911. Otherwise, please see your primary care physician regarding any questions you have.

Thanks for all the replies, everyone! It's great to hear your own stories where you had to work outside the box in conjunction with medical control to make sure that your patients got the best treatment possible. You guys are all right, EMS NEEDS medical oversight, and while protocols may not be the best way to go, they're the current system and we have to work within those boundaries if we want to be not only good clinicians but lawsuit-free providers. I'm at work right now, but I'll just say that today has been a very good day and I feel like I've really been putting treatment first. Called the docs twice so far to get authorization to provide the best treatment to my patients, and I was granted my orders both times to the benefit of my patients. It feels like a weight has been lifted off my chest, and like I am free to quit fretting over protocols and figure out what's wrong with my patients and what I should do. There's a time for protocols, but like I've said, you've got to be thinking what is the best treatment for those patients first, and THEN find the protocol that will allow you to deliver that treatment or, if there is none, call the doc and make it happen. Oh, and I finally gave dextrose for the first time today. Checked, double checked, and then triple checked to make sure my line was good. I've heard enough horror stories about people pumping dextrose into blown veins that I was NOT going to have one of my own to tell.

None of us got into this job thinking planning to compromise patient care for the sake of keeping our bosses happy, but many of us, myself included, somehow ended up doing just that. And that's a shame, because there's something extremely and intrinsically noble about medicine and paramedicine as well. But in this world of paperwork, administration, and protocol, somehow we became removed from our patients. It stopped becoming about them, and started to become about making sure all the paperwork was just right. I realized that the first time when I first saw a respiratory therapist with not a stethoscope to be found on his person, but damned if he didn't have his little mobile computer. Like I said, I'm not advocating for anyone to disregard their protocols, but I'm asking for anyone who's ended up in the same state I've been in, where you're more concerned with how your care will look on paper than what's right for the patient, to change that mentality. Because in the end, good patient care will justify itself; and for every employer that will compromise care for picture perfect paperwork, there is an ever increasing number of paramedics and services that will see that and know that that is the true mark of a great paramedic. We can't be cowards any longer. We can't compromise what we know is right for the sake of paperwork. Every time we do, we drift farther and farther away fromt he dream that is the future of EMS; one where we are true providers, true clinicians, and true professionals. We relegate ourselves to appealing admin instead of doing what is right by the patient. It is our first and foremost obligation to protect our patients, like you said, Dwayne; from themselves, and from other people--all other people. Their lives come before us, their care comes before us. And until we can all embrace that mentality, we will always be struggling against the forces that be to do the right thing. Lonestar, I admire you. You have shown your true colors, and those colors are good and pure and noble. Never compromise, never surrender. Never fall into the deadly trap of ever thinking that you mustn't protect your patient even against the forces that be. Because in the end, admin is there to cover themselves and the service; and like any business, if that means screwing one customer for the sake of obtaining and keeping others, then so be it. Our integrity as paramedics and providers is challenged every day, and every day is an opportunity for us to grow farther away from the noble ideals we had when we first started paramedic school, and every day is an opportunity for us to live up to them and be the paramedics we always envisioned we would be. Unconditional caretakers, unconditional wardens against all the dangers our patients face. It's not about you, or me, or admin, or paperwork, or anything or anyone else--it's about the patient. Let's never lose sight of that again, let's never compromise what is right for our patients again. Because that trap is a deadly sinkhole, and there's not enough Dwayne's in the world to keep us all in check and to kick our asses back into order when we mess up. Like I said, I know I'm not the only one who's ever slipped up, so if you have too, it's okay. Like my preceptors would tell me, that call is over, it's done. Focus on the next one.

Hey, everyone. So I just finished day two of a five day stint today, and I had a couple of interesting calls and a good learning experience from one that I'd like to share with you guys. Patient number one was a female in her early twenties complaining of abdominal pain and difficulty breathing. Shortly after arriving on scene, I determined she was in diabetic ketoacidosis (blood sugar of 346, Kussmaul respirations present, abdominal pain and polydipsia) and I got her packaged and ready to go with an IV line running wide open. Unfortunately, I'm not (or wasn't) that familiar with just how quickly an open line should flow in, and while I checked it periodically to make sure that it wasn't flowing in more than I wanted to, it didn't occur to me that in my ten minute transport time I should have gotten the full liter in, and it also didn't occur to me until when we got to the hospital that she had had her arm bent and had kinked the line--which is why only about 150 made it in. My other mistake on that call was to let my uncertainty about our clinical guidelines and protocols get the better of me. I should have given the patient pain relief, but I didn't due to the fact that I was more concerned with what admin would say about mixing protocols. As it turns out, I would have been fine, but the real lesson learned here was that I need to be developing my treatment plans FIRST, and worrying about how it fits into my protocols second. I know what treatments I want to give, but I oftentimes get too wrapped up in worrying about what my protocols let me do that I start thinking only in the form of protocols as opposed to sound treatment. I spoke with Dwayne about this call afterwards, and he really helped to set my head on straight. He told me that I need to be putting the patient--not protocol--first, and he's absolutely right. Treatment plan first, how I'm going to make it work within my protocols second. It's about performing sound clinical judgment, and either finding a way to make your protocols agree with what you know the correct treatment is or getting on the radio and getting the doctor involved so you CAN perform the right treatment. And I know this sounds like common knowledge, but it really is a hard balance to get right, especially for a new paramedic. And even though I later found out that I COULD have treated the patient's pain no problem, it's the simple fact that when I'm assessing my patients, I'm not thinking of how I need to treat them, I'm thinking of what protocol I'm going to work under. So Dwayne's message to me was a good wake up call, and one I'm not going to forget. I'm not out to blatantly violate protocol, but my primary focus needs to be on how I can make this patient better or at least prevent them from getting worse and on how to at least treat them appropriately. And thankfully I got the chance to redeem myself in a way on my last call today, where I forced myself to take a step back and think about what TREATMENT I wanted to give, and then later found the protocol that made that possible. I'm not too proud to admit I messed up today. I had a chance to positively impact a patient and I let it slip by me due to my incompetence (not double, triple, quadruple and quintuple checking my IV line) and due to my preoccupation with protocol over correct treatment. And I'm sure I'm not the only one who's ever made this mistake, and if you work under pretty rigid protocols like I do, you've probably found that it can be hard to do what's right and still be within your protocol. Dwayne, you're the bravest paramedic I know, I've gotta say it, man. You are the epitome of what our mentality towards patients should be. You lost your last job doing what's right, and though it can be hard for us to stand on principle over practicality, you've proven that if any one of us want to be half the medic you are, we have ABSOLUTELY got to put the patient first. I wasn't doing that before, I knew the lines, could recite the mantra back and forth, but it takes more than just being able to read the script to really be that kind of paramedic. I know I get a lot of praise here for being "such a promising newbie", but the truth is, I'm not half the paramedic you guys are. If you guys could see me in action, you'd see just how green I am and how much, for all my words and strong beliefs about what EMS is, I haven't lived up to the message I've tried to deliver. But I'm going to do better. Because I want to be THAT paramedic who never compromises, who never puts anything but the patient first. I messed up today, and I messed up before today. And to be honest, I'll probably mess up again. But I'm going to try not to, I'm going to try and follow through with that I say, to act in accordance to my very strong beliefs about medicine and EMS. And maybe, just maybe, some day I'll really be worthy of all the kind things you guys say about me. But that day isn't today, and it isn't tomorrow. But every patient I see, I am going to remember what you said, Dwayne. I'm going to keep your words in the back of my mind and I'm going to try my damnedest to do what I claim to believe in. So thank you, Dwayne. You forced me to take all my philosophical bullshit and really prove that I mean what I say. And every day, I'm going to consider it a challenge to live up to the things I say and the beliefs I hold about medicine. And this is my challenge to the rest of you guys. If you've been letting protocol dictate your treatment, if you've been thinking protocol first and correct treatment second, if you've been saying the words but not living up to them, I want you to change that. I'm not asking you to violate your protocols, I'm asking you to think about what is the BEST treatment for your patient, and either finding the protocol that lets you deliver that care, or getting on the horn and asking your physician to give you orders that provide that treatment. Practice what you preach if you're not doing it already, and if you already are, make sure your partner is as well. Because that partner could be just like me, waiting to here the same words Dwayne told me, to break them out of their "what protocol do I use?" shell and back into thinking like a paramedic.

Hey guys, sorry I was a little slow responding to this. I've had a little bit of time to cool down and think about things. It seemed like I had finally plateaued by the end of internship, and now that I'm on the streets "for real" I'm back to square one. I guess this is what they meant when they said you're never done learning. It's harder to remain assertive when I don't have my preceptors' cattle prod egging me onward. Thanks to everyone who replied. Herbie, you're right, I am the senior medical officer on scene and I do need to show it. It's hard to really step up to the plate when most of my coworkers could be my parents, but it's something I'm going to be working really hard on. Thankfully (I think) I'm working Sunday through Thursday straight so I'll get a chance to really get a good amount of experience as opposed to the here and there shifts I've been dealing with lately. Dwayne, as always, you are like a mentor to me and I can't thank you enough for your advice. I always look forward to it and it never fails to inspire me or make me reflect on how I act on every call. To be honest sometimes it does feel like I just lucked into becoming a paramedic, and that lack of confidence in myself is something I've struggled with for a long time--even before I ever got into EMS. Undoing the "failure" mentality is an ongoing process for me, but you're right, I did sweat and struggle and fight every day for over a year to become a paramedic, and I really do need to step into those shoes and recognize that I have proven myself and trust that I really DO know what I'm doing. Mateo and Medicgirl, thanks for the words of encouragement and the advice. I need to get going to bed but I want you guys (and everyone who's replied to this thread) to know that I have read all of your words carefully and I'll surely reread them again and remember them when I'm working this coming week. I'll try to follow your guys' advice the best I can, and try to "find myself" as a paramedic and really live up to the title. It's hard to share my weaknesses with others, and to admit my flaws, but you guys hopefully know me by now and know my intentions are good. I told my preceptors at the end of my internship, I'm not a good paramedic yet, but I'm going to continue to try every day to become one. It's the foundation that they and my college built for me, with the guidance of my colleagues like you all, and my own determination that will eventually make me a good paramedic. Until then, I'm just a paramedic, but I look forward to the day I can join the ranks of you all, and with your continued help I'll surely see that day.

Hi everyone. The topic of the day is scene control: seizing it and keeping it. Controlling the scene is one of those things I've struggled a lot with, for a variety of reasons. Before I begin, I'd like to share with you a story from today. I had loaned my car to a couple of friends last night so they could get home (I was unable to give them a ride due to having a bit of ETOH on board), and this morning I went to pick it up from them. However, on the way home, I happened upon a fresh accident (see, airbags still smoking) and got out to check everyone until EMS showed up. They were all fine, however when fire showed up (fire around here are all EMTs who generally arrive prior to EMS and are there to assist EMS), I attempted to give them a report and was summarily ignored by all of them. I'd identified myself as a paramedic with the county however the firefighter in charge cut me off in the middle of my report and instead went to speak with one of the other firefighters about the patient that I was trying to give the report on. Fine, whatever, you don't want my report? That's cool with me, I'll just wait till EMS shows up and give them the report instead. None of the firefighters had thought to ask the patient about their past medical history, and because she had a defibrillator/pacemaker I wanted to make sure EMS was aware of that before I left (also, I can't turn over patients to EMTs). And when EMS did show up I let them know about the patient and was on my merry way, however the incident left me fuming. Around here, EMS has ultimate control over all medical scenes and fire is there to assist us. However, it seems like I very frequently encounter a lot of difficulty with the firefighters and tend to be "overlooked" or ignored even while I'm working on duty. Anytime we show up to a call, my partner is the one initially addressed even if I'm first in and obviously teching the call. It's embarrassing to admit it, but I must confess that I don't provide a strong enough presence on scene though I believe another part of the problem is the fact that I look very, very young for my age. Anyway, the point of this is that I am sick of being treated like a junior firefighter on scene or otherwise being ignored and I recognize that I need to strengthen my presence on calls and I'm looking from advice from you guys on how to do that. I often find it hard to be confrontational with folks I'm not familiar with (being so new, I'm afraid I still have that overwhelming urge to "defer to the more experienced folks"), and I'm not looking to stir up any bad blood with fire folks but I'm getting ever more pissed with being talked down to by firefighters who don't have the same level of prehospital medical education as I do. To be honest, I really want to just pull a couple of those firefighters off to the side and say, "Hey, I really don't give a shit if you're twice my age because I'm the paramedic and you're the firefighter, so this is my scene and you guys are going to do what I say, got it?" Though I think that may be a little inappropriate or rude. So, to all you more experienced folks out there, let me know: how can I be more dominating on scene? Paramedic represents the highest level of prehospital care, and I feel like I'm failing myself and my profession by being so god damn meek. I became a paramedic to be a leader, not to be a follower and letting firefighters walk all over me isn't doing that. In conclusion, I'd like to share a quote from my AMLS book: "If you don't take control of the scene, someone else will."

Uh, what? Also, out of curiosity, how does a deaf healthcare provider listen to lung sounds or take an auscultated blood pressure?

Wow, you've managed to take stupidity and refine it into a substance so pure and free of any semblance of intelligence that it would merit an award if they gave out awards for such. Congratulations, man! That's quite an accomplishment!

Wow, Crotchity, I can think of few tests to gauge how racist someone is that are as horrible as that one. But for the record, my fiancee is ethnically Middle Eastern. And I'm white.

Couple of things, 11outof10. First off, you're right. A two year degree doesn't make you a paramedic. But you're talking from a far different position from Dwayne. He's been through paramedic school, he knows what it offers and what it doesn't, as do many others here. You're going to realize as you near the end of your paramedic program and after you're done just how little you've learned about medicine--and that's in a two year degree program as much as in a certificate program. It's astounding, it really is, how vast the field of medicine is. Even the specialty of emergency medicine is far more expansive than what we paramedics learn. And you're also right that you WILL learn a LOT during your first couple of years as a paramedic, and indeed, throughout your entire career as a paramedic. But the education you're going to get is hands on learning, not academic education. And THAT is what's severely lacking in EMS. Paramedics with decades of experience still fall short when it comes to academic knowledge, and fall short when it comes to understanding the full breadth of medicine. We learn about emergencies, but the bulk of what we do is not emergent. Are you learning in your paramedic program about eczema or photodermatitis? How about prions? Scoliosis? Ankylosing spondylitis? Multiple myeloma? What about the mechanisms that turn proto-oncogenes into oncogenes? Are you learning about what emergent conditions can result from amyloidosis? I'm guessing not. But you know what? We deal with patients who suffer from these conditions. It's not enough to do the whole IV, O2, monitor and transport with these patients. And it's not enough to simply transport everyone to the hospital. That's bankrupting the system. But there's not hardly a single medical director out there who will let their paramedics treat and release or release and refer--not in the U.S. And you know why? Because we simply do NOT know enough about medicine to be able to accurately distinguish between emergent and non-emergent conditions. Increasing our education is going to do a lot of things for EMS. First and foremost, it is going to make us better providers. Much better providers. Secondly, it's going to raise our professional image. If you can't even mandate a MINIMUM of an Associate's degree, why in the world would you EVER expect someone with an MD to trust you to do ANYTHING to ANY patients? Why would anyone let someone who only has their high school diploma and a 12 month certificate perform ANY sort of advanced medical procedures on themselves or their loved ones? I'll tell you why, because the public knows almost nothing about EMS. If they knew how woefully inept we are, they wouldn't let us so much as touch them except to give them a ride--and nothing but--to the hospital. I don't pull out the "well, I'm a paramedic card" because I am a brand-spankin' newbie, but in this case I am going to make an exception. You may think you know so much about being a paramedic because you're in school to be one, but you obviously haven't been in the program long enough to learn the most valuable lesson paramedic school can teach you: that we are a joke. We're not prepared to hit the streets, we've just got no other choice once our time in paramedic school has ended. So we do the best we can, hope it turns out for the best, and leave it at that. I was in the top of my class in paramedic school. I was praised by my professors and classmates for being "Google" (my pre-Bieber nickname), and my preceptors told me that I needed to go to med school or PA school because I was "too smart" to be just a paramedic. And you know what? I don't know jack shit. I struggle every shift because I feel undereducated to do the job. I feel like I don't know anything and the idea that someone is actually trusting me with their life is terrifying. Because even though I went through a degree program, that still IS NOT ENOUGH. We HAVE to raise the standards. Twelve months is not enough. Two YEARS is not enough. I'm qualified to do the bare minimum, the VERY bare minimum. I need to learn so much more before I will be a real asset to anyone. But I can do the job of a paramedic as it currently is, but that is a transient and fleeting thing because in order to be of any REAL benefit to anyone, I HAVE to learn more. And so do you. And so does Dwayne. And so does every other paramedic on this forum and everywhere in the country. Our patients deserve more than a two year degree, and they certainly deserve more than a 12 month certificate. They deserve professionals who know more than a very narrow window of medicine--and not even the full depth of that. You make think you're a smart guy, and maybe you are. But I'm a smart guy too. And I've been through the degree program. And I'm telling you, I'm not that smart. I'm not as smart as I thought I was and you're not as smart as you think you are. You want to be a good paramedic? You want to elevate the profession? You want your medical director to trust you and give you more freedom? You want ALL paramedics to be able to do more and be given more faith by their medical directors? You cut out this misguided notion that the degree doesn't matter, because it does. And you cut out the idea that paramedic education at any level below that of the few four year degree programs that exist in this country is adequate. Because they're not. And I'm proud of my college, and I think they gave me a good foundation, but neither I nor they think that they're perfect or that their paramedic program doesn't need improvement. You've got a long ways to go. I've got a long ways to go. We've all got a long ways to go. The only difference between you and me, or you and Dwayne, or you and a number of other paramedics on this forum is that you haven't yet realized that that long ways to go begins with our educational system.

The saddest part of this all is that it's now 2011 and we still need to be taught how to be decent human beings to people who don't share the same religion, culture or color as us.

Hmm... I guess I forgot that a bunch of you work in rural EMS, and about that pesky little "dust" stuff. That's a good argument against white.

You've got to go for the two year degree. Got to, got to, got to! You can't skimp on your education and to be honest every single person that gets their paramedic the "quick and easy" route brings down the entire profession and everyone in it. EMS in the United States is atrocious. It really is. Our educational standards are pathetic, and since our leaders don't seem all that interested in fixing the problem it's up to every one of us to be a part of the change by rejecting paramedic mills and non-degree programs and actively seek degree granting paramedic programs. And this isn't just for the sake of the profession, but for your sake as well. Let me tell you something, in my state it's REQUIRED for all paramedics to get their Associate's as a part of their program. So I've done the degree paramedic thing. And you know what? I STILL don't feel like I know anywhere NEAR as much as I should. And maybe you're a lot smarter than me, it wouldn't be that hard, but all the same, how prepared do you think YOU will be if you spend less time in school than I did? You absolutely have to go for your degree. For the sake of your patients, for your own sake, and for the sake of our profession. We are healthcare professionals, or at least we should strive to be healthcare professionals, and part of that battle towards recognition means taking the hard road and insisting on degree level education. You need to make a decision. What kind of paramedic are you going to be? And yeah, you could be a great paramedic after going through a 12 month program, but I doubt it. And whatever you decide, you need to realize that you're going to be setting the tone for your career. Are you going to be the kind of paramedic that takes the faster and easier route, or the longer and harder and ultimately more rewarding route? Good luck on your journey towards becoming a paramedic.

To be honest, I can only think of one time since August when my shirt would have gotten dirty as a result of patient care--and I work in a busy urban environment with plenty of trauma. I know I haven't been doing this long, but I think the idea that white would get especially messy might be a little overrated. I do agree that the white button up isn't especially comfortable (it feels like I'm always having to readjust it or re-tuck it in as well), though I think it's fairly functional. Having pockets on my shirt is a big step up from the red polo I had to wear as a student. You say you don't care what the uniform is as long as it's functional and comfortable--what kind of uniform do you think meets that criteria?

Really? Care to share any photos or give the brand names of the individual articles of your uniform? How do you like that kind of uniform?

Bringing this topic back from the grave. Right now we wear white button ups with black EMS pants. They look good, but I feel like we need something that makes us look more like healthcare professionals as opposed to public service professionals. I would like to see jumpsuits (preferably) or some heavy duty scrubs (possibly with EMS pants). Actually, and most of you probably will disagree with me on this one, I really think these uniforms look pretty cool. The picture's of a paramedic and doctor in Germany, though don't think they still wear these anymore. I'm a big fan of the white, that I think, more than anything else, screams medical to me.

Hey, Dwayne, look what I got in the mail today. Thanks again, to you and everyone else on this forum. The gift is nice, the recognition is nice, but being a part of this awesome community is the real reward. EDIT: Oh, also, much thanks to Tribal Hollywood!

Being ornery, I think in LA their idea of an extended scope of practice is letting paramedics start IVs by standing order.

Nothing so far either, Dwayne. I sent my bio as well. Chbare, the only way to send photos is to just send a URL where the photo resides.

I've had the same Wal-Mart boots for over a year now and they're starting to get ragged on me. Worst of all, Wal-Mart doesn't carry that brand anymore. Guess I'll have to shell out the dough for an actual pair of duty boots.

That's a good point, Dwayne. I ran a call from an outpatient surgery center where the staff stated the patient had gone into cardiac arrest after the surgery while he was waiting to be dismissed. The nurse said she'd done "thirty seconds of CPR" and gotten him back. I believe she said he was asystolic, in any case the patient presented alert and oriented x3, perfect regular sinus rhythm no ectopy, non-diagnostic 12 lead, stating he'd been taking a nap and the next thing he knew he was having CPR done on him. Did he arrest? Maybe, but I have my doubts. Long story short, we gave him a ride to the hospital and monitored him. He threw up his orange juice. Which, by the way, was all he'd had for the last twenty-four hours. Talk about a sickly sweet odor!

I'm not going to go over all of your posts thus far, but I will say that I agree with the others that you did not present yourself in the best of light, and you're going to want to change that. I get that you're a young man, but if you want to be taken professionally, and treated with the same respect as an adult, you're going to have to work a little bit harder to act like an adult. That aside, welcome to the forum! I'm glad you're interested in the medical field, we need as many people as we can get. That said, I think you very strongly need to step back and take a hard look at yourself and think about what you want to do, and the reasons why you want to do it. There's a lot of things you've said that make me wonder about your motives, and make me concerned that you perhaps haven't fully worked out your reasons for wanting to get into medicine and the military. Medicine, and the military, have very unique cultures as I'm sure you know, and neither of them are really for everyone. Despite what you've said, it DOES still sound like you've got a romanticized notion of what medicine and the military is. And that's concerning, because neither job is really like what we think it is in our minds. Little did any of us know before we hit the streets that we wouldn't be running critical traumas and cardiac arrests every day, but runny noses and bumps on the head. Likewise, little did many soldiers realize before they signed up that they would be spending most of their time waiting for a battle, and then when it actually came that it was nothing like they expected. And consciously, you may be able to see that and say, "Yeah, I get it. It's not like that." but there's still some things you've said that make me think that, at least subconsciously, you've still got a much more "TV friendly" view of what both are like. One thing you said in particular that has me worried: Let me tell you something up front: don't get into medicine because you like the idea of helping someone. First of all, what we do rarely makes the difference between life and death and on the rare times when we CAN make a difference between life and death, all too often death wins that battle. Secondly, I don't like you saying you "love the idea of truly helping someone". You've got to want to be in medicine for more than just that, because garbage collectors truly help people as well. So does the cleaning lady. And the CNA. You need to ask yourself, "WHY do I want to be in medicine?" I also don't like the way you phrased your comment about sending fathers and brothers and husbands home alive. You said, specifically, "if that's the case, how many fathers and brothers and husbands could I send home alive?" Two things about that, first of all, the military has already implemented tourniquets, so realistically the number of people you can "send home alive" is probably around the same as any other soldier--seeing as they all know how to use tourniquets and have them available, not just the medics. You also have a bit of an ego in there, it seems, and I've got to tell you, man, it's not about us. It's not about you or me or any other paramedic or combat medic or RN or doctor or RT or anyone else. It's about the patient. You and I don't matter. If not us, then someone else. Yes, the whole is only as much as the sum of its parts, but I promise you that every patient you may save and every patient I may have saved would have been taken cared of by someone else had it not been me and if it isn't you. You can debate the philosophy of it, but in the end we're not special for being there and saving them, we're just the ones who happened to be on shift at that time and happened to be the closest available unit. And I use civilian paramedicine as a reference, but the same principle applies anywhere. The point is, it's not about us, and I really hope you see that. Anyway, I hope none of that discourages you but I really think you need to take a good hard look at yourself and reevaluate your position. You're young, you're very young. And I'm very young myself, and I'm still older than you, and I'll tell you that I have spent a lot of time trying to figure out what I want to do with my life so believe me when I say your views are going to change as you get older and you may even change your mind about what you want to do with your life. Take your time, you have plenty of it, and make sure that this is what you truly want. When you come to these forums, and you speak with professionals, and that's what we are, professionals, you need to take a step back and look at where you are and where everyone else is. I know you're at that age where you want to be treated like an adult, but you've got a long ways to go before you hit that milestone. Everyone here has proven themselves amongst their peers and their instructors, and some of us--myself included--are still a long ways away from obtaining the kind of recognition that some of the more experienced ones have. And that's what it comes down to, experience. I'm a paramedic and I'm twenty-four, and I'm a long ways from being considered experienced or carrying any kind of weight to my opinion. And that's okay. I'm not here to prove myself to anyone, I'm here to learn from people who DO have that kind of experience and who DO carry a lot of weight with their views. You need to present yourself for what you are, a young man with very little life experience and very little experience in the field of medicine and in the military, and take advantage of this opportunity to learn from people who know a hell of a lot more than you or I about life and the medical field. If you can do that, if you can stop trying to prove how adult and experienced you are and just come here with the attitude of "if I knew everything I needed to, I wouldn't be looking for the advice of people more experienced than I", you'll be proving that you ARE an adult without even trying. Good luck and take care.

Wow, Mobey, what an incredibly complex case both from a medical standpoint as much as from an ethical one. I don't have much right to approve or disapprove of your actions, but I really think you did the right thing. It doesn't sound like that guy had much of a chance of living, and I think you gave him his best possible chance to stabilize enough for transport and it just didn't work out. I personally don't consider intubation and artificial ventilation in the absence of ongoing resuscitative measures to be contraindicated by a DNR, but I can understand why you opted not to on this guy. And in the end, it sounds like it was best. The daughter was able to say goodbye to him while he was at least somewhat responsive, is that correct? You can't hope for a better outcome with a patient like this. Tough call, tough decisions to make, and you did so like you've been doing this since the day you were born. Bravo, man. My hat's off to you.