vs-eh?

I still stick by my post 100% I am surprised no one has brought this up? Don't your services require some sort of baseline eye/ear/pulmonary testing done by an independent service to get a baseline on "adequacy" and for insurance purposes? I did. I would find it hard to believe that a person who is only hearing 10% out of one ear and 85% out of another would get by standards. I would think some red flags would come up, no matter how you got by in school. This isn't personal Alco, but you said it. Are you considered legally deaf? I am blind without my glasses. I would not be able to read threads on this site from more than a foot away from the screen without my glasses/contacts. This problem is easily correctable and does not interfere with core aspects of paramedic practice. Unless of course you catch me on a day in the field when I was wearing my glasses and they got knocked off. PS - I only wear my contacts on the job. Yes, I'm vain. There are hundreds of thousands of those in EMS who wear glasses/contacts. How many do you know who wear hearing aids? Hmmmmm.... It also appears that some people are equating "deaf" with "deaf and dumb". Having a disability does not = lack of intelligence. Stephen Hawking anyone? It does however prevent you from from holding certain jobs in life. It is nothing personal, it is just the job. The issue with EMS and assessment is not all about auscultation of lungs and taking BP's. No, it isn't. It IS however a CORE part of your job. If you have a condition that prevents you from doing this properly/adequately/accurately compared to equally tested persons without this condition, it tends to be a problem. Sorry... And again, your partner can do it. You must REALLY REALLY REALLY trust your partner on ALL assessments which you may be adequately able to do. Just as the doctor example, as Rid said it is the PA actually, not the doc, that is assessing you. That is quite a bit of trust when you may not have a second opinion... This will seem like a silly example but hear me out (relating to the height issue which is pretty equivalent)... Would you work with a 4'5'' paramedic who managed to get through school? They are a genius, they can do every other aspect of paramedic care, flawless assessments...except lift. For whatever reason they got through and were able to be hired. They can't practically lift patients, for obvious reasons, regardless of strength. I wouldn't work with them... Again...Unless you work in a system that affords you to have multiple (read: 3+) people on the scene/ambulance with equal or greater medical education than that person with a disability that impedes their ability to adequately do their job should not be there (hardcore sentence). This system also allows multiple people in the back with that same person. A midget can be a genius paramedic and can do everything but lift. Are they going to be hired? Nope.

Disagree. Accelerated 3rd degree? I don't that term exists, you might as well call it VT. Especially when the initial rate is about 150. And with all things being equal with only a lead 2 interp, hard pressed to call it a VT for various reasons...

This is an unfortunate reason that many people get into this profession, when in actuality they shouldn't have. Sorry, but I would never work with a legally deaf person on the job. Never ever. In the end they are going to be putting me at risk for many reasons, both clinical and practical. I don't second guess my partner if he/she decides on a treatment plan. Unless A) They ask. It is grossly apparent to me that it may not be the right diagnosis C) It is against standing orders. Because in the end, I could very well get in trouble for not reasonably recognizing it. The only exception that I can see is if you work in a system where you have a lot of hands on EVERY scene, and they are one of them. Unfortunately most normal EMS systems have 2 people in the vehicle and no other "trained" help on scene. Sorry, in the end it is my job too...Same goes for people that can't reasonably lift... I find this hard to believe. Part of your job is to diagnosis based on YOUR findings, not on someone elses assessment. Auscultation of various sounds (lung, BP, etc...) is an INTRINSIC part of YOUR job. You are unable to do this? Sorry, look into research medicine. I don't take my partners word (nor I assume do they take mine) on EVERY element of an assessment. You disagree? Want a second opinion? Do it yourself...Unfortunately this disability limits this wholly...

In less than 32 months working EMS in any capacity (though it has all been full time) I have seen oh I would say 30ish deaths (I will exclude trauma)....workable or non-workable... EDIT - 32 months full time greater than 33% has been on a zoom car...Not anymore though... I'm ball parking...But we will average a death a month (that may be high or low). Honestly I don't remember nor care... I would wager 75% of them were when I worked on a zoom car (by myself). Follow my math kids....22.5 patients ish I would wager 75% of those I canceled off any other response (we'll say 17ish). Because I thought they were either recently (but beyond resus) or grossly dead (I don't need ALS to tell me this, nor do I attach leads) Because I can cancel people on any call who I believe are obvious deaths....which seems to fluctuate in reasoning here (on this site) for some reason. There is never any issue...If I call an obviously death (when I'm the only medical person on scene)...all other ambulances are canceled (I'm BLS) if they are still on route. No question. Yes, I remember my first "code". Nothing I could have done. You try... Considering, in the end, death is often an ACLS algorithm, you shouldn't take stuff personally unless you know them... If you do know the patient take a day or several. If you don't, choose another profession...

100% true. Totally how I feel as well. I truly don't understand how people could work (especially full time YIKES!) at $8-10 dollars an hour in this biz. Which unfortunately a lot of my American friends seem to find themselves doing. Currency conversion and cost of living aside... EDIT - I recall reading somewhere at some point the phrase (or paraphrase) of "EMS - It is a lifestyle, not a job". EMS is a job, pure and simple. Anyone who thinks EMS is some kind of "lifestyle" should take a step back...I would not be doing what I am doing if I felt that I wasn't being adequately compensated for my education and the job I do. Financially, benefits, retirement....I'm satisfied. A lot of people around here simply stay in this job because of the benefits (read financial gain) that it affords them.

Hit and run, and failure to stay on scene (to me) are generally the same thing. Vehicular assault (and especially manslaughter) are not warranted. Again, (to me) there is then an element of intent or forethought. But then again I don't exactly know why people are charged with vehicular manslaughter (DUI or otherwise). I would think that most of these cases don't have people purposefully (again that can be broad because you decided to go behind the wheel while drinking and in turn likely using "poorer" judgment, beating someone and they end up dying to me is different, intent or not) killing you with their car. But I dunno... Let's assume and generalize that there are no laws pertaining to accidentally striking an officer with a vehicle as per CHP's laws in CA. If that is the case then hit and run/failure to remain is likely the only charge, legally. Morally, other things apply...

If police dogs are officially made officers (which I don't know if they are everywhere, nor specifically here) then why would striking a police officer be absurd? Attempted murder? I agree that is silly. People who are more versed in the law can tell me, but attempted = some intent to me. This again was likely an accident, it is about decisions made following it. If police dogs truly are officers here, then the person should be charged with fail to remain AND striking an officer. Refer again to my human police officer examples. Just because a person may not know/ignorant/failed to realize something, doesn't exclude them from being charged with full charges. It is like saying "Well ya I stole that thing, but I had no idea it was worth THAT much. Why do I have to be charged now with a greater theft charge?" Thems the brakes, live a learn.

You are driving along a city street. You accidentally clip an on duty uniformed officer who was on foot patrol. You realize that you might have hit something (there is damage to your side view mirror), maybe even a person, but instead carry on. The officer is uninjured but gets your plate. You get a knock at your door later that day and you are charged with varying offenses, including hitting an officer. Now, while I don't for sure if the dog was "marked" that it would identify it as a police dog, but in the end it was an officer on duty. Obviously the above scenario would not apply if the cop was off duty. At least the hitting an officer part I believe. If the above scenario applied to a plain clothed officer on duty (and not obviously a cop) would you still be charged with hitting an officer? I dunno, but think about it.

To comment on what Ruffems said... As I said in the end it does not matter that the dog was a police dog, the essence remains the same. Obviously the only reason this dog got media attention is because it was part of a K9 unit. You have a moral and as CHP said very likely a legal obligation to stop in these circumstances. It will almost always be an accident and potentially unavoidable. So say you are parallel parking and you accidentally hit the car in front or behind you. Nobody sees it. Your car has no/minimal/damage you don't care about. The other car has some obvious damage. Do you simply shrug your shoulders, tell yourself oh well, and drive off and find another spot? When you hit that dog the other day did you eventually stop and check on it? Were you driving on such a precarious twisting mountain road that it would have been impossible too? Something tells me you were not unless you have a seriously large problem with a lot of stray dogs roaming around where you are that they can appear in any environment. I assume you had the ability to safely stop and check VERY VERY soon after you struck the animal (say within 100 feet or so), just as the person who struck the police dog did. They did not, did you? Your last thing is pretty silly. So if a person hit a HORSE they would pretty much have to stop, I doubt they would have much of an option. Especially the ones our city uses, your car would be totaled and you would be lucky to escape injury, if not death. Of course I would not expect you to equate this random horse with some kind of police horse, but really that is beside the point as I have said.

In the end it is irrelevant if the person knew it was a police dog or not. Though, potentially given the footage that I saw of the area they were in and the 2-3 cruisers that were shown, it might have made ever more of a difference. It seemed to me that again all things being equal, if you were driving along and saw some "police activity" in the area, you'd be like hmmmm. Then you strike something on the road, see in your rearview it was a dog, you might be "Oh, sh!t I just hit a police dog!". It is reasonable, then as Dust says it adds to the fear and you drive away. I highly doubt that the officers who were handling this dog were too far away when they saw/realized that the pooch had be hit, but obviously far enough away to not get a plate. Unless this person was driving a semi or something huge, they would have realized they hit a dog and should have stopped stopped. They would have been met soon by police officers, apologized, and things would have been dealt with. I see Dust's points on all levels.

Apparently this person drove away... On the news today was the story about a Toronto police dog (they actually, I think, refered to the dog as an officer at one point) that was struck by a car. There was a training exercise being carried out (with no doubt an obvious police presence), and for whatever reason something caught the dogs attention, it ran out onto the road and was struck... The driver failed to remain. As an animal lover in general, this is a sad story on any level. Now I'm no hardcore PETA activist or anything, I'm a carnivore to the core, but it brings up an interesting topic... It is quite amazing to see that on real fire scenes (which, inevitably you will see the most emergent animal cases in EMS) the effort that police/fire/ambulance will take to "revive" an arrested or obviously sick animal. Something that basically none of us are formally educated in, but the improvisation, the effort, the "mouth to mouth" (read mouth to snout/nose) effort that would never ever be done on a human, is done often without hesitation on a cat or dog. I know people that can't look at animals being taken out of fire calls, or that may go on about how it is "too bad", far longer than any human death. But back to the issue...It was raised in the news story what (if anything), this person who hit the dog should be charged with? Accidents happen, cars hit dogs/cats/squirrels/birds/etc...Many times they are unavoidable. But most people realize they have hit something, be it a piece of wood or an animal. Most people would at least pause for a sec, pull over, and be "WTF, was that?" Now if you hit see you hit a wild small animal, and it's obviously dead. You may be like "Sh!t, that sucks", you may pause and reflect, and carry on. But if you hit a larger animal, and especially one that is more than likely domestic and a pet (read cat or dog) then perhaps something more should be done. The officer in the news piece was too distraught to even speak on camera. Thankfully, it sounds like the dog will likely pull through. I think the driver should be charged (at minimum) with fail to remain. If you hit a person and drive away (regardless of injuries) you will be charged. This is also regardless if the incident is deemed unavoidable. You chose to not use basic common sense and ignore laws, so you should be charged. All things being equal, it is a hit and run. The police on the news were simply asking the person too identify themselves to police so things could be clarified and that they could let them know how the dog was doing. Nothing more, yet... I'd like to see this dirtbag hit a deer or moose and keep driving off. That would be interesting...

Ummmmmm.... 1) What is PNT? I've never heard of that...Paroxsysmal Normal Tachycardia? 2) V-tach? Ummmmm....All things being equal knowing nothing about the patient and not having a 12 lead...If you were to show this lead 2 strip to anyone educated in rhythm interpretation you would be very very very hard pressed for anyone to say the initial rhythm was a V-tach. What would lead you to that? QRS is within normal limits (again lead 2 and likely in a non-diagnostic mode) and *whispers quietly* V-Tach will show p-waves as well (at times). It is just that normal conduction is being overridden by ectopy. Take a look at what V-tach normally looks like in lead 2 monitoring. While I would never say beyond a shadow of a doubt that it is not VT, even playing odds (which is what you would do in this case) I don't think anyone, if that rythym continued, would treat as Vtach. This strip appears to be a "conversion rhythm". Call it an SVT. The term SVT actually encompasses (technically) a lot of tachy rhythms, and not just the one that most people would give adenosine for :wink: . Sinus tach is technically an SVT... SVT that is converted to another rhythm that appears to be in a bigemeny. Bigemeny is pretty clear I think.

A few that I found funny... Apotemnophobia- Fear of persons with amputations. - Oh hello there, let me shake your hand....NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO!!!!!! Bacillophobia- Fear of microbes. - You're screwed. Bacteriophobia- Fear of bacteria. - You're screwed. Bolshephobia- Fear of Bolsheviks. - You're screwed...Inevitably...they are everywhere... Cnidophobia- Fear of stings. - http://www.imdb.com/gallery/ss/0120917/Ss/...;path_key=Sting Dutchphobia- Fear of the Dutch. - see Bolshephobia Genuphobia- Fear of knees. - You're screwed. Hypnophobia- Fear of sleep or of being hypnotized. - I like how they equate sleep (which is inevitable) with being hypnotized. LOL....Maybe it's just me... Ithyphallophobia- Fear of seeing, thinking about or having an erect penis. - I'm screwed. Lutraphobia- Fear of otters. - see Bolshephobia. Medorthophobia- Fear of an erect penis. - see Ithyphallophobia Megalophobia- Fear of large things. - see Medorthophobia, then see Ithyphallophobia Onomatophobia- Fear of hearing a certain word or of names. - Craptacular....Uh oh........NOOOOOOOOOOOOOOOOOOOO!!! Opiophobia- Fear medical doctors experience of prescribing needed pain medications for patients. - I don't even know what that means... Poliosophobia- Fear of contracting poliomyelitis. - NOW THAT IS SPECIFIC Rhabdophobia- Fear of being severely punished or beaten by a rod, or of being severely criticized. Also fear of magic.(wand) - http://www.realmagicwands.com/ Scelerophibia- Fear of bad men, burglars. - Again, I like how "bad men" are equated to burglars. Is this man bad? http://personal.carthage.edu/jrivera/image...ns/PB063263.JPG Teratophobia- Fear of bearing a deformed child or fear of monsters or deformed people. - Pleasant. Xyrophobia-Fear of razors. - Ladies? I hope not... Ya it's dumb.

http://photobucket.com/albums/e268/emt6388...nt=WierdEKG.jpg

Very tough to tell.... The initial rate looks pretty regular narrow complex @ 150 until about the 7th or 8th complex. Call it what ya call it to there. Are those p waves? Are they burried? Meh... Then it looks like there was potentially a p-wave with no QRS...Then we go into the other rythym... Did those reduced amplitude complexes conduct? Looks almost like a bigemeny... I dunno...SVT into a junctional escape rythym with ventricular bigemeny... Very very likely wrong. No meds? Would help.

WOW!!!!!!!!!!!!!!!!! HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!!!!!!!!!!!!!!! *wheeze* *cough* *ahem* *woooooooooooo* *cough* *ahem* *snort* *heh* *woooooo* Man, would I love to see services like this. I....I'm speachless....but the phrase cookbook medicine applies I think. And even if management insists on an IV for Johnny Stubtoe, start a lock, and let the basic attend. Not all IV's have to be bags... Double ACP crews in Ontario are quite rare. The vast vast vast majority are PCP/ACP....

You assess what you can and let whoever does your extrication do it. You do your best. In these situations you can never be faulted. If extrication is going to take 40mins regardless of anything and the guy goes apneic...well....if you could potentially get a collar on him (even though you couldn't) and you are ALS you can try to digitally intubate. I doubt you'll get a laryngealscopy in this scenario. I assume you can also check for a pulse... Try that...again if the guy arrests and you still have a prolonged extrication time, get on the phone, and call for potential pronouncement. Obesity aside (which I'm not doubting could compound this guys problems, especially the apnea issue) it is a blunt trauma problem.

So you get 8 more ambulances and 47 more fire trucks (hey it's a fire, you need at LEAST 47). Because of the aforementioned poor road conditions they all approach the scene and ALSO crash into each other and various surrounding buildings. Everything is on fire, everyone is burning alive and looking at YOU to save them. As you stand there adequately practicing BSI and scene safety... 4x4 and epipen in hand, a bus looses control and smashes into the scene as well. You get the feeling this isn't any normal bus.... :shock: With his last gasping breath, the bus driver says "This.....*gasp*....this bus is FULL OF BABIES!!!!!!....." Then he dies. Shortly thereafter the bus explodes sending like oh say 40 babies everywhere. Keep in mind you still have those 4x4's, plenty of NRB's that you are dying to give oxygen at 15L/min with, and of course a fist full of epi-pens... NOW WHAT DO YOU DO?

We don't have either a spinal "protocol" or a clearing "protocol". I am aware of the Canadian C-spine Clearance thing and yes I loosely use it at times but in the end I will repeat... The assessment of whether or not to spinal immobilize a patient is basic, not complex. It isn't a chest pain or an NYD abdo call. It is based on clinical assessment and observation. And, in the end, if doubt remains? Then board them, just don't do it blindly because "protocol" says so. How do you immobilize a patient without a backboard? Are you saying that if you think they really need immobilization they get a board and if not they get.....a scoop? Collar only and telling them not to move? I don't follow...If I choose to immobilize a patient they get it all - board, straps, head rolls and collar. None of this BS collar only garbage, I always laugh when I see patients (thankfully it's rare) come in like this. And yes I know that patients in hospital this is often done, but that is the docs decision. KED - Only used it twice and funny enough it was the same week :? First was a roll over and my partner (who FYI hadn't attended an emerg call in years) said that we should use a KED, I was like ummmmmm, but whatever. The other one was a highway extrication where the roof was cut of, I suggested a KED to pull the patient out (only because of the call a few days prior) and we did it. Worked well. But here they are only used for ped immobilization where boarding the kid isn't feasible. It limits assessment too much and is more trouble than its worth.

And again these should be all based on BASIC assessments done on scene. The differential diagnosis for spinal imobilization (FOR A SCENE CALL) isn't like a chest pain or abdo pain call. It's pretty cut and dry for treatment based on probably 30secs of assessment. Don't base it on protocols and what not...Base it on patient complaint and what you clinically and objectively observe...It ain't rocket science. Will "mistakes" be made? Sure, happens in medicine. But then the doc clearing that same patient with a twist and a jerk right? USE YOUR HEAD. You don't have x-ray vision, true enough. Clinical judgement is all that is needed.

Implaed kniting needle to the gluteal region. It was classic, we get it as a "stabbing" get their and fire has this kid who is standing there with his arms crossed with an NRB on his face. He turns around and there is a kniting needle sticking out of his buttocks. Me - "Ok, lets walk out. Take that mask off him. Lets go to the hospital bro" Transported him prone for obvious reasons. :twisted:

I don't think any services in Ontario have specific spinal "protocols". And if there is it is news to me. For us it is based on clinical judgment, pure and simple. I honestly don't understand how it could be based on anything else. I mean using basic assessment skills and observation, it is pretty easy to see if someone needs a board or not. Simply following "protocols" blindly because they say so is foriegn to me. It's analogus to treating all chest pains as ischemic, all SOB as CHF or broncoconstriction, all alerted mental status as hypoglycemia/narcotic OD. I could go on... This is a basic assessment. If you can't do that, I'd hate to see that same person on a chest pain patient (especially one that speaks minimal english) or an NYD abdo pain. Good luck. And anecdotes are irrelevant imho. You can't win 'em all. :joker:

CCP flight in Ontario would carry pretty much everything (close) to what you have listed. Here are a few others that are on their drug list... Levophed Esmolol Phenobarbital Dilantin Fomepizol Potassium Chloride Stemitil Pentaspan (this is also carried by tactical medics here) Ketamine Propofol Ergonovine Hemabate

When Ontario initiated the move from 1-year full time PCP program to the 2-year program, the system didn't collapse. I realize this isn't an entire country...but you can see the comparison.

Inform the public and government officials of the current state of EMS... Do they want a period of time (say several years) where the possibility will exist that they may not get a "rapid response" to their apparent emergency. Yet, they will have more educated and competent EMT's and Paramedics? Or will they settle with the current system where epi pens apparently are a sticking point in scope's of practice? :roll: Honestly, public education on what exactly is an emergency and when an ambulance is required, as well as telling people you don't need an ambulance (necessarily) for chronic or minor problems would go a long way. Patient - "I cut my finger" Me - "Ok, sir, you live like down the street from the hospital" Patient - "But, there was a lot of blood" Me - "It's not bleeding now...looks like you may need a stitch and certainly a tetnus shot...Save yourself some money, we're not going to be doing anything for you...Your buddy there has a car? Take a little trip." Patient - "You think I need to go to the hospital?" Me - "Well, you called 911, so I assume you felt it was serious enough to warrant a hospital trip" Patient - "So you think I should go?" Me - "If it was me, no. But I'm not you...would you like to come with us, or will you make your own way to the hospital?" Patient - "Ummmmm, ummmmm, ummmmm I think we can walk down there" Me - "Good plan, here is a band-aid, peace."