cosgrojo

Love this conversation fellas... I'm kibbying in my chair reading your banter. 100% agree with Dwayne's ideological stance. Have long felt that we are too cavalier with the public's civil liberties. I personally don't understand the CYA treatment modality... feel that it is backwards thinking, promotes poor assessments and lack of critical thinking within the first responder universe. I'm sure you are sensing it... BUT... I completely agree with Fiz that there are a lot of situations that could come back and bite the provider in the buttocks... and worse turn out to hurt the patient's health and well-being... and none of us wants that. Personally, I work for a private company that would hang me by my toenails, assault my body with papercuts and shower me with lemon juice if I signed this guy off. In fact, my employer has gone to great lengths to inform us that we should take every person that loosely meets the criteria for a "patient" to the hospital. While I am offended by the policy and feel slighted by the implied slight against my ability to assess a given situation... I like my paycheck... in fact I require it. In these cases I rely on my relationship with local fire and PD. If PD is convinced that he is "just a drunk" (and I've done my due dilligence), I may be able to call this a "Police Matter" or "Domestic Matter," and clear without patient contact. I'm going under the premise that he never called us and does not really fit the criteria for a "patient." If someone called an ambulance and transported me back when I was in college and getting knackered on a regular basis... I'd be still paying off those medical bills! Great conversation, and I agree with you both... which is weird because you two appear diametrically opposed on this one. I guess I'm a bit wonky myself... should never have taken that shot of everclear... I just used forms of the word "slight" with only 3 words seperating them... please... somebody give me a negative reputation mark for that. I stink.

HA! Not even bad ones... it's the thought that counts.

Back when I was a younger fella' and worked a gajillion hours of OT... I used to drink them. I found myself getting reliant on them, and eventually they didn't work anymore, which was very concerning. Went cold turkey and detoxed from them. A week and a half of chronic headaches later and a lot of proper hydration later, I was back to normal. I have no clinical research or studies to validate this claim... but I have found for me personally, if I remain properly hydrated throughout the day, and keep my blood sugar in normal ranges... I can turn it on any time of day or night. Drink lot's of water... works for me.

I remember my first emergency call like a nightmare. I felt like I was standing still lodged in mud with everything moving about me. My partner and EMS mentor appeared to me to be picking me up by my boot straps and sigle handedly managing a difficult patient. I honestly cannot remember a single thing that I did to help during the call. Afterwards, in discussion of the call... partner tells me I did fine, that's the way you feel after the first one... you'll get over it. He was right, I got over it... but I never wanted to feel that useless again. I began to really dial it up from that point forward. (Good times... eh admin?) So what I'm saying is... get over it... get better from it. I have the feeling that a light bulb popped on over your head during this discussion (yes ABC's can be assessed from the hallway before you even see the patient... weird huh?). Good luck. The City can be supportive if you let it.

I guess this debate makes me a little bit confused. Does the knowledge of the Golden Hour really cause pressure on providers to shirk their on-scene responsibilities? I know about the Golden Hour, but I don't think it ever even entered my mind during a call. On a trauma call I am focused on managing injuries, extricating and packaging, and doing the job I am there to do. I've never refused to do a required intervention because of this Golden Hour Principle that I learned about in EMT school. Is there a major storm brewing in your' respective areas about the Golden Hour and how it is the be all end all? Do companies actually set policy by it, as was implied earlier. Are job performances being judged by the Golden Hour concept? If so... that is ridiculous. Are there really people out there doing this? I've never seen it. For the most part when people rush, skip intervention, and do a poor job, it is not because they are trying to observe the tenets of the Golden Hour... it is because they are scared, uncomfortable, and not good enough at their jobs to do it right. I agree that the principle itself, "The Golden Hour," is a silly thing that does not accurately portray the pre-hospital needs of the trauma patient. Every patient is different... as others say, it is situational. I don't see providers putting much thought into the Golden Hour concept, I think that the vast majority of providers simply do their job as best as they can in the situation that they are placed in. Admittedly, some provider's "best" is not very good, but let's not place the blame on the Golden Hour. I prefer to think of the Golden Hour this way: At every step during a call (trauma or medical), if I am not doing something to further the patient along to definitive care, then I am not doing my job. As long as I am not taking a time out to flirt with the Fire Fighters, and sip some Mai Tai's, then we are doing all right. I prefer never to rush, I feel that if my movements and assessments and interventions are done correctly, and with high efficiency, I am making up all the time that someone else gained by rushing. Concepts like the Golden hour, to me, are just reminders that we should always be moving towards the hospital.

As LoneStar said, camera's in the back on the ambulance would not be a feasable solution. The privacy nightmares with that are almost endless. The solution is to build a culture within your' service of responsibility and accountability. Too often bad deeds go unreported... and therefore unpunished. If yiour partner won't let you get away with those types of shenanigan's, you are going to be less prone to do them. If you know that the partner you have is meek, and afraid of making waves... and you already have the unfortunate predilictions to do these types of deviant acts... then you are more likely to attempt them. We must make it known to our co-workers that we will not tolerate these types of behaviors.

If there is an afterlife... if there is a higher power governing over us... I would like to believe that the experience would be different for every person. I would like to think that each after-life experience be unique to each individual. Everyone is unique in their own way, everyone believes in a different way. Why not have a post life production that is tailored to the individual? I have lived a life far different from anyone else on this board... as has everyone else. We all have taken different journey's and have metabolized that information differently from each other. I would like to think that each one of our moments of passage be just as personalized as our lives have been. I would like to have Ruff's version come true for him... I would like Splenac's version to happen for him... I would like 4C6's Ass to glow brilliantly into the hereafter. We all lived differently, why would we pass on in the same way? Seems like that would be a rip-off. If you believe in the Catholic's version of God, I hope that you see Him when it is your time. If you are a Buddhist, I hope that you keep coming back until you get it right. I would want everyone to get what they expected. I am not a religious man. Spirituality is not one of my strong traits. I believe in Pro's and Con's. I hope that at the end of the line that the good deeds I have done outweigh the errors in judgments that I have committed. I don't believe in wiping the slate clean. I hope that whatever higher power awaits me takes the full picture of my efforts and is able to confidently say, "this guy did more good than bad, he's alright in my book." I want to be rewarded for my positive traits, but at the same time made accountable for my negative ones. So... to answer your question Ruff. I think that it will be different for each one of us... with any luck.

EMS49393- So you've never known anyone that has test anxiety? You've never had it yourself? That's all this was. She was nervous about an experience that she had never had before that she heard nightmare stories from others who have taken it. Clearly you are the most knowledgeable and composed test-taker of all time, so you would never get any anxiety, nor would you ever get a question incorrect, because then you wouldn't have had complete comprehension of the subject... which is of course mandatory in your version of EMS. So you got 100% proficiency in every test you ever had? Never guessed at a question? What happens when you don't know something (in the rare event), do you just leave the question blank? The fact of the matter is, some questions are tricky... some questions are WRONG. Have you never taken a test, answered what you would swear on a pile of bibles was right, only to get the results that you were wrong? I've taken exams where I fought the answer to certain questions, some I've won, some I had to be remediated... The point is, even the test-makers aren't perfect... unlike you. Of course the NREMT-B test isn't difficult, but people who haven't taken it, don't know that yet. Now she does, and knowing is half the battle.

Unless you guys got 100% of your questions correct on your NR test, you probably shouldn't be so vociferous with your condemnation about floridastudents' test question observations... Did you guys get any questions wrong? I'm betting you got at least one or two... you should have guessed better, so that it would at least appear that you have KNOWLEDGE. Floridastudent- You'll do fine, and if you have to guess on a few of them... it's OK, you don't need a 100 to pass, we all can't be perfect.

Whoah... did Dwayne finally find a Basic that is worth working with?!? So the B on my sleeve doesn't make me useless? (Sorry Dwayne... couldn't resist.) Foz, what I think was stuck in the head of your Lady conversationalist was the old adage of "Think Global, act Local." Many people truly believe that if everyone focuses on fixing their own back yard, that nobody would ever need to help anyone else. While ideologically true, it is not a practical solution to such many and varied issues. Issues that you, me, nor anyone else will be able to effectively explain to the uninitiated. While I applaud your attempt to try and peacefully educate the Lady, it was doomed to end in frustration for the both of you. People with only a broad frame of reference are always confused by those with experience and intimate knowledge of the inner workings of... whatever.

I couldn't agree with this statement more. There is no room for cheats in my version of EMS... I have no sympathy for these suspended individuals... some of which I know personally. I don't like having to do refreshers, and I am taking full advantage of the "exam in Lieu of" option (for New Hampshire & NR), but I would never take a fraudulent class and lie to the State licensing people just because it was easier than actually going to a class. It is different... and it is a lot easier. You only have to complete 28 hours of con ed every two years for the EMT-B level, and ALL con-ed can be obtained via on-line sources. The course has to have a MASS OEMS approval number, or be CCEMBS certified... No other requirements... accepted without question. Re-licensing in Mass is the easiest State to relicense in the three States that I have held cards in (it costs 150 smackers though... you pay for the convenience I suppose.

My understanding is the 45 day ones were CPR refreshers. 9 months were the EMT refreshers. The rest were the people in charge of the programs, "teaching" the programs, signing the rosters, and making the decisions.

Clearly this Kate woman is not someone I want caring for anyone that I know or care for. She does not seem to understand the basic tenets of responsibility. It is clear that she wants no part in taking any responsibility for her transgressions. But let's not fool ourselves about refreshers here people. I know we are all pro education, and anyone that isn't shall be fed to the angry Gods of the City, but refreshers are mostly handled poorly, taught inadequately, and not to mention, being phased out by the Registry. If Refreshers are so important and vitals to becoming a better EMT, why is the Registry trying to streamline the process? NR now offers a Test-out option in-lieu of traditional class and practical time. I for one am glad for it. Being a full time EMT, and occasionally involved the the education of new EMT's I am constantly staying abreast of the "new stuff." For me, refreshers seem superfluous. I would rather just prove my knowledge through a quick and easy test, and not be bothered with sitting in a class room for 24 hours getting bored to death. This is not an anti-education spiel, but I am anti-refresher... for me. That's why I like the refresher opt-out clause that the registry has come up with. If you know your s%#t, prove it... and we won't make you sit through it again... if you fail... take a seat and try and remember it this time. My problem with these people is that they are not taking their responsibilities seriously. Whether you agree with the way the system works or not, you have to abide by the rules, or get out. If you don't like it, get involved to try and change it, but don't try and cheat your way through, and then say you cheated because the requirement is stupid. In my opinion these people deserved their punishment, and they only have themselves to blame by accepting a program and a recertification that they knew was against the rules. Not wanting to go to a refresher is normal, actually skipping out of it and falsely claiming you went may not mean you are a poor EMT, but it does make you a cheat, and a liar. And if you compound that by then trying to say you didn't really do anything wrong, then you are just stupid and a bad person.

Wow, haven't been around for a while... just occasional lurking whilst being incredibly busy with life... I have to admit that two years ago I would never have guessed that Dwayne would turn into the City's conscience. I'm impressed... I'd like to think that a couple of our knock-down drag outs had something to do with it. Following your threads over the years... it is a study in psychosocial evolution. I would like to state in response to someone's post earlier (no disrespect for not quoting it, just not good at it), I think that it is good to sometimes pick fights around here. As long as all sides keep the vitriol to a minimum, fighting something out just to fight something out sometimes yields unexpected information and forms unexpected bonds. My advice is to take risks... just think them out first. Pick on someone bigger than you. If you notice someone with a bloated reputation number that is probably ill-deserved and obviously sent an extra "payment" to Admin to accumulate it *cough*Dwayne*cough*, then take a run at him with an argument. Just make it good, think it through, and try to use correct sentence structure and punctuation... except for ellipses'... feel free to abuse them without regard to there literary intentions... I do! Aloha Y'all

If I feel that it is safe to stop and help... and I think that my help would benefit the situation... and I believe that there would be an extended response time for actual on-duty rescuers... and if I'm not angry from the 24 hour shift I just got out of... and if the scene truly looks confused or disorderly... then I might stop. Not to Parrot what others have said... but what usefulness am I without my Ambulance? I know when I am working and I go to a call and there is an "off-duty" EMT on scene telling me he/she is an EMT/RN/MD/CNA/RT/PT, I don't really care. I don't know you, and I don't trust you. Thanks for helping stabilize before I came, but I'm here now... you can go. I have stopped maybe 2-3 times while off duty in the past. As soon as flashy lights approached the scene and someone was quickly briefed on the situation... I'm out of there. I don't want to hang out, and they don't want me there. I don't trust them, and they shouldn't trust me. The worst is when I am in uniform coming home from work... sitting at a traffic light and a fender bender happens in front of me. People spot the uniform and start calling me out of my car to help. Good Lord I hate that. Just leave me alone, no one is hurt... I'm sorry that the other guy doesn't have car insurance... I'm hungry and I want to eat my Bagel... Sorry guys... not that this has ever happened to me before or anything...

Welcome fellow New Hampshire person... Welcome to EMTCity, and welcome to New Hampshire EMS. Maybe we will see you out on the road when AMR (hopefully) takes over Manchester... I can't wait to live and work in my home town again. It's been a long time. We are always looking to add staff, if you are having trouble finding contact information at AMR, feel free to e-mail of PM me... I can get you names and numbers to contact. Good Luck!

I think for the most part, most of the people I work with try and follow-up with patients that we dropped off at the ER. We do this to both find out what was actually going on with them, as well as to find out what we did right and what we potentially did wrong. We aren't always able to follow-up due to a myriad of variables, but it is not due to lack of want. We all accept the liability inherent of working in the emergency medical community, and one would be crazy not to expect a "muck-up" or two along the way. I for one love when I get feed back from the hospital... both positive and negative. These are issues that are at every level of medicine, not just EMS. For every level of "education," there is another level of liability and extenuating circumstances. I guess I'm curious how you expect anyone to learn how to perform the skills (that you've seen botched in the field, and in the hospital) without ever practicing or trying them out? I'm with you on the education bit, I've stated that before, but we still need to be able to "physically" perform the *gasp* "skills." I am a huge basketball fan, it's my favorite sport... I have studied the mechanics and strategy of the sport since I was a young child. I even read books about proper form and technique required to shoot a basketball with high efficiency. I can dissect a guys shot with one glance, and can tell him how to improve it... but I can't shoot myself. Physically unable to do it well. My point is that while I could write a thesis about the form and function of a jump-shot, and could get into a rousing debate on the merits of jump vs. set shots, a 12 year old gifted with a modicum of athletic talent could beat me in a game of HORSE, and never know why. As much as we talk about "education" being more important than those evil "skills," we still need to be able to do the skills. You can't expect someone to be able to perform a skill without ever being able to practice it live, based solely on how many books you read and how many lectures you sat through. These things we talk about... Education, Experience, Skills... everyone seems to be taking sides and I don't have the ability to understand. They are all important, they all serve a purpose, and a superior provider will have equal parts of all of these attributes. It's like the laminated cards I see on the RN's med cart... ensuring the patient's rights. Right patient, right route etc... It's about the "right" education, the "right" experience, and the "right" skills.

But you were allowed, and it was a major component to your learning/educational experience. I do not have a problem with students being allowed to attempt things they don't quite understand yet... if properly explained, they are excellent learning opportunities and can spur the student to get more interested in the subject. If people never tried things they don't understand... there would be no medical community at all. Lisa O- Education is wonderful... paramount to being a well balanced provider. One does not need experience as an EMT-Basic to become an excellent provider... However, having experience as an EMT does not have to be a negative thing, and does not mean one should feel ridiculed for having it. Not everyone that has 10+ years of EMT-B experience is as dogmatic and backwards as our venerable EMTCity panel suggest. Experience is like education... it is only as good as YOU make it. Don't let anyone tell you otherwise with their blanket statements to further their own agendas'. It is not appropriate to discredit anyone's education/experience when you don't actually know what it really is. You can always learn something from someone. If you approach both education, and experience with an open mind, and a diligent work-ethic, you will do just fine. Ahhhhh... it's good to be back... happy new year everyone! And for the record, while I have no fundamental issues with general abdominal assessments (including palpation) by the EMT-B... I would not have allowed my student to touch that abdomen, and I probably wouldn't have touched it myself... I would have gone to the ER, pointed at it, and let the Doc get all handsy.

Despite the apparent tonal issues in this thread, I think that some very good points were raised on both sides. Now I'm certainly not trying to play impartial moderator because I clearly come down on one side more than the other. While I have, in the past, interpreted Vent's "tone" as anti EMS provider... I have come to the conclusion that I think it is more accurate to describe it as anti "bad" EMS provider. This I can not have an issue with, for I dislike bad providers as well. I still disagree with some of her arguments... just don't care whether the argument carries a tone or not. I myself have been guilty of over-toning my posts, so I suppose it would be disingenuous of me to take exception. I think that it should not be the jobs of EMS to play Monday morning social worker. We are ill equipped for it in experience, education, and not to mention the time it takes to accomplish this. However, I also agree that it is incumbent on EMS'ers to properly nudge people in the right direction. Make the proper referrals and recommendations to the patients, family, and staff. If we see something that could be fixed, and we know who is supposed to fix it, we should notify those people. I've done these things dozens of times over the years, and they can be done within the framework of the call without much effort or wasted time. That's were it should end though. We shouldn't get any more involved... I think it blurs the line of what our purpose is, provide pre-hospital emergency care. I don't want to be a social worker, so I would prefer that my job not expect me to be one. This does not make me an insensitive beast (I don't think), but it does make me someone who knows his current limitations.

I would be VERY surprised if he was an actual person from India. Fake persona methinks. Nice detectors Kaisu... mine were ringing too.

Guys... Gupta here seems to exhibit the same annoying sentence structure of our favorite "kevbutnobacon" supposed Englishman. His syntax and stereotypical writing is not fooling me... and he has been banned. I would imagine that he was exposed at the admin level. Thanks for patrolling the waters Admin.

The correct word usage should have been either "laid," as chaser said, or "lied." While "lied" doesn't sound right when you read it or speak it... it is not grammatically incorrect. You should not have used "lay" because that word is usually followed by a noun. The other small issue is that you should have only quoted the word "twitching," and left "was" out of the quotations, unless you are quoting what the staff said and you didn't witness the twitching yourself... in which case you should have also added ""staff states patient "was twitching."" If you saw the "twitching" and were making a generalized assessment because a better term was not available for what you saw, then you should have left "was" out of the "'s. Again, like chaser stated, these are particularly small nits we are picking. Other than my continued misuse of ellipse's, I believe that sentence is grammatically correct. *edited for grammatical mistake... I meant "lied" not "lie"...I must go flog myself now.*

Au contraire mon frere... On Saturday we had our annual 25 hour day... I hope you used the extra hour to advance EMS, and advocate for your patients. Vent- I sincerely believe that your vision of what EMS should be is what we should all strive for (in spirit, if not in practice). You advocate education, training, well-rounded understanding of not only medicine, and emergency care, but core values of the human provider. No issue can be taken with your ideals. The thing that continues to befuddle me is the possible implementation of these ideals, and your insistence that everyone subscribe to them. Yes, change is coming, and I welcome it, it will force many a provider to poop or remove oneself from the proverbial pot. However, the changes you want are not plausible. If we all, everyone of us in EMS, increased our education 4 fold, became masters of medicine and politics, and spent the amount of time it would take to lobby and participate at local, regional, and national levels... who would work the street? Who would do the transfers? Who would respond to these Life-line calls for the quadriplegic who can't reach her glasses? Clearly not someone with the education, training, political savvy, and connection to the bourgeoisie of EMS and Medical muckity mucks. If I decide to take the route you propose, and am successful in doing so, I'm not going to want to still ride the truck... what would be the point? Then you would decry that I was wasting all of my education and knowledge when I could be in a conference room advocating for even more change. We still need people to work the trenches. Go ahead and educate us to a higher standard, but there is nothing wrong with being happy and content with what we do. I love my job at the *gasp* Basic level, I truly feel that I make a difference every day I pull on my uniform and bend to fate's will. If I could guarantee that my aging body could continue to work on the road for the rest of my working life, I probably would, and I would probably be more inclined to raise up a couple notches on the certification hierarchy. Unfortunately for me, I see a finite road ahead of me in EMS, and I have no desire to enter the administrative world anymore. Scoobykate, for instance had to cut her street career short because of health concerns that were out of her control. While she is continuing her love of medicine in other arenas, would she be less commendable if she pursued non-medical arenas that interest her? Of course not. While I am not trying to say that you, Vent, are implying that argument (I actually recognize that you appreciate hard work and education in all fields, not just EMS), I don't think that people that like their jobs and only do what is required of them to meet the industry standard are blights on the system. The system NEEDS them too. Those are my thoughts... I tried so hard to stay away from this one too...

Wait a minute... your not an English Teacher? Couldn't tell.