cosgrojo

The one thing that jumps out at me is that the patient was complaining of "a tiredness in lower thoracic area." This is not a normal sensation, one that would perk my interest. In the area that I was trained for c-spine rule out... any direct complaint to the head, neck or back automatically get a board. Granted that "tiredness" is not something that we associate with pain, it is significantly different from what we would expect to hear as a complaint. Distracting injuries only play a role if he has no complaints of pain to his head/neck/back. Did he say that this tiredness was a chronic condition that he had even before the collision? I suspect the answer to that question is no... so how did P-instructor phrase it... board that gourd.

I don't think it is fair to expect anyone to know "everything," especially a student ride-along. Not only is it not fair, but it would sap you of obvious teaching opportunities. The best learning experiences are often the ones borne of mistakes. As a preceptor, I want my riders to make some mistakes... that is why they are there, to make mistakes under as controlled an environment that we can provide for them. Hopefully the services have chosen well and provided the preceptee with a smart and experienced preceptor. I, along with many over the years on this on-line community, have yelped for better education for EMS. I have even done my part in some small way by becoming a part of the education process. Wanting higher standards and more progressive education does not mean that you also have to expect perfection (for lack of a better term). I think it is important not to lose sight of the fact that EVERYTHING is a learning experience, and our students need to be given every opportunity to get the most out of all the different ways there are to learn. Many people learn in different ways. Some may devour the med lists and contraindications like I do buffalo wings, while others learn from going out and seeing it in the field while riding next to letmesleep. I think that this is the reason why we provide them with these various opportunities to learn... and if it isn't the reason... it should be. We aren't like bees... we are not brought into this world knowing everything we need to know. Some of us are slow learners, but once they get it... they get it. It is imperative to remain patient with our riders... even the ones that you don't think are going to make it. Just some random thoughts based on the convo.

I am sorry I was not more specific... My comment was based on the criteria for LSB station, not PA... and this is kind of the issue. We send mixed signals to the students. We tell them to collar immediately after manual c-spine being held in long board, and then give them an option during PA. The students do not always understand or even identify this gap in instructing. Sometimes they do, and then I have to explain (ineffectively, I might add) why PA and LSB are different and we are teaching to do it one way over there, but telling them you will fail if you do it like that over here. While trying to simply teach them a "skill" we sometimes make it harder on the students to get the "whole picture." Ideally they would all get the fact that in the field, they are going to need to integrate all of these skills together, but far too often they do not. We try and hammer that point into their heads, but they are too focused on breaking everything down into it's own segment because it is easier to remember that way.

I am conflicted on this issue. As a "seasoned" provider (as my much younger co-workers call me), I know that there is not much harm in when you perform the application of the collar. In fact doing it a bit later in the process provides you with more assessment data. As an instructor of BLS practical stations, the criteria is to apply collar immediately after you have determined that trauma is involved, or suffer from critical criteria fail. It is not often that a student will think about this issue long enough to even think about questioning this philosophical difference between criteria and assessment... so I rarely have to defend myself or explain the dichotomy. I also think that we overuse the board and collar. I cringe to myself every time someone meets the criteria for getting one, and I know that it is going to cause harm/discomfort/pain. I hate the fact that I sometimes put these things on patients just because that is what the hospital expects of me, and what the State DOT standards blindly tell me to do. If I don't put them on, I get an earful from the hospital staff (depends who's on... some Docs' in my local are more willing to accept divergent behavior than others), and when I do put them on... 50% of the time the hospital has discontinued the whole thing even before they get to x-ray.

Cannot disagree with that at all. Wow, that is some rough criteria before you get out into the field. There are some people that will be riding third for decades. I've been in EMS for over 11 years, I've never ran a pedi code. I know that I am just a basic... but I've worked in systems that I am the primary response unit, so I am not going to be held back from responding just because of my license level. I like the concept... but it would be impossible to implement. If they are the only lawyer in town available to handle the case... then yes. But fortunately for the lawyering community, they don't have to be ready to be at the court house in under 10 minutes of the crime, fully prepared to argue their client's innocence... Lawyers and paramedics.... apples and oranges a bit, I think.

I've often thought that the most realistic Medical show on television has been "Scrubs." I think that there should be an EMS show in the mold of Scrubs... Maybe you could call it "Nine Pocket Pants."

I almost gave myself a negative 1 for it...

While, like Dwayne, I am very a-political in nature, I do take a certain amount of perverse pleasure watching and listening to people rancor about. I believe that this point has been skirted around during this discussion... and I'll try to explain my perception. It appears to me that this prize is being awarded to Obama for being a World-wide "symbol" for peace. During his campaign he was lauded as a symbol for "change," and with that for peace as well. He has become an international symbol for these concepts. We all understand that there are many instances of symbols being over hyped, and no one has a better hype-machine behind them than the first African-American President in US history. Obama has a chance to be far more powerful as a symbol than he does as an actual catalyst for change through his policies and regulations. Symbols are powerful, people mobilize around them and then they become catalysts themselves. My guess is that the Nobel people want to use this symbolism... to hitch their wagons to this world-wide phenomena of "Change" and "Hope" and "Peace." So we may ask ourselves... what has he done to deserve it? And it is a fair question... but who is a more unifying figure in our world today than Obama? Do the other 209 people on the list of nominees have the same name recognition to get entire nations to stand up and take notice? Nope... in my opinion... it's all about symbolism. For the record... I vote for the guy who built the schools in Afghanistan for Girls.

Does this mean I am finally popular? YES!!!

Unfortunately there is not a lot that we could do for this patient. Patient is Alert and Oriented, wants to go home, wants to stay in this environment... your hands are tied. If you feel that this patient is not making the correct decisions based on pressure from the family or caregiver, than you must report it to the proper authorities based on your local protocols. You can not take someone away from their home against their will. It is sad that people live like this, but there are many out there that do so willingly. People have a right to live like pigs. You can only actively get involved if you think that this patient is not mentating appropriately, or you think they are making this decision under duress from an outside source.

Strengthening your back is great, but if you are lifting correctly... you don't use it much. Focus on lower extremity strength, core strength, and shoulders. One of the fastest growing injuries in EMS, shoulder injuries.

This is a standard week of questions by both my son and my sunday school kids You can answer any of them except number 10. 1. Why is blood red? Because red means stop... and it is important to stop all bleeding. 2. Where do babies come from? Mommies 3. Why are there craters on the moon Where else would we put them? 4. If you were a super hero who would you be and what would your super power be? Stretch Armstrong... for obvious reasons. 5. Why is the sky blue? The sun's rays hit the Earth's atmosphere, where the light is scattered by nitrogen and oxygen molecules in the air. The blue wavelength of this light is affected more than the red and green wavelengths, causing the surrounding air to appear blue. At sunset, the sun's light passes farther through the atmosphere, deflecting and decreasing the blue in the air. Scattering by dust particles and pollution in the air causes the sunset to appear red. 6. Where do babies come from? Didn't you hear me the first time? Mommies. 7. Tell me about the birds and the bees Birds poop on your freshly washed car, and bees sting you. 8. What is your favorite weapon Preparation. 9. Did you know Barack Obama is our First Black president? What???? Where have I been? 10. Who was the best president, George Bush or Barack Obama 11. Can we go back to Baltimore and do the pedal boats Sure... any excuse to go to Baltimore for a pit-beef sandwich. Yummy. 12. Dad, when are you going to quit being on the ambulance and go back to travelling for work. (tough and loaded question) Are you trying to get rid of me? These are the questions in just one week that I can remember off the top of my head. Now how was your week? Not as difficult as yours Ruff...

Crap... messed that one up... I meant Kyle Orton... sorry. Seneca Wallace couldn't beat his red-headed step-child. I agree, but there are no absolutes. There will always be someone that breaks the mold and is able to thrive, and improve no matter what system they are in. Damn curve-busters... I hated them in college.

While I agree that it is not appropriate to "expect" that an MD could also be a plumber, there is nothing wrong with an MD that is a plumber, and no reason to think that he/she couldn't be good at both. I may be wrong, but I have interpreted this question to be about the ability to do both fire and EMS proficiently, and not about what we would think is the best EMS/Fire "system." There is an opportunity cost to everything that we do... is it better to be superlative in one thing, or be well rounded in many arena's? That is a personal decision people must make for themselves, and there is nothing wrong with either decision... provided you do it well.

Of course Fire Paramedics can be "good paramedics." Can they be as good as they "could" be if they didn't have to split their time learning multiple roles? Of course not. But so what? I could be a better EMT if I spent more time than I already do bettering myself with extra education (instead of incessantly creating new and exotic chessecake ideas), but I don't. We all have other things we do in our lives. Just because we don't completely focus on one thing and one thing only, does not mean that we can not become proficient in it. For instance... Splenac (I'm not picking on you, just using you 'cause you started the thread)... is their anything else that you do with your life? Any hobby or talent that takes you away from your EMS study? Do you think that your devout fanship of your beloved Cowboys (who are going to be upset by Seneca Wallace this week btw) is taking away from your ability to be a better Medic? I think that there is room for both in your life... so why not allow that a person can be good at fire fighting and at paramedicine? I may not ever become the "best EMT", and I will never become the "best cheesecake maker." But I am pretty darn good at both... and that is enough. 46Young- good posts... but I think that you might have a sticky mouse button or something... In no way am I endorsing that fire should dominate EMS, and not allow our wings to flap free... just answering the question at hand.

I recently transported someone with tako-tsubo syndrome. I obviously did not know what it was at the time. The call came in as a life-line (fallen and can't get up buttons) activation, that my dispatchers treat as BLS response criteria. Luckily the patient had a print out about what it is, because she couldn't explain it. She was c/o nausea/vomiting... no acute distress upon our arrival. It was my partner's tech and he went about the business of interviewing the patient and getting vitals and all that. I was reading the material and getting medical history and the med lists... Based on his assessment, my partner was treating it very BLS... He got her on the stretcher as I started reading the handout. We got half way out of the building as I got far enough into the pamphlet that I started to worry. This could go bad, and it could got bad fast. While the majority of people with this syndrome live a long, uncomplicated life after the first attack, and rarely have another one... when they do... they don't do so well. By the time I realized how bad this could go, we were far closer to the hospital than our ALS counterparts. And the last thing I wanted to do was increase the anxiety on this lady. Based on what my partner gave for a report to the hospital, they were going to put us in an over-flow room (I do not blame my partner... how was he to know? I had the info, and I didn't want to raise the warning bells because of the possible anxiety). I quickly corrected this so that we could deposit into an acute telemetry room. Within 15 minutes of putting our perfectly normal looking, non distressed patient on the ER bed, she was unresponsive on the bed with her eyes rolled back, body rigid as a board. I got another call right after that and did not get a chance to follow up on her. Scary...

Lowly!!!! I'm quite tall you know... and no problemo.

My company just got into the EPCR world, and we have an automatic fax feature that when we transmit our PCR to the Auditor's database, it sends it to the ER fax machine. It has been slightly unreliable, and sometimes takes 3 minutes, other times it takes a bit longer. What about installing the software onto one of the ER's computers and having our PCR's transmitted directly to that computer? While it would cost the extra software, in the long run, it would cut down on a lot of paper goods. When a MD or RN needs to see our report, they can just open a window on the computer... there are probably many logistical issues involved that would make it difficult, but I think the idea has merit. *edited for too many ellipses... I have an addiction*

If you are going to continue to play the role of the moral inquisitor and suffer from an intellectual superiority complex... the least you could do is spell correctly. It's "puerile" not "purile." (unless you were talking about the British rapper Purile) Do you not have spell check in England? Nothing worse than a know-it-all, who doesn't know it all. I may be mistaken, but I seem to remember an article posted on the City a month or so ago about an English paramedic, while patient loaded, driving back to the base to get out of work on time. That does not seem to jive with your assertion that everything is on the up and up over it Britannia.

Well, well, well ! So Spenec has become a Paramedic ! I have taken the liberty to read some of your hillarious posts, and may I say I laughed until I thought my sides would splitt. Your wit, irony and pathos left me a quivering quaking mirth sodden mass. May I bow in reverence to Americas greatest living wit and raconteur ! You must be so very proud of yourself. All the self opinionated and self absorbed nonsense you have written and you are not even a Paramedic ! What a sham. What a chalerton you are.

OK, I'll play along... but I do not believe that these were the parameters of the actual call Dwayne was on... the scenario was neither as simplistic, nor as rigid as these rules. Fiz- my only problem with your opinion is that regardless of what the provider "thought," we do not have enough information about the patient to come to any definitive diagnosis. While your first thought (#1 stipulation) is logical, and we have enough differential information to deduce the issue with a fair level of certainty; the second thought (#3 stipulation) is grossly assumptive, and shouldn't enter your mind as a provider who is always on the lookout to treat the worst case scenario. If the provider could guarantee that #3 is the case, then that person missed their calling as a professional prognosticator. While there is nothing wrong with understanding the normal process of the hypoglycemic emergency, there is something wrong with assuming that it will always be that way. As far as stipulation #4 goes... I don't know anyone that would turn down the opportunity to get a refusal if you didn't think that there was any medical reason to transport the patient (barring obvious reportable environmental factors). If for some reason the provider just hates doing refusals, and would rather just transport a person who does not require, or want our services... then we have a clear ethical compromise, and delaying the treatment would only be the tip of that ethical ice-burg. It is our duty to think not only what we think is going on, but also what else might be going on. We are not supposed to put ourselves in positions where tunnel vision dictates our treatment... so why let it dictate our ethics? *edited for innapropriate use of a form of "There & Their"*

Spenac - I stand by what I said... but stand rebuked for the attitude. I am at the tail end a 40 hour hell-grind shift, and have been a little testy during it. Not an excuse... just an explaination. Even I can admit when I have strayed from common decency... but you have to admit... it was well written...

Dust- That was incredibly comprehensive, and I doubt that anybody could really add anything to it... I do feel that I need to elaborate on my previous post though... I only participate in co-ed pillow fights.

I agree with that... but conversely, the Fire Service that is constantly trying to perpetuate their own ego, and hound all of the aforementioned glory, are also in it for the wrong reasons. I know many more fire fighters that got into it because they want to be "heroes" more than they want to actually help people. Anyone who gets into Fire/EMS because of some misplaced Hero-complex, should have not been allowed through the public safety door to begin with.

Unfortunately Jwade, you have narrowed possible responses to your question by instituting your "qualifying" guidelines. Anybody who is a CPR instructor who went through the 2005 update process and actually read through the materials that you posted knows the answer to your questions. But since this is apparently the only answer that is acceptable for a response, what do you want? Anecdotal evidence is all anybody could possibly have for any other techniques or procedures. Since the AHA sets the standards for the most part, and national protocols are (eventually) adapted from their research, no other answer could be backed with proper scientific data and statistics that you are requiring. I agree with ERdoc's original post. Maybe it would have been a less contentious conversation if you just posted the material you wanted to discuss, and enquire if we did it different in our respective neck of the woods. I'm not suggesting that you were trying to pick a fight or be condescending, just that when you narrow the answer to only what you were going to post, there is not a lot of directions the conversation can go. BTW, the majority of quality posters on this site are just as against posting without backing or some form of research... but there is room here for everybody.