cosgrojo

Well...there goes the hat collection again....

I guess the only question left that I want to know the answer to is... Why didn't he automatically have to respond to this ALS criteria call? Why would he have to wait to be requested by BLS? I believe that this guy shirked his responsibility... but if your system does not require him to respond IMMEDIATELY for ALS criteria calls, then I think you guys have another problem, and the lousy system is partly to blame.

Not really... we just need 2-6 relatively strong people to follow the ambulance to the scene, carry the bags, and occasionally help lift the bariatric patients. I don't see why that needs to be the Fire Department at all... but I suppose since there aren't a lot of actual Fires to fight... they need SOMETHING to do. I bet we could get some guys from the local gym to come out and help lift for a lot less money than a full-time fire department salary costs us... and they would be providing the same service... only they would probably do it better.

I guess I just don't understand "volunteer" EMS. This medic is at home with his kids, or is he being paid and sitting in the station? Does he have a department vehicle with appropriate responding apparatus, or is he supposed to be flying toward scenes with his personal vehicle and a post office strobe light? If you are at home, not being paid... how can you get in trouble for not responding? It is Volunteer... right? From my understanding when you are on a volly squad, you only go when you can or want to go, if you are indisposed... that is what mutual aid is for. When BLS crew called for medic... was the medic in between the call and the hospital, or would they have had to wait for the medic to arrive? The way the call was presented it seems to have taken a long time to get ALS determination. If I was on that BLS crew I would have been requesting ALS on the way to the call... mobilizing them as soon as possible (are there dispatchers involved? Or are we still hopping phone-booth to phone booth to get emergency resources?). If I got there and it was BS (or nature of call was different than dispatched), then I would cancel them. If this medic was truly "on-call" then he should have gone out when the original call came in, and responded with the BLS crew. If your system is set up to respond BLS on ALS criteria calls, and rely on updates from BLS to DETERMINE whether ALS even rolls out... then you guys should suspend your system without pay and leave the medic alone until you guys get your s#it together.

Mobey- Training and educating "veteran" EMT's and Paramedics is often the most challenging project that an EMS educator can take on. I believe that these are challenges that are not unique to EMS. Veterans of all industries are often resistant to change, and difficult to inspire. It doesn't really have anything to do with the industry, but mostly Human Nature. We humans are paradoxically prideful, yet susceptible to an extreme lack of self-confidence. There is an inherent aversion to change and education because internally these people question there ability to learn and provide the new services that are going to be required of them. Yet their pride allows them to talk the talk in between calls, and quote their years of experience in an attempt to somehow prove their worth. These people can be motivated... they can be brought onto your side. If you are able to, you have quite an Ally on your hands. Veterans like the pack... they like the group dynamic. If one of their group all of a sudden is getting involved and holding himself to a higher level, the rest are likely to follow. Getting them to convert is a tricky matter. My advice is a multi-faceted psychological attack. First off... you must be complementary to these people. They need to have their ego stroked a little bit to get them onto your side. I am not advocating shining them on, but they need to know that their service to the community, and years of experience is something that you respect. If they feel that you respect them, they are more likely to be passionate about your changes. Secondly... YOU must be dynamic. You must be passionate about the subjects, well informed and knowledgeable, and you must project that not only is it your job to provide these trainings, but that it is something you WANT to do. They must be able to feel your passion, because it then becomes infectious, and people don't like being left out when they see people enjoying themselves. Try to make the material as exciting as possible... be a dynamic and energetic presenter, don't just kill them with power-point and a Ben Stein mono-tone. Lastly, and most importantly, make sure that they understand that in the end, it is about the patient. These new skills and information will ultimately lead to better care for the community, and better patient outcomes. Better patient outcomes and improved patient care leads to an increase in respect from other medical professionals, and a better working relationship with complimentary services (PD, local Hospitals, and the med-flight crews). I'm sure that you have thought of most of the things I propose... but I hope that some of it was helpful. Good Luck! You have a difficult, but interesting challenge ahead of you, I'm sure you will do well. *edited for stoopid typos*

Like being a diabetic... and a fat-ass? I think that it is patently clear by now that I am not able to talk like a normal person. Recognize my disability and work around it please... but you were able to decipher my code well... I will teach you to speak cosgrojo yet, young grasshopper. Your reply is exactly what I meant, and I need to reflect on my own stratagems as well. It is hard to try and write something that will speak to the masses in a way that everyone understands. It is the major obstacle to being a good teacher... we do not have the luxury of one-on-one time with each individual "student" (i.e. readers of these forums, of which we are all students). I have noticed that my "wordy" proclivities tend to obfuscate most of my statements... but as you can see... I am unable to de-program myself easily. It may be that our interpretation is that the strong-willed ability to defend yourself and your patients is very important... but others may not. Some people are not built to be brave. That doesn't mean they aren't good providers, just not someone you want around in a scrap (physical or intellectual). It is exceedingly difficult to find people that are able to encompass all of the qualities we want our providers to have, and that goes for all walks of life... not just EMS. But on the whole, I agree with your statement. I will capitulate this point... but I resent the Shakespearean overtures... I f'n hate Shakespeare. As much as I enjoyed our squabble and look forward to future squabbles... I'm not sure that others have the ability to take a step back like we did and re-approach the subject. This unique ability to go for the jugular is not always accepted by all. I believe that some times it is our methods that push people away. I, like you, think that it is spineless horse-bleep to run and hide when things get edgy... but I think we have some responsibility as long time residents of the city to regulate ourselves for the common good. But it is possible that I am just a wuss...

What? Dwayne... I thought you hated Basics regardless of their intellect or education simply because of their patch.... Now you are defending them? You are an astoundingly complex individual. I have neither received a hug, nor a high five from anyone on this site... and frankly I am beginning to feel left out. I too tend to get frustrated by the lack of intellectual debate, and educational banter... But I slightly disagree with your methods. Maybe it is BECAUSE of the fervent challenging of peoples positions that make them reticent to post and defend and get involved in subjects over their heads. As much as I thrive on conflict and direct opposition, I don't think that that agrees with most people's personalities. While most think that people in EMS are type-A personalities, I do not. Most in EMS are sheep-like in their lack of personality, and don't have the confidence or drive to stand up to attackers or challengers. Don't misunderstand me Dwayne... my tactics don't seem to work either. The soft and cuddly word-smith routine only lasts as long as I keep the aggressive nature of my argument style at bay. As you have noticed in past debates... passively trying to draw people into arguments only to aggressively torture them when given the opportunity. So what I am trying to say is that we all have played our roles in dumbing down the caliber of debate... some through aggression, and some through passive aggression. What I do not like however, is calling people out by name and handle and making them the pariah of the thread. It is uncalled for, and definitely takes us down a few notches on the civility chain. It is possible to rant and get your point across without having it devolve into personal attacks, because then we just either naturally try and defend ourselves personally, or go on a counter attack... or even worse, do not reply and end all discussion right then and there. In the past it was a complement to be the last poster on a hard fought thread, because you were the final word on a hotly debated subject, and that sometimes meant that no one could counter your last statement. Unfortunately now it just means no one cares enough to continue on with their arguments. I have been decidedly disappointed with premature thread ending several times during my not-so-triumphant return to the City. There have been some very high quality threads that have died unnecessarily. (BTW Dwayne... severely disappointed in your lack of participation in the Kumbaya thread, thought you could have added a lot... and you buggered off on the BLS/ALS integration thread too...*sigh* had such high hopes for them.) To comment on your female poster mantra... I agree, if any of the women that I grew up with had balls... they would be bigger than my head. Women are naturally more ferocious in intellectual and interpersonal debates, and have a hard time stopping themselves. It is the one thing that I have been pleasantly surprised since I've been back... much more female presence... and they appear to swing with the boys quite nicely... (double entendre most definitely intended). Shame on you spleenac... I expected more fight out of you... well maybe not fight... Ok.... i didn't really expect much at all out of you... but maybe in the future you will.... no... sorry. *didn't actually edit anything... accidentally hit edit button and immediately saw the comedic value of it... and this addition is the result *

Well this is an incredibly salient point Rid... one I agree with completely, and one I have been incredibly ostracized for stating (i.e. Medic's on all trucks, all the time). Granted you have approached it from a different angle than I have in the past, but I think you struck something important. As far as ETT goes, I have done BLS codes with combitube (available in New Hampshire), and with ETT with medic partners. ETT always takes longer and usually causes more provider consternation. Combitube goes in easy, and is just as secure in my opinion. Already within the last couple of years they have taken away intubation rights from Intermediates in New Hampshire. If they see a trend of diminishing returns with Medics, I believe they will do the same with them.

That was the most awesome, yet frightening thing I have ever seen....

Green tea is also know to cause impotence. Ruff... what's wrong with you!?! Really didn't think that was funny? I wasn't falling over in my computer chair, but it was certainly funny. You didn't laugh when the guy was talking through his SCBA mask? Good job and good luck cchen

While I agree with your stance on education, I don't think that it would really allow us to ignore patients request to go to the hospital. If that were the case, then RN's and MD's would have the right to turn patients away at the door shortly after triage questions. But they have to let them in, and so do we. If you work in a system that allows hospitals to kick you out before receiving care, then we obviously don't work in the same system. Everyone has the "right" to receive medical care, whether they need it or not... unfortunately.

Cosgrojo's Story In High School I used to play football. Before Freshman year started, football practice began. During the brutal heat of summer we were required to participate in Two-a-days. For those who are not crazy enough to have played football... "two-a-days" mean two full practices (in our case 3 hours each) a day, one in the morning and one in the afternoon. Having never been involved in organized sports before, I was unaware of the difficulty that lie ahead of me. My sporting life prior to High School was intramural and pick-up games. The budgets for organized sports were cut completely in my elementary and middle schools. First day, first practice, about 3/4'ths of the Freshman recruits (including me) vomited multiple times due to the unusually brutal nature of our practices (The thought of up-hill bear crawls sends shivers through my spine even today). We would have about 4 hours off between practices to rest, recover, and have some lunch, and rehydrate. I would go home and spend most of that time laying in my bath-tub with cold water running over me trying not to puke. My step-father was an asshole (I know, appears random... but I'll work it in). My step-father was quite fond of my older sister, and spent a lot of time with her and a lot of money on her. She is the classic all-American girl with good-looks, tremendous athletic talent, and exceedingly popular. She always got what she wanted. I don't resent her that, if I had those gifts, it would be hard not to use. I did, however, resent how she was favored. The two of them would come up with these odd things that they wanted to do, and once they realized they really didn't want to do it anymore, and it required more work than fun, they stopped. Often times this meant that I now had to finish what they started. My Mother around this time was going through some mental instability problems, and was not fully aware of the strange dynamic that appeared to be brewing in our household. One day after practice number 1 was completed, I limped home, covered in bruises, feeling like I have been beaten with a baseball bat, barely able to bend down to untie my shoes, I was given a task. My step-father and my sister had apparently decided while I was at practice that they wanted to paint our porch. Now we were not rich, but had a big house. Real estate in the early nineties in rural Maine was very nice, big houses for no money. We had a gigantic porch. They had maybe gotten 4-5 feet (out of 20) of porch painted, when they decided that they would rather go water-skiing with some friends. I was told in no uncertain terms that this was now my responsibility. It took me a week. If healthy and without any physical pain or defects, would have gotten first and second coat on within the first day... easy. I didn't eat lunch, I didn't shower between practice, and I didn't make a peep. If anyone cared to look I was obviously struggling to overcome the trauma my body was under, but no one looked. My best friend Dustin would come by and offer to help, but I would tell him no. I didn't complain or bitch or make a scene. I knew that if I brought this to my Mother's attention that it could end badly, she appeared to be very emotionally fragile at the time. I knew that my sister didn't care, she was having a blast, and I knew my step-father was an asshole and just didn't care. When I finished, my friend Dustin was standing there with me admiring the job, and commented that I should be proud of what I did (mind you he is being very sarcastic, and paying me back for my persecution complex). He off-handedly commented while he was on a particularly good roll comparing my struggle with those of the holocaust, that I should sign it like Michaelangelo did all of his great works. I smiled and agreed. I went and found some bright neon green paint and slapped my initials in bold font "J.C." on the concrete slab in front of the porch. We lived right off of a major road in my bumpkin town, and the slab is literally less than ten feet from the road. I was pleased with my statement, and Dustin was scared enough to go home and make me promise I didn't say it was his idea (Dustin is a sweet guy, funny, sarcastic, bright... not much of a stand & fight guy). I won't tell you what the fallout was, That's too personal.... but I don't regret it. I don't get much opportunity to go back to my home town much, nobody I care about lives there anymore. Couple years ago when my Grand-mother was in the ICU (eventually died), happened to be driving around with no particular place to go, and found myself driving toward my old town. Much has changed, much has not. The current owners of the house have repainted the house, the barn and the porch. Remodeled the fenced in yard, and improved the lawn, and generally changed a lot. Almost didn't recognize it... until I saw the initials. Not sure if that is why I started crying right then, and am tearing up right now while typing, or something else entirely... Thanks for reading.

Well then... he's screwed. From the information we would be able to attain in the field, it would be highly unlikely to accurately guess this one. Unless like chbare, you somehow know Fijiian viral and bacterial common infection rates. Cuz' I certainly don't. Everything I know about this subject I have researched in last two days. Dude... once again... you frighten me.

It seems that over the time I have been a consumer of this fine web-site, that there are many instances where we make judgments on people based on their posts. I have found my self doing it in the past, and after some critical thinking, I have determined it is because of natural prejudices that I have. We all have them, we all (rightly or wrongly) use them. I, for instance, tend to immediately discount posts that are incredibly hard to read and do not at least attempt to have some grammatical accuracy. Even though I know better than to equate bad posting grammar with intelligence... I still do it. I know that some on this site view me as the funny wordy guy that disappears for 8 months out of the year, while others see me as an arrogant rabble rouser who is more concerned with sounding “smart,” and less concerned with content. The truth is that I am neither of those things... this site, and my posts do not define me any more than they define the rest of you. Some naturally stereotype each other based on education, race (yes crotchity. Racism still lives, but there is no need to turn this into one of those topics), religion, political leanings, country of origin, what EMS system you work in, who you work for (paid vs. volunteer)... and so on, and so on. What I would like to accomplish here is to try and bridge the gap between some of these prejudices. I contend that we often misrepresent each other and misinterpret things simply because we have no idea what type of person you are, and we make the mistake of using our posts on an EMS message board as a barometer to judge our intrinsic value as a person and provider. To use some City veterans as examples, I've seen Dustdevil characterized as a cranky, BLS hating, Canadian disrespecting, arrogantly mean-spirited dude. He has come under attack multiple times for his stances on certain subjects (sometimes by me). I've read enough of his posts that I believe this characterization is incorrect. There is a sensitivity to many of his posts that we all usually miss. An understanding of fundamental quality on a human level, fiercely proud, loyal to those who he calls friends, and unerringly steadfast in what he believes in... education and enlightenment. Quality people equal quality providers. DwayneEMTP is the guy that pokes you in the chest when he senses weakness (in mind or in argument). Challenges you in a brusque manner, and throws haymakers until it's over. What I think is sometimes missed about him is that, at heart, he is a pragmatist. Why walk in a circle if you could get there in a straight line? A man who is eminently capable of the subtler arts of vocabulary and diplomacy, but doesn't see the point. Anything worth knowing is worth fighting for. If you back down and are unable to defend your stance (or lack thereof) than you weren't worth the educational experience to begin with. He's not being it to be mean or hurt feelings (as I only recently came to realize after getting' all up in my grill), but to cut to the chase and provide a learning experience for us all. It's a harsh tactic to some, but one that makes sense if you look at it from their perspective. Some even view VentMedic as a sanctimonious unicorn... (sorry, was too funny to leave out). So what I request is... tell us a story. Tell us something that has happened to you that was important to your values, tell us about an event that shaped who you are, tell us something about your family that you are particularly proud of (or not proud of, if it is applicable), tell us something that will give us some insight into who you are. Give us some context, some reference point, some humanizing detail that allows us to more accurately view you as a person, and not some EMS robot. Not only can doing some internal assessment be something that will allow readers to understand you more, but I sometimes find it cathartic to unleash a little bit of your own experiences on others... makes you remember how you got where you are, and sometimes surprisingly tells you where you should go. These stories do not need to be about EMS, or your place in EMS, but it is okay by me if it is. Those of you brave enough to participate... one simple ground rule. No replying to these posts. Allow them to stand alone. Any discussion should take place in PM if desired. Just tell us a story, and enjoy everyone else's. If you don't use proper grammar, then I will surely judge you.

Unfortunately the DOT in New Hampshire controls the curriculum, and the class hours. You can increase the hours only if the additional hours are approved by the State and they have had a chance to rule on the curriculum. The most problematic issue when contemplating adding onto what the state mandates is from a business perspective. Adding hours adds the need for more resources, additional instructors, and eventually price hikes for the students. As we all know, most that are interested in EMS do not come from a wealthy background, and higher prices tends to lead to students going to other schools. No students, no school. Also most students without any real life perspective or understanding of the future benefits of more education will choose a shorter class in order to just "get it over with." It is a fine line between what we want and what is reality (see the proliferation of accelerated programs and "zero to hero" classes). There is nothing that you have ever said that I agree more with than those first two sentences. It is tiresome working with 20 plus year EMT's that haven't updated their skills in 15 years expecting that you treat them like Gods because of their tenure. As to the last sentence, I don't see why these two attributes have to be mutually exclusive... can't I have both experience AND knowledge? I don't want a partner that I have to rely on that only has one of the two. And Dust may say that... and know that he has... but he also is a man that understands (and have read posts that strongly advocates) that providers have to have a strong set of core values to be all that they can be. So brush aside his cranky veneer, and you have a bleeding heart idealist standing by the door ready to offer you a hug for a job well done. Yes... remember... utopia. And yes... exceedingly rare. But wouldn't it be nice!? Thought so, your welcome. You could have at least given me two paragraphs!!! It is exactly because of a cost-benefit equation that you can not have an ER full of MD's. They would either have to start paying MD's less, or increase payroll by a significant factor. And I've never seen a MD clean a bottom before, so I don't know if they can do it as well as an RN... RN certainly has a leg up in the experience category. Clearly we all need to move to Colorado, for you make it sound as if it is Utopia. No one balks at doing calls, no one is lazy, everybody lifts without complaint, the grass is green, and the girls are pretty.... oh please, oh please, won't you take me home. I'd be closer to AMR corporate as well!! It does sound like paradise! It's not about a "better" skill set, rather about delineation of skill sets so that providers can focus on specific goals, thus increasing efficiency. If a MD is providing care and consulting with a specialist, I don't want him/her to have to interrupt those tasks because the linen cart needs re-stocking. And I certainly don't want to pay a MD their salary for them to only be in charge of re-stocking and other tasks usually accomplished by ED techs. There have been a lot of glitches on the site lately... maybe it is from all the format changes... Honestly Admin, these monthly changes of format are going to cause me to have a technological aneurysm. I look forward to any reply, if you want to e-mail it, that is fine with me. It doesn't appear that anyone wants to play with us... Are we the smelly kids at school?

No argument here, but in my research on this subject since it was posed has shown any number of sources that state that it is highly unlikely that someone who presents without at least one of the triad of complaints has meningitis. So the zebra in this scenario looks more like a horse to me. Thanks

You will be welcome to join the fray... as long as you have a healthy mistrust and distaste for EMT Basics. They are EVIL!!!!! But seriously... welcome.

The more I look at it... it more closely resembles signs and symptoms of Ebola virus... yes? no? Or am I just crazy? BTW - to answer many of my own questions... I, for some reason, kept completely skipping over the mosquito bite part of the opening sentence. Just caught myself, that would explain the route... but I still think it would be difficult to come to that conclusion (meaning meningitis) based on the complaints at hand... unless you are going to tell me he has a fever, then we are talking... Although Ebola fits just as well.

Kiwi- Does this patient have a Temperature? I'm still not sure how we landed on bacterial meningitis... It is very rare for meningitis to exist without at least one of the triad (nuchal rigidity, High temp, Altered Mental status). What do we know about how he acquired it... Animal bite? Some sort of blunt trauma to the nose or face? A different viral infection that broke down the sinus cavity causing the Bacteria to be introduced? After doing a bit more research, it appears that meningitis that exhibits the petechiae rash, almost has to be bacterial in nature... so that makes sense. Just a few more thoughts on the subject.... thanks for the scenario.

Alcohol is a Central Nervous System Depressant. I don't know what is going on a a cellular level, but as the Nervous system continues to be depressed, it eventually gets to the point that unconsciousness happens.

Was this patient recently bitten by an animal? Endotoxins are commonly found in animal saliva. Endotoxin from animal saliva enters blood stream, causing blood vessels to lyse, clot, and create petechiae. I don't know what knowing the cause of the bacterial infection will change any patient care... but it would be great information for the hospital.

As I am at work and afraid of being cut short to have to perform my limited skill set (Note: Humour intended), I will not comprehensively reply at this time. CBEMT - Most of my Utopian views are pointless... but I will never let that stop me. I am aware of the regional statutes of Medic/Medic response ambulances. And for people that don't know, if a P/B truck is asked to respond to a 911 call, the Medic can only act at the I level... Personally feel that to be highly insane... A medic can only be a medic if it has another medic to baby it them? I would like to believe that Medics have more competency than the State is allowing for. Is every call you do of ALS in Nature? The majority of calls in my area (North Shore) end up as BLS transports (roughly estimating 3/1) requiring nothing more than a ride to the hospital... I would think that that would cause more Burnout... a medic having to spend two-thirds of there time doing calls that do not require their skills. Or do you work in a tiered system where BLS automatically do the primary response? Dwayne - Thank you for the complements to my argument, am glad I at least brought something new to the table you may have not thought of before. I will respond in more detail later... BTW take my handle and add @comcast.net CHbare - I'm not sure the argument is completely without merit. I obviously agree with your points and your assessment of the ER and hospital, but I think that maybe you underestimate the diversity of an EMS scene. In EMS we use a support team that is harder to manipulate due to their lack of medical knowledge. We need to know how to direct by-standers (admittedly rarely, but it does happen), fire fighters, and police officers... often of whom do not have much medical training or skills appropriate to our needs. While these are not skills that are necessarily learned in a traditional "class-room," they complicate scenes and sometimes delay patient care. In a hospital setting, things are more clinical in nature and you are relying only on people that have some form of education, training, and understanding of internal procedure. So I believe that your assessment of the "homogeneous" environment, is correct from a medical "scope" aspect, but not so homogeneous from an overall tasks aspect which is still things that EMS has to deal with, and Hospitals not AS much (meant to acknowledge that scenarios exist where procedure gets thrown out of wack, and hospital staff must respond appropriately).

I don't even know what half of this stuff is!!! You'll be fine, I have a feeling I might see you on a P90X commercial at 3am while I'm eating some cheesecake.

They used to say that cigarettes aided in digestion... does that count?

Wife