THE_DITCH_DOCTOR

From what my friend Jamie tells me EMS in Ireland isn't exactly a job that makes money hand over fist either. Guess some things are universal.

I guess I just see the exceedingly dismal chances of this patient having any recovery, and a few people don't. I also I would also like to put out that I am correct in saying that it is an incurable condition- last time I check there was no drug, no procedure, no therapy that could erase the genetic error that underlies this syndrome. The symptoms are somewhat treatable to varying degrees- although ameliorating would be a better way to describe what can be done for these patients. We shouldn't delude ourselves by believing that amelioration equals a cure. It doesn't, and even amelioration is a pipe dream in many developmentally disabled kids. It's not that I think they should all be rounded up and summarily executed- I don't think that, never have and I wouldn't question the sanity and humanity of anyone who believes that such a course of action is proper and appropriate. It is that I believe that Down's patients should not be treated any differently than those with any other long term debilitating illness. If this patient had end-stage Alzheimer's or was schizophrenic (using examples of conditions that mess with people's cognitive ability and ability to function), no one would have batted an eye to pull the plug following a closed head injury sufficient to cause cardiac arrest. The only reason this discussion is going on is because of the mental images we all possess of what a few of these DS patients can achieve, we feel for them, we empathize, we want to see them succeed. We should check our feelings at the door in cases like this and make decisions based upon what we know about the pathophysiology of cardiac arrest related insults to the brain and long term disease. Sure a special education teacher knows Down's kids very well, but this isn't a normal case- this patient suffered a hypoxic brain insult on top of the effects of the Down's. Perhaps asking a neurologist would be a better choice.

I agree LMA's are very easy to insert, but only slightly more so than a Combitube. I just don't see any tangible benefit over a Combitube.

I carry 25 of them. Personally if it is the "big one", my triage practice consists of: "If you can walk, go over there" *Points* Those are your green tags "If you can crawl, crawl that way" *Points* Those are your yellow tags "If you can't crawl or walk, I'll be to you as soon as I can" Those are your yellow and black tags. This is known as the Durand Method of Triage, after Airman Durand, the Air Force EMT who first introduced me to this way of thinking.

The major advantage that I've seen (having used both in the out of hospital setting) is that a Combitube is more stable when inserted (i.e. less likely to become dislodged) than an LMA is.

I got my former medical director to write me a script for it.

I don't know. I think we should defer to Rid on that one. He's the elder statesman of this forum.

I retract my prior statements in regards to Dr. Bledsoe. I have been proven incorrect. Thank you for correcting me Rid.

Edited for the sake of keeping the peace: Keep your self righteous opinion to yourself SHP

Damn, I knew you Canadian medics had it hard as far as schooling goes, but damn. No wonder Richard's in such a pissy mood all the time. You wouldn't see any American paramedic program involving texts on mechanical ventilation, diagnostic imaging or diagnostic testing. Sounds like the Canadians have the right idea- education as opposed to training.

I wasn't planning on writing the book all by myself, even if I did decide to do this, only certain portions of it (cardiology, pulmonology, toxicology, airway management), the parts that I am most qualified to write about from both my perspective as an EMT-I, and an RT.

I meant it's a hobby in that I only do it now for the enjoyment I get out of it. Sorry for the misunderstanding- I take it as seriously as ever, just it's an avocation, not a vocation at this point.

As for why I don't get my NREMT-P....I have other priorities- I don't want to be a paramedic for the rest of my life. I don't want to be a fire department employee, I don't want to work 24 hr shifts as a paramedic, and in any job other than perhaps flight nursing, my EMS credentials don't mean crap inside the hospital. I don't make more money as an RT for being EMS qualified, I certainly won't make more as a dentist if I happen to be a paramedic. Yeah, I could probably smoke the course without a problem, but I simply don't want to. EMS is no longer my career- it's a hobby more or less. I don't see why I should delay finishing my degrees and going on to dental school just so that I can be an EMT-P instead of an EMT-I. As for making more money, trust me Dixie, I can make far more as an RT by working in a NICU in a large city than I could ever do as an EMT-P even under the best of circumstances. Or better yet, I can finish my degrees go and get my DDS and pull in $100K a year more than any paramedic. That answer your question about my reasoning? I also understand that getting published is exceedingly difficult. I was just tossing around an idea when I started this thread. It probably won't go anywhere, but oh well. I have bigger and better things to do with my time. As for my attitude....sorry, didn't mean to offend you.

People would eat me alive if I wrote a new EMT-P exam....people gripe about passing the NREMT-P exam now, you'd see a lot more people failing out because they couldn't pass the exam because I would include what is necessary to really understand what is going on with a patient. The test would be more like the USMLE (US Medical Licensing Exam) than any EMT exam you've ever seen. :twisted: :twisted:

If I had MD syndrome, then why am I not pursuing medical school? I know I'm not an MD, don't really have much desire to be one (the hours suck too much and I'm tired of seeing people die on a regular basis as part of my work- that's one reason I don't want a paid position as an EMT-I again). Just because I know the physiology, pharmacology, toxicology, and other underlying sciences better than 95% of the people on this site doesn't mean I have an ego complex- it just means that I like to know more than the next person about this and that I have made an effort to be the best RT and EMT-I that I can possibly be through better educating myself. I'm not saying Bledsoe doesn't know what he's talking about- I just have the same opinion of him, that you seem to have of me. He seems like a pompous arrogant doc who looks down his nose at medics, which is something I find especially disheartening seeing as he has advertised the fact that he's still an NREMT-P. I'd expect that kind of behavior from someone who hasn't ever had to fend for themselves prior to becoming a doctor, not the ones who rode the rigs to put themselves through school. Clinically, I've never worked with the man, so I can't say one way or another in regards to his skills, but I have read what he has written and I am not impressed by his skills as an author or educator, which is totally separate from clinical knowledge and ability. In regards to medics who don't want to learn- perhaps we should be trying to weed out those who don't wish to advance the field (or at least keep them out of ALS level positions)? Just because they don't want to learn something, doesn't mean that they shouldn't be forced to- if you want to be a doc, you have to learn obstetrics in med school even though chances are you will never use it again in what you specialize in. Same thing holds true in medic education- if you want to be a medic you should be well educated enough to be able to not only do your job, but find ways to improve your job and defend why those improvements are necessary. Maybe if we increased the educational standards we could weed out some of the less qualified medics out there. As for my supposed arrogance, I guess it's just because I don't piss around when it comes to telling someone the truth (also I think it lies in that no one can truly read much in the way of intent when it comes to something said on one of these threads). Granted, I have been rude on a few occasions, but there's reasons for that in the majority of those circumstances- if you're referring to my straightforward approach to the occasional sundry crackpots that have come into the chat room, LittleFirecracker being a perfect example, since I was extremely blunt with her. I don't coddle people who are simply looking for attention, and I don't tolerate liars. Nothing you can say about me, or to me will change that. I speak my mind, I say what I believe and if you don't like it, then don't listen to me. Simple as that, but I do believe you are missing out by viewing me as arrogant- I know what I know, and I will correct people when they are blatantly wrong, and I will question someone when I disagree with them- not in an attempt to be discourteous, but mainly to ascertain a couple of points: 1. What is it that they believe about this topic? 2. Why? 3. Do they actually believe it or are they talking out of an orifice other than their mouth? Where the apparent rudeness of my approach stems from is that as soon as you disagree with someone, they assume you're being rude or vindictive. If I am wrong, I will apologize, and have done so to a couple of people on this forum (EMSGirl and IcyHot being examples), but I refuse to apologize or back down when I am not in error or out of line.

Lord help us. He doesn't seem to think very highly of medics based on the way he writes and speaks in EMS magazines- which is surprising seeing as he flaunts the fact that he was one. Just my opinion, but he seems to have a major chip on his shoulder in regards to his possessing a DO credential.

Vacuum splint is the first thing I'd reach for.

What does everyone think? Should I write a paramedic textbook? I would like to do so, only because I don't think the books out there are doing an adequate job to teaching physiology and things beyond the bare minimum. My contempt for Dr. Bledsoe and his book are well known. Does everyone think a new (more advanced and thorough) book is in order?

And you bitched at me for supposedly making fun of retarded people.... :roll:

Yeah, when did we quit the United Nations and join the Justice League?

As a matter of fact SHP, I'll be a dad as of September. If my son or daughter were born handicapped and then placed in this situation, I'd be the first to say pull the tube and let them go. It has nothing to do with being a parent or not, it has everything to do with being a realist. Perfect example: My cousin Tomi is mentally retarded due to hypoxic brain injury as a result of seizures, and I know that if she coded her chances of recovery are next to nil because she's already starting out at a serious, serious disadvantage. So if the chances of survival in a healthy person are in the single digits, or low teens even under the best of circumstances, then what are her chances? Probably zero. That knowledge would affect my decisions for her care (and I know my grandmother, who is Tomi's caregiver, would turn to me for advice and guidance if something happened to her) more than my love for Tomi would, because I know with almost guaranteed certainty that whatever the outcome, she won't be the cousin I grew up with and came to love very dearly. It's not that I don't believe the mentally retarded don't deserve good care- quite the opposite- I was just openly wondering why people seem to be so hostile to the realization of the levels of medical complications that come along with these conditions. Down's and other congenital disorders are no different than other diseases and disorders, except perhaps in their cruelty- they strike at a time of what should be great joy and they only bring great sadness. You're not going to pick a fight, because there is no fight to pick.

Down's is a condition with both mental and physical manifestations SHP, as I'm sure you're aware. It's still a long term illness and it will negatively affect the outcome. That's what I'm saying.

I think you're missing something here....I said that given his prior medical history AND the insult he suffered, there is little chance in him surviving. If this were a 80 year old with end stage Alzheimer's who coded we wouldn't be having this debate, despite a similar baseline level of mental function and similar likelihood to live for a long period of time. What is it with the warm and fuzzy feeling that so many people have for the mentally retarded? It's a medical condition just like anything else that destroys or prevents the capacity to function like the rest of us, so I don't understand the disparate opinions.

I haven't made any low blows, especially not to Countrygirl. I've just made statements that you don't happen to agree with. A low blow would be (for the sake of example) calling you (DaEMT) a close-minded hillbilly who only votes for a given candidate for people based on his alleged religious affiliations and because he talks like you do, who probably is missing a good number of his permanent teeth, who drinks heavily, beats his wife, and couldn't find Afghanistan on a map because you probably failed 10th grade geography. That would be a low blow. Calling you a Republican isn't a low blow- especially when one of the only national politicians I happen to have any large amount of respect for is a high ranking Republican (John McCain). Personally I think John Kerry is a spineless douche bag but that's beside the point. And what's on the ballots or in political advertising has nothing to do with who is in office from the last election- unless they are running for reelection. Besides, last time I checked we didn't elect police chiefs (at least in most places) or Supreme Court Justices. Sorry I don't care if someone's dog just died, if they have lost their job, if their wife left them for their sister, their child has cancer. There's no excuse for being uneducated. Does it really take that much time to read a newspaper or watch the nightly news (30 minutes for the latter and maybe an hour for the former if you're a slow reader-)? You don't have to attend every city council meeting to be an informed citizen and you aren't required to watch CNN for hours on end. Run the damn answers in the paper weeks before the election (just don't announce when) for all I care. The point is this: this country is supposed to be a democracy, not some manner of stultocratic theocracy, much to the chagrin of Dubya and his cronies. As for who heard of Bin Laden, the Taliban, al Qaeda, etc before 9-11....well let's see we'd launched cruise missles at bin Laden and his al Qaeda training camps and weapons stockpiles in Sudan and Afghanistan as far back as 1995 (I can double check that if you want to be 100% certain, it could have been 1996), the Taliban regime's take over of Afghanistan, its destruction of several UNESCO World Heritage sites (the two Buddhas being prime examples), and its brutal oppresion of women were frequent fodder for news on Fox News, CNN and Headline News. It's not a matter of these people and organizations not getting press coverage- it is completely a matter of most Americans being inattentive unless it directly involves them or if it involves NASCAR, the NFL, the NBA, or some celebrity. By the way, since there might be those of you out there without the time to find a dictionary, stultocratic is the descriptive form of "stultocracy" which means rule by morons.