DwayneEMTP

Hey Beibs, I can't remember if I considered the option of meeting her enroute or not. I'd like to think that I did, but if I didn't I certainly should have. It is an interesting point that we're forced to take someone against their will secondary to suicidal ideologies or actual attempts, but allowed (forced?) to leave someone that we believe could be making a decision that will lead to the premature ending of their life, right?

Yikes, Kat, a little on the grumpy side? This is the 'funny stuff' forum Brother, drivel is exactly what it's intended for... :-) Deep breath my friend...it's all going to be ok...

Hey all...Sorry, only have a little time with internet, not nearly enough to respond as everyone deserves and won't be able to before it's time for me to fly home likely... I don't believe that all the guns in the world would allow me to defend myself from an out of control govt, yet I also don't see where saying, "screw it, I can't have enough guns, so I might as well not have any." The spirit in the gun ownerships is the same I think. Maybe my biggest argument is that once again we're going to try and demonize certain weapons instead of identifying and mitigating the pathologies in our society that are truly causing the issues. We've demonized drugs and put a ton of people into prison for them, without creating any type of measureable gain. Demonized sex, yet kids are getting pregnant younger and younger, demonized prostitution, yet it thrives and is often visited by those making the laws against it. Now we want to demonize a class of weapons despite 99.999% of those weapons being used in a law abiding manner, simply so that we can allow a ton of people in the country to feel that something productive is being done when once again we're just pretending... I'm really tired of watching society apply bandaids to cancers....And even more tired of watching the celebrating afterwards of those saying, "See! We can't see the cancer any more! It's the same as being cured!" Blah...

Sorry all, I only have a few minutes with internet so can't answer all of the questions... What I ended up doing is writing out my concerns, loss of leg, shock, loss of life, etc, etc. I had the manager on site witness while he read it out loud to his wife on the phone and then had him and the manager sign that it was read aloud and understood. Had the supervisor assign a worker to sit with him until his wife came with instructions to call if his mentation or physical condition seemed to change in any way, and left him there. I do understand that I could have forced him and later justified it with his refusal being an obvious sign of altered mentation, but as mentioned above I'm a true believer that I am a patient advocate first. This guy understood the risks, he's just had a lifetime of experience of ignoring such risks and having things work out ok for him. I wasn't able to convince him in my limited time that his experience might not work this time. I left him on scene. About an hour and a half later I got a call from the site supervisor telling me that he'd decided to go to the hospital due to increasing pain. The employee had driven him instead of calling me back, which was faster anyway...I lost track of him after that... Thanks all for the discussion. I do find these types of cases sometimes more mentally challenging than some medical patients... One thing that I have come to believe, that trying to be morally and ethically sound with these types of patients seems to be becoming less and less popular. That the, "Screw it. Take him and tell them he was altered, no one will ever question that.." is more and more prevelant...That's a shame I think...

But it was also the federal Govt, led by the FBI, that did those things at Waco, right? And I'm not suggesting that a time to rise up and violently defend ourselves against any level of govt is here, or even near, but only that to wait to prepare until the s/s of such a need appear would make it a bit late, don't you think? As well, that the attempts by our govt to infringe on a basic constitutional right should be considered one of the signs and symptoms that should perk up people's ears and raise suspicions that things are going sideways. A woman can not choose to abort her own fetus, a gay couple can not be recognized in the face of the law, we have kids in prison for lifetimes for selling/smoking weed when the much more destructive drug, alcohol, is sold freely, we have people being beaten to death by the police on video tape without the slightest punishment being delivered, the govt has begun passing laws to which they have exempted themselves, etc, etc, yet for some reason, when the govt suggests that I should relinquish my ability to defend myself against them, I'm seen as unreasonable when I choose not to trust in them to behave logically, and/or in my best interest? What in the above situations is logical? Why should I suddenly believe that their handling of my right to bear arms will be more so? It truly makes me batshit crazy when people say, "Well, yeah, Waco. That was a mess, but they were just a bunch of idiots anyway..." Waco wasn't a mess. It went on for WEEKS, every govt agency in the country had the time and ability to step in an stop it, even to the point of several of the FBI units walking away and abondoning their stations in protest of the actions taken, yet the country watched as those people were burned to death. Then we watched on national television as the FBI destroyed and altered evidence....yet nothing was done...I don't know why more people aren't horrified by that. Now, many would have us all sit in front of our televisions and watch again as they attempt to disarm us, using the "no need for these weapons for hunting" argument....The second amendment isn't about hunting, it's about freedoms. Freedoms that we enjoy, and the freedoms that we need to feel obligated to violently defend should that need be forced upon us. Again...I'm not Minuteman...I don't like guns much though I grew up as a hunter. I spend a lot of time out of the country so I have two handguns at home for defense purposes...mine is not an argument for a call to arms...but a search for some kind of realistic view of the situation. Should we have mandatory background checks and training in order to own firearms? Of course...can we? No...Why? Because there is much, much more evidence than should be necessary to show that the govt, at any level, has proved that they are not able to handle that type of responsibility morally and ethically...

I knew from the beginning that you all were going to ask why, yet believe it or not, though I know that I knew then, I can't for the life of me remember why...I think it was probably because he was afraid that he would be moved beyond the reach of his wife if she wasn't traveling with him. Not an unrealistic fear, though I don't remember if that is accurate or not. As to making a recording for his wife, I love that so much! But no, I didn't think of it. But will use it in the future. I once pointed to a man's 20 year old duaghter, his EKG showing tombstones, and asked, "Are you ok with your daughter doing CPR on her dead father? That's what you're asking if you refuse to come with us!" And yeah, halfway back to the station we got redispatched and he was dead... I did use like tactics on this guy, but he was unswayed. He was obviously a threat to himself, but not purposely so. I just couldn't convince him that his life/leg was in danger. Not because he seemed altered in any way, but in the same way as if I was trying to convince him to quit smoking..."Yeah, I know what you think, but I'm going to be fine or die...that's life." Know what I mean?

This is such a slippery slope for me... I would love to say, "of course manditory background checks and training make sense..." But those would be managed by the government of course. In the same breath I would love to say, "Of course a woman has the right to make choices about her own body without govt censur...who could question that?" (Edit: Or, "of course a same sex couple in a committed relationship should enjoy the same rights and protections as any other couple.") And yet questions, and laws, and restrictions there are, right? Nothing would make me happier than to implement background checks and manditory training requirements for a right to own firearms and be confident that it would stop at reasonable limits, but how can a reasonable person have faith that that is where it will end, instead of being simply a foothold for the govts next 'minor' change? I think the vast majority of gun owners and second ammendment supporters feel the same.. I would be curious to know though, and this isn't my argument, but my cynical side showing is all...how many of the attacks that have happened would have been prevented with those measures in place? (I've no idea of the answer.) Edit: Sorry for the redundancies...we've been posting at the same time... Also, my opinion on the intentions of the 2nd Amendment are my own based on very limited readings on the subject. They seem to make sense to me based on my understanding of the reasons for founding our country and what seems to be logical precautions coming from a group of very logical men.

Actually, I was injured/unemployed during the entirety of the congressional hearings of the Waco mess, and there was never any evidence that anyone was held against their will, as testified to by the undercover FBI agent that had been living with them for the previous 6 months and more.... But, maybe that's beside the point. I'm not clear on why the Fed Govt having little to do with you has bearing on whether or not we'll someday need to defend ourselves against a corrupt govt, either local or federal? Or how it applies to gun control issues? And to Chbare, though the drafters of the constitution may not have seen assault weapons, they would likely have drafted their documents with the idea that the people would have weapons in line with those possessed by the govt, right? And in that regards it seems the relativity hasn't changed much, except that the govt has weapons much more sophisticated now...

I'm not sure why you consider that a mockery? Our country was founded specifically because our forefathers felt the need to run from a repressive government in a country that was careful to keep them powerless, and then had the wisdom to try and create a new society where they had learned from that and attempted to disallow themselves from ending up in the same situation again. That just seems prudent and intelligent, doesn't it? Also, not having been raised in that culture I can understand where you're feelings come from. I have just as hard a time imagining living in a place where I'd ever be comfortable trusting in the good will of my government to always "do the right thing." Though, I've heard that your government might have one or two issues of your own.. :-) In my country being a resident of the Land of the Free comes with a responsibility to be prepared to defend those rights. I can no more imagine putting myself in a position to need to beg my government to preserve my rights than you can imagine having to defend yourself against yours...maybe it's a gap we'll never really be able to bridge.

He's unwilling to leave the place where he was injured unless his wife takes him.

Pt shows all of the signs of being a heavy 'off shift' drinker. Thin, sinewy (?), wrinkled face, yellowed nicotine teeth, but also all of the signs of a serious, life long responsible bread winner. No signs of drugs/alcohol at this time, pupils are PERRL at 3cm, speech is clear and appropriate. Two far from my area of response responsibility for me to stay with him. Lone medic slot so no one else to cover. Only Local National staff available and they're not qualified for me to hand off to. Pt refuses IV, and I considered snowing him, I really did, but couldn't justify it morally or ethically.

This is an actual patient/scenario of mine. It happened in a Non American country, though in an environment where the moral/ethical/legal rights of the patient and responders are pretty much the same. Going into this I'd ask us to proceed accepting a couple of assumptions as fact, in the spirit of the intended question. The first that I am at least minimally competent in assessing a traumatic patient, to include an accurate assessment of mentation. The second, that I'm at least minimally competent where getting difficult patients to bend to my will is concerned. In other words, even if you don't believe me competent in those areas, please don't take the easy way out, ("You couldn't do it, but I could have.") in this discussion. See what I mean? You're dispatched by the comms shack to a 'man with a hurt leg." Upon arrival you are pointed to a man sitting on a stack of pallets, he's calm, smoking a cigarette, and in good humor. He answers questions quickly, clearly and appropriately. He is aware of all that is going on in his environment, his balance as he sits there is confident. If you could see him from the knees above only there would be no sign that he has any issues at all from your initial impression. Below the knees however you notice that his left lower leg is being held in place by a 2" diam piece of of lateral skin, the distal lower leg swinging freely. Evidently he's the driver of a truck that's come to pick up some rolls of steel cable. While directing the forklift one of the forks traps his lower leg between it and the palet, effectively amputating the lower limb. The injury is approx. 20 minutes old at this time, bleeding seems to have been limited by the fact that the leg was separated with a crush more than a clean cut, there is very little active bleeding at this time. Sandy/gravel conditions make it impossible to estimate blood loss. Pt rates his pain at 3/10 while looking at his leg and swinging it in little circles as he smokes his cigarette. His only real concern is whether or not it's care will queer the vacation plans that his wife has worked on for two years, set to commence in the next two weeks. While my partner goes for the cot (trolly, gouney, etc) I lay the patient down, got a good set of vitals, packed the stump with gauze, lined up the lower limb, smashed it into the proximal packing, and tried to hold it all together with a SAM splint and elastic bandages. When the patient sees the cot coming he immediately says, "I'm not going with you! My wife will be here in a couple of hours, I'll have her take me to the hospital. I'm not going with you, and we both know that you can't make me." Vitals: B/P 136/96 P 98 SPO2 99% r/a (sea level plus smoking) Skins p/w/d L/S full all fields with only the expected dispersed light wheezing common in chronic smokers. Described injury the only discovered or reported. Hands/knees/elbows atraumatic. No n/v, dizziness, drugs/alcohos reported nor suspected. Unfortunately I've cared for the wound in a rudimentary fashion before the discussion of transport becomes an issue and the patient is convinced that it is more than satisfactory to keep him well until his wife can transport. I use every argument I can think of up to and including loss of limb and death, even my tried and true, "if you have anyone that you love, or loves you...anyone that depends on you to be a man, then you have no right to act in such a foolish way!" but none so much as makes a tickle in his resolve to wait for his wife. I call his wife, she's two hours out, explain to her that I need to take him now, she talks to him for 5-10 mins, but he won't budge. I've never really been exposed to such a patient before. I'm comfortable making the argument that he was mentating clearly despite being nearly uneffected by the severity of his wound. Those that have worked around the old time farmers or cowboys can maybe picture this patient...You'll just have to take my word for the fact that you can not legally make the argument later that you took him against his will due to an altered mental status. (You can probably make that argument later and succeed with a CYA tactic, but you can't truthfully make this argument and pretend to stay moral and ethical.) What do you do? Do you fill out your refusal and leave him? Can you justify this in your service later? If you choose to force him into the ambulance, what legal powers do you use to justify this? What are your moral and ethical responsibilities here? I look forward to your thoughts...

I actually find the fact that we may need to defend ourselves from our government the least laughable of all of the arguments. I would hold out Waco, TX as a perfect example of that. That slaughter had a mish-mash of nearly every law enforcement agency in the U.S. involved in killing men, women and children accused of no crimes. Not only did they all participate in attacking American citizens, they did so with zeal, and in the end were ok with the fact that they murdered them all in cold blood. Can there be a clearer example that our government can't be trusted to protect us when they believe that we're unable to protect ourselves? (Before making the argument that the government believed they were going there to confescate illegal firearms, reference the question asked by Sonny Bono during the congressional hearings, "Do you normally approach a compound that you believe houses illegal .50cal weapons hiding inside a horse trailer covered with a plastic tarp?") All of those people killed illegally and, to the best of my knoweldge, not a single person went to jail, or even lost their jobs. I'm truly surprised that these killings continue to be part of the anti-gun debate. These crimes are being committed using guns because guns are the golden ticket to the lead story in the news, in my opinion. Take way my guns (I'm not a gun fan, though I own two handguns), and instead I'll simply drive my truck down the school sidewalk as children are waiting to be let into school. Instead of shooting a theater full of people I'll throw a five gallon pail of gasoline over them followed by a zippo. My body count will likely be much higher. Plus, what do you suppose the odds are that the next hundred people needlessly killed will be killed with vehicles/gasoline instead of firearms once I've made front page news? I saw a poster on FB recently, one of those with Willie Wanka (The real one) that said, "So making guns illegal will take them off the streets? How is that working for Marijuana, Crack and prostitution?" Though you may label me as a fanatic, I do truly believe that within the spirit of the Second Amendment is an ability to protect ourselves against our own government, and that need is as relevant today, again in my opinion, as it was then, perhaps more so.

[Edit: Posting this as Justin posted it on his FB page as well. I'm not revealing a confidence.] I'm going to post this as I'm guessing Beibs has other things on his mind... The lastest visit to his doc showed that their child had miscarried... Love and thoughts for peace and healing to Des and Beibs during this terrible time, from the Womacks in Colorado.. Dwayne

Unfortunately Brother, this is going to get you some negative responses as it shows that you're simply another guy wanting to ride a fire truck but has to pretend to know how to do basic medicine to do it. Most of us here take medicine pretty seriously, so questions of "What's the cheapest path, with the least amount of actual work that I can take to get a cert that allows me to brag about saving lives??" I'm truly not trying to bust your chops, just explaining that you'll need to be a little thick skinned in this thread is all. To the best of my knowledge there is no place to take it completely online, but we have a few here that have done the didactic online and claim that one of the schools is pretty good..though I can't remember the name... They'll find you here though and help you out. Good to have you here...have a good day!

Hey! Welcome to the forums.... We sometimes bash on hosemonkeys, but as far as EMTs, until they start the "Paramedics save lives, EMTs save paramedics" nonsense, they're pretty safe.... :-) I think that you'll like it here if you really want to learn...feel free to jump in. Even the replies that you don't like are coming simply from an internet forum...they're not terminal.. I look forward to your thoughts!

Fair points from everyone... [Edit] And Mike, I have no doubt that you are in fact creative enough to do so. I guess the parts of your posts that get under my skin a bit is the static nature of the thinking, at least to the way that I read them. "We can't do that because...." Add, "yet" and I'll have a much easier time leaning over to your side of the fence. Like Chris mentioned, it's a culture, and as with any culture changes need to be planned, and nurtured, and that's just not happening in many places I think. Not because it's not doable, but because people are comfortable with the pathologic way that things are, and have always been. And that kind of thinking, in any area, just gets my back up... The more open system works, it's nurturing and productive, all of the steps down the path have been laid out by others over the last 20 years, but implementing it just hasn't become easy enough yet for most. They're all waiting for directions to the trouble free, pain free path. That, of course, is unlikely to ever happen, regardless of the provable benefits.

Agree completely. I don't disagree with the snipped sections, but am only trying to be brief. I get frustrated with the, "Yeah, this can't work because...." arguments, though I don't mean to imply that anyone here is using them, because I've seen these systems work, and work so much better than traditional models. But you are absolutely right. On the Developer I can't imagine there the situation where a rouchneck would have been laughed at or scorned for making an error, but the vast majority of the crew would have been angry to find that s/he'd tried to hide it. The attitude being, "You're smart, and that happened to you, and yet you were going to remain silent and let me make the same mistake someday?!?!" At the time that I was there their production stats were through the roof, as well as their safety record, and they'd been over 6 years without a lost time medical incident....amazing. I love working in the culture, but it's one that they had to dream of, and then invest themselves, each person as well as the company, to develop, no one gifted them with it... I've tried to follow that model here, where "face" is everything...it's been difficult, but amazingly satisfying....

Again, it's crazy to wait until a problem is sytemic to identify it and try and mitigate it for the future...If one person's had the issue, it's likely another has already as well and simply hasn't admitted to it, or that another will have the same problem in the future. Why not take every opportunity to resolve small issues...why wait until they become larger to learn from it? But again, it appears that you will continue to restate your feeling that a single person issue should be dealt with in private without really making any effort to show why that belief is productive either to the individual or the group, but instead only to an organizations HR manual.

Because that has been the context of the conversation up to this point. And not any personnel issues in general, we've been discussing errors in particular. If the process is not punitive, then why is it not used to the full benefit for the learning opportunities possible for all?

The fact that you've always done it that way more makes the case for it being more likely archaic, not less. I've owned two relatively successful businesses that used learning instead of punishing significatly and successfully in their management practice. In each place that I've worked the remote medic has a supervisory role that has to interact with the HR dept, so I'm aware of the rules, but don't agree with them more because of that. In each of my current gigs the medic is tasked with improving the performance and competency of the staff. My biggest struggle here is to get people to celebrate errors instead of hiding them. Why? Because the system that you love, accept (wasn't trying to be intentionally irritating) has been in place in these environments for far too long... On the Maersk developer, while leased/managed by Exxon/Mobile certainly one of the most successful companies in the world, there was no punitive action, ever, for a first time error. And each error was brought up in the company safety meeting at the beginning of each shift complete with the names of those involved, as those involved almost always brought the error to light. Those making the errors were considere very productive for their honesty, both by management and crew, and the new information that they brought to the team to help everyone avoid making the same errors in the future. Read the book, "Straight from the Gut" with Jack Welch, considered by many to be the most successful business manager in American history and he makes it very clear that removing any punitive measures from errors, and making the exposure of errors to everyone laudable, is largely responsible for taking GE from bankruptcy to one of the most successful and powerful companies in the world. The only realistic argument that you can make for the practice is that it plays out better for some companies legally. There is no argument that I can see that you can use to defend that it's not archaic and counter-productive. It's just simply too well proved to be so...