Lone Star

*gives Dwayne his missed dose of Haldol, and sets him back in his chair in the corner of the room (where all the dust bunnies hang out)*

Of course, you Squint with your super secret macho shit, I can see why you need anonymity. Me personally, I'm just an ol' medic and have no desire to hide from the opinions that I post here or elsewhere...

* Edited to add quote and image

I think I broke my alphabet!

A couple things that I learned in the field (under fire, you could say) was

1. what a disgusting feeling it is when you're doing CPR on an 85 year old female and you feel every one of her ribs either break or separate from one side of the sternum

2. We constantly hear about the patient expressing that 'feeling of impending doom' ("I think I'm gonna die!"), but they NEVER tell you about walking into a patients room or house and YOU getting whacked with that feeling of 'impending doom', and its so thick you could cut it with a knife....

I think what sucked the most about learning those two lessons, is that I had to learn them BOTH on the same call. Unfortunately, she didn't survive (even with ALS on scene)...yeah, that one tends to stick with you for a while....

It was drilled into my head during my first EMT-B class that the typical B/P has on average a 40 point 'gap' be tween systolic and diastolic pressures. I was further told that widening B/P gaps signified hypovolemia (whether internal or external) and narrowing pulse gaps were indicators of rising ICP (as from closed head injury/CVA).

Am I remembering this correctly, or has my alzheimers kicked in again?

I remember seeing a television show that featured him. Didn't the police also suspect his brother as an accomplice?

Ok, it's about time you quit laying around and soaking up the sympathy!

Get better quick!

LS

I'd be leaning toward an anaphylactic reaction to a previously unknown allergen. We've seen people develop seasonal allergies that have never had them before, so why wouldn't that apply here?

One question I would like answered is, "Which department of the supermarket was she in when the symptoms started?". Another question is, "Is this a regular supermarket like A&P/Kroger's/IGA, or is it a store like a Super Walmart?

Could it have been induced by another patron? We've all come across those people who seem to think that perfume/cologne is something you bathe in. I had an incident at school where I got into the elevator to go to my classroom, and found that someone who had used the elevator before me had so much perfume on that it was actually suffocatingly heavy in that little metal box.

Based on no urticaria isn't sufficient evidence to rule out anaphylactic reaction. Complaint of 'light headed and dizzy' may be a result of hyperventilation. Did they complain of tingling in the distal extremities?

What was the ambient temp both inside and outside the store?

Any complaint of N/V?

I think that initial treatment would include monitor/high-flow /O₂, IV (NS/KVO), transport.

I'll take the words of the spinal surgeon over someone who can read a dictionary every day. If you really want to get technical and go by the definition you presented, "...motor and/or sensory function..." would certainly count for Mr. Carson making him a quadriplegic based on the definition you presented.

Ok, let's try this from a different point of perspective. Since I was essentially paralyzed on my entire left side (except for my face), I was by all definitions a hemiplegic when my aneurysm presented itself.

Since I have regained the use of my left side ( I can walk, talk, write (I'm left handed) and do all the other day to day activities that I used to be able to do, am I still considered a hemiplegic?

I do have some residual effects, such as medial rotation of the left foot, and when I get tired or extremely cold, there's that ever lovely 'toe drag' (which has ruined more than one pair of boots). I also have what would be considered hypersensitive reflexes and on occasion I have what can best be described as focal motor seizures in the left lower extremity. If I try running, the left leg tends to 'lock up' and I look like a peg leg pirate trying to haul ass across the deck of his ship....

No "poor provider garbage" from me. I'm simply calling it like I see it. Every once in a while I think you've demonstrated some growth. Then you say something to blow it. I have no doubt that when you're actually dealing with people face to face you can come across as a reasonably intelligent person. Unfortunately, when you post here you're consistently inconsistent. You have shown improvement, yes. But you still have a long way to go.

If you weren’t implying that I was a ‘poor provider’ based upon the opinion that I posted and have defended, then why did you even include my competence and ability to provide care in the following comment?

Really, LS. Every once in a while you post something that makes me think you're really growing and progressing as an individual and as a provider. Then you go and post something like what you've posted in this thread which makes me realize that I was wrong.

My abilities and skills should have NEVER been brought into that statement! You have no clue what kind of provider I am, and therefore comments like that appear to only have been intended to inflame.

The main question that I had was this, what about his condition would lead you to believe that he shouldn't be allowed to make his own adult decisions?

We see it in EMS every day…..people doing stupid stuff and making really bad decisions. Since Mr. Fogle couldn’t perform all of the necessary tasks associated with skydiving safely, but yet chose to do it anyway; then someone needs to step in and prevent such activities from taking place.

Let’s say for example, you want to learn how to juggle; but you want to learn with running chainsaws. We both agree it’s not really an intelligent decision on your part. Should I just sit by while you attempt it (at least I’ll be able to pick up the pieces as we wait for an ambulance), or should I do something to prevent you from carving yourself up like a bad Thanksgiving turkey?

Activities are regulated even for the ‘able bodied’ on a daily basis. Since you mentioned motorcycles, let’s look there. Most states have enacted mandatory helmet laws simply because there are too many people out there who think that they don’t need them. What about drinking and driving laws? I’m sure every drunk will tell you that they can drive BETTER when they’ve had a few…..

Before you bring up my motorcycle wreck, let’s look at a few facts there…

I’m physically able to perform all of the tasks necessary to operate that motorcycle in a safe manner. I was also able to take actions that are consistent with trying to avoid the collision. I had to deal with the actions of someone who chose to ignore the fact that I had the right of way, and tried to beat me across an intersection.

I’m not saying that any ‘less than able bodied’ person be forced to live in a bubble, unable to do anything. I merely suggested that when a person doesn’t have the ability to perform all of the functions to ensure their own basic safety, then maybe someone needs to step in and prevent another senseless injury/death.

Nobody was giving you grief for posting your personal feelings/views on a topic. You were getting grief because you demonstrated a pretty flawed understanding of what was going on. This is compounded by the idea that you should know better based on where you are in your training and comments you've made in other threads.

The part your missing is that Mr. Carson is a quadriplegic. You stated that quadriplegics cannot use their arms or legs. So yes, in this instance you are, in fact, wrong. And that's what you were getting called on.

There are no flaws in my understanding.

quadriplegia [kwod″rĭ-ple´jah]

paralysis of all four limbs; motor and/or sensory function in the cervical spinal segments is impaired or lost due to damage to that part of the spinal cord, resulting in impaired function in the upper limbs, lower limbs, trunk, and pelvic organs. This term does not include conditions due to brachial plexus lesions or to injuries of peripheral nerves outside the spinal canal. Called also tetraplegia. adj., adj quadriple´gic.

http://medical-dicti...om/quadriplegia

paraplegia [par″ah-ple´jah]

impairment or loss of motor or sensory function in areas of the body served by the thoracic, lumbar, or sacral neurological segments owing to damage of neural elements in those parts of the spinal column. It spares the upper limbs but, depending on the level, may involve the trunk, pelvic organs, or lower limbs. This term is correctly used for describing cauda equina and conus medullaris injuries, but should not be used to refer to lumbosacral plexus lesions or injury to peripheral nerves outside the neural canal. adj., adj paraple´gic.

Based on those definitions alone, one can conclude that the quadriplegic cannot use their arms or legs.

Furthermore, the very title bar of the webpage for the NY Times article online states “Once a Quadriplegic, John Carson Competes in the Ironman Triathlon-NYTimes.com”. In the article found here:

http://well.blogs.ny...ner=rss&emc=rss

The article states that he was initially able to regain the use of his arms (negating ‘quadriplegic status’ and being classified by definition as a paraplegic. After being moved to Mount Sinai Medical Center’s spinal cord injury rehabilitation program in New York, he learned to walk again, thus actually negating both quadriplegic AND paraplegic status. This is where MY story came into play, having had my entire left side wiped out by a cerebral aneurysm; I had to learn to walk, write and do everything that I was able to do prior to the TBI and am able to do now. THIS is why I’m QUALIFIED to speak from experience! Its not that I was making this ‘all about me’ but pointing out my qualification to make the statement I did.

The fact that Mr. Carson made such huge gains in his fight to recover is worthy of respect and all the accolades he can handle.

You don't know that he was being reliant on anyone or any device. It didn't say he made all of his jumps relying on his reserve to safely land. It seems you're taking information from an incomplete story and making quite a few assumptions.

SALMON, Idaho (Reuters) - A quadriplegic skydiver plunged 18,000 feet to his death because he was unable to manually deploy his parachute, and his emergency chute was not set to automatically release, authorities said on Monday.

Fogle, a veteran of 125 jumps over five years, was hampered by his physical disability from manually activating his primary parachute and was likely counting on his backup chute to deploy.

Nope, no assumptions here….those are direct quotes from the article.

What's interesting is that there are practices in play here that should have ensured that all the devices in question were set up and working properly. Of course, this goes back to an open and incomplete investigation into what happened and someone, you, making assumptions about what happened.

There's no evidence in the very short news report. Do you really think they had the space to write out his life story and provide a detailed functionality report? You're assuming an awful lot.

And now you're being judgmental based on incomplete information.

I can only work with the information that’s provided by the articles, however the only assumption going on here is you assuming you know what I’m thinking, when you haven’t got a clue!

I realize that the investigation is still open and ongoing. If the news service decides to post more complete information when the investigation is done, I may change my stance; but as it stands now, based on the information available, I can only work with what little information that is released.

Really, LS. Every once in a while you post something that makes me think you're really growing and progressing as an individual and as a provider. Then you go and post something like what you've posted in this thread which makes me realize that I was wrong.

Save me the ‘poor provider’ garbage! Just because I have a different opinion than you do has absolutely NOTHING to do with my ability to provide competent and professional care!

Here’s a newsflash for you Mike: I’m not furthering my education and working on obtaining my degree for you or anyone else! If you MUST know the reasons behind my educational endeavor, it’s to enhance my knowledge base, so that I can provide better care for my patients. The side effect of that quest is to attempt to become more intelligent along the way. Nowhere in there is anything about impressing you!

Q: Why are divorces so expensive?

A: Because they're WORTH it!

You know, its comments like the ones from AK, Paramedicmike (and even in a small way from Dwayne) that make people regret ever posting their personal feelings/views on any topic.

Just because I choose to look at things differently than everybody else, doesn't imply that my thought processes are flawed, or that I've got my 'head up my ass' or even that I'm wrong. It simply means that I've got a different viewpoint and I chose to express it. Before you start running your yap and telling people how wrong they are, maybe you should try to figure out WHY they think like that; it might open your minds to another way of looking at things!

With that being said, it's obvious that there are some who are unable to follow my thought processes, so I'll take them by the hand and lead them through the basics that brought me to my opinion. After that, I'm done with this thread!

First off, Ironman John Carson was already in training for an Ironman competition, when he was injured. Despite the fact that the doctors offered little hope of recovery, he was eventually able to walk again. *SIDE NOTE: Just because I was in a similar situation and commented on it, doesn't mean that I was making it's all about me', it simply pointed out that I've 'been there, done that' and have personal experience and can relate to the hardships and struggles that Mr. Carson went through in order to reach this point in his recovery, and have a deeper appreciation for his accomplishments than people who have never had to go through something of this magnitude.

Even though Mr. Carson was able to walk and still ride his bicycle, he still relied on a wetsuit for buoyancy in order to be able to swim.

The article on Mr. Fogle stated that he was 'hampered by his physical disability from manually activating his primary parachute and was likely counting on his backup chute to deploy. This changes his status in my opinion, from 'active participant' to 'passive participant'. This is why I made the statement that there should be some sort of physical requirements to be able to participate in an activity. I would have said the same thing if Mr. Fogle had chosen to participate in scuba diving. I can understand the concept of being reliant on certain devices to ASSIST you in your quest, but to be completely reliant on a device changes things. Everything we do requires some sort of physical input. If you're hampered or unable to do what is physically necessary (in this case, pulling the 'rip-cord')...maybe reconsidering the activity is a good idea.

Additionally, since Mr. Fogle had completed 125 jumps and WAS experienced; logic would dictate that in view of his physical limitations, he should have been even more vigilant in ensuring that the devices that would keep him from getting injured or killed would work when they were needed to perform their task!

Unlike Mr. Carson's story, there is no evidence to support any claim that Mr. Fogle was even remotely able to do ANYTHING, other than verbalize his wishes to have something done for him.

There is no evidence to support or refute that this was nothing more than a suicide attempt by Mr. Fogle. If it WAS his way of going out 'in a blaze of glory', then shame on him for making a public spectacle out of his death!

*edited to correct grammatical and puncutaion errors. No significant changes to content were made.

Personally, I would have filed a complaint against the preceptor, even if it was just with your instructor. There is NO reason that the precepting medic should have treated you like that....absolutely NONE!

I had a preceptor of similar caliber recently, and since this ain't my 'first rodeo' either, I'm not going to let some chucklehead burned out medic treat me like his personal 'go-fer', and treat me like I'm just some idiot who doesn't know his way around in EMS.

Granted, you may only have 'student status', but you're there to LEARN, not be treated like shit because of the fact that you only have 'student status'. It sounds like the medic preceptor in question needs to be either removed from the preceptor program, or be given some SERIOUS retraining in professional and interpersonal relations, as well as improving their communication skills.

EMS may known for 'eating it's young', but for a preceptor to intentionally give a student grief for no other reason than "Just because" only serves as one more reason why EMS is treated like the ugly step-child that it is always crying about being treated like.

One would think that there would be certain requirements that have to be met in order to take part in these types of activities. I realize that certain allowances can be made for certain disabilities, but shouldn't limitations be enacted?

I could understand a paraplegic skydiving, because they at least have use of their arms, and in this case could have manually opened their chute.

Since the Mr. Fogle was in fact a quadriplegic, he couldn't have even checked his own equipment, but rather was forced to rely on someone to 'look out for him', from the moment he was put on that airplane to his unforutnate demise.

This raises another set of questions that must be addressed:

Investigators drew their conclusions from video of Fogle and statements by skydiving partners. An examination of Fogle's equipment showed no malfunctions, suggesting the skydiver failed to properly set a device that would have caused his reserve parachute to open on its own.

Shush you .. I am trying to sell a sightly used White Ford Bronco !

Only driven at low speeds?

I do not think they would fit .. they got put away wet and are shrunk a tad.

If the glove doesn't fit, you can't convict!

Seriously, if you're going to put on a pair of gloves, try to not spread your fingers out as far as they will go......even YOUR gloves won't fit YOUR hand if you do that!....lol

Haha - I knew there was a reason for my grouchiness, and I am clearly so blessed that I have a halo!

The owner of said halo has stated that they will not press charges if it's returned forthwith.....just thought you might like to know....

Yeah, that's the impression I get. Television overdose. Had I not lived 5 years in California, I never would have heard of RA either. It's just a firemonkey thing, just like Dallas FD calling their ambulances MICUs. They can't handle the truth.

Michigan has some services that also have MICU/NICU trucks.....

If the term 'bus' was such a part of common vernacular in NYC, then why don't our NYC members all use it? I can't think of one time someone like RichardB has used that term.....

You just gotta love those people that take all the shlock churned out by Hollyweird as gospel (I saw it on TV, so therefore it MUST be true!)!

ô¿ô ^{_♫♪♪♪♫♪}

So maybe he works for LAFD? He hasn't answered that question even though I've asked at least two times for the answer.

He talks about RA's, and yet refers to his ambulance as a Bus (NYC terminology)......

I'm begining to wonder if he's not watching too many of the 'whacker shows' (Trauma, Third Watch, Rescue Me......)

Why not go to the home association in question and ask them for a key to put on the ambulances. I know of many services who have a huge ring of keys in their ambulances and fire trucks just for that occasion. Number the key and put the number in a book.

Knox has a system for storing keys in a secure vault type device. I've seen them permanently mounted to buildings and other areas with controlled access.

All that means is that you're wrong, too.

I'm only half joking.

And what's the deal? We've had an influx lately of non-EMSers looking for info. Not that that's a bad thing. I just found it interesting.

I really don't mind the questions from the concerned citizenry/general population, as it gives us a chance to interact with them in less stressful situations. I also think it's a good thing that they're concerned enough to take the time to find out just how we deal with certain obstacles.

*Edited to add response to Mike

We can still find ways of getting into the gate. I actually carry a battering ram in my bus (laugh at me all you want, call me a whacker, whatever, I'm prepared).

Damn, son! Is there anything you DON'T carry? Is there any situation you CAN'T mitigate? Listening to you, you're the boy scouts, the Marine, S.W.A.T, and Marcus freakin Welby all rolled into one!

Bus:

AMBULANCE:

Hi everyone. I just wanted to let you all know that I have a new piece of equipment that I use on every night scene as long as the patient has been pepper sprayed and handcuffed.

It's only used for low light situations where I need much more light than a silly ole mag light or scene lights on the ambulance.

http://s4.photobucket.com/albums/y136/ruffems/?action=view&current=tron.jpg

And if anyone can get this to show in the post let me know how to do it. I never get it right.

If anyone wants to know the supplier of my AWESOME new uniform let me know.

Ruff

Gentlemen... ask a police officer how many times he has had to shoot someone. You'll find that the answer is usually zero. Occasionally, you'll find one who has had the unfortunately pleasure of opening fire in the line of duty. If you go to a bad neighborhood, you may find an officer whose had to do it more than once, but they're the exception.

And how many of those that answer "zero" only do it to shut the little ghouls up? I absolutely HATE being asked "What's the worst thing you've ever seen?"! Obviously, the worst I've seen is the stuff I would most likely want to NOT remember....

Around here, I don't think any police officer in my county has had to open fire in the last decade. So with your guys logic, they shouldn't carry guns. You'd ask them, "Does that one situation that hypothetically might happen warrant carry a firearm? You're a wacker, dude." They still carry their weapons because of a little thing called the "precautionary principle", which states that you don't wait for the emergency before you start preparing. .

Law Enforcement carries a side-arm because its part of their duty gear. OC spray, handcuffs and the other accoutrements that you profess to carry/possess 'just in case' are more related to Law Enforcement than they EVER will be related to EMS.

I've never use the term "combat gear". I have combat training (close quarters, firearms, hand-to-hand, building searches, raids, vehicle extractions, and so on), but the extent of my "combat gear" is pepper spray (which, as I've stated before, 16 year old girls carry in their purses). That hardly makes up a "combat kit".

Again, more geared toward Law Enforcement than EMS. You come off as someone who walks around like Billy Bad-ass, just LOOKING for a 'reason' to drop kick the shit out of someone for looking at you sideways, and you wonder why you're being called out on this and labeled a 'whacker'.....

Personally, I think if everyone carried OC (not just first responders), the world would be a much safer place. It's a highly effective less-than-lethal weapon, very low risk, and easy to use. This is why even kids can use it.

If everyone carried OC, we'd have a shit-load of people laying on the ground crying, slobbering and gasping for breath. There's a reason that not every chucklehead who wants it can get it.....

The handcuffs can be seen as a bit much, I acknowledge that. I've been carrying them for years, and have just made a habit out of it. I've never used them before, but it's really not a big deal to pack them in a pouch just so they're available if the day comes I need them.

The thing is...if you NEED handcuffs in EMS, you're probably in a situation that you would have been better off waiting for Law Enforcement to secure before you went running in like some 'junior coder'. It's that VERY attitude that will get you, your partner, or your patient FUBAR-ed in very short order....not to mention getting you standing before a judge/jury.

No disrespect to you guys, but I couldn't give a rat's ass about post count. If a EMT-B has a thousand posts, I respect the EMT-P with a dozen posts as the guy having more training. For the exception of the ER Doctor, I am just as high, if not higher, than most of you on the respect scale. So to you, respect or disgrace.

You guys all seem like cool people. But you can't argue with results. And I bring the results.

Your arrogance isn't going to win you any friends around these here parts, pal. As far as respect....you're heading in the wrong direction with your posts and your attitude to EARN respect around here. Dismissing the EMT-B as 'insignificant' and unable to contribute anything of any value is the wrong way to look at it. Rather than dismiss them as 'insignificant', you should be fulfilling your responsibility to encourage them to further their education.

Remember this: Even Superman had a weakness...his was kryptonite; yours appears to be everything above your shoulders!

They're in separate compartments. Give me some credit, geesh.

I have a cheap PROTECH vest that spray painted "EMT" on the back of. I never wear it, though. It mainly stays locked up in my safe room.

Though, it has optional tactical pockets that would make great storage. I think wearing that vest would be a bit much, though. Don't ya think?

We've also thought that your handcuffs, POV light show and your '100 hours of combat training' were a 'bit much' too!

Kid, treat others how you wish to be treated.

You named the theme, we're just playing by the rules....

If I remeber correctly, both Dwayne and I made comments on the intelligence levels of the majority of the new posters....unfortunately, the good 'doctor' has proven that the pendulum has begun to swing the opposite direction and is picking up speed as it does....

This in no way detracts from the compliments earned by the majority of new posters, it is intended to show how much of a 'weak link' SD has proven himself to be.....