Lone Star

I understand the diplomacy concept. I always try diplomacy first, but oftentimes diplomacy fails. Diplomacy didn't work with Hitler, and there are way to many people I haven't a problem comparing to the man. I've only had one confrontation where diplomacy failed (the dog one), but I'm ready for the next (if and when it comes).

Are you gearing up for the zombie invasion too (if and when it comes)?

I prefer latex for the better feel, but I know alot of people are latex sensitive/deathly allergic. I make it a habit to ask my patients if they're allergic; if they reply in the negative then I use the latex, if they reply that they are, I use the Nitrile. If they're unable to respond, I err on allergic and use the Nitrile.

You were asked if you keep them in the same pouch.....or do you have separate pouches? How do you keep from cross contaminating when 'restocking' these pouches?

I've worked in the roughest parts of Detroit (Highland Park, Harper Woods, Ferndale, the 'Cass Corridor'; to name a few) and I've NEVER needed the kind of training or firepower/weaponry that the good Doctor' advocates.

The most important weapons I carried was common sense, courtesy, logic, compassion and an over active ability to pay attention to my surroundings....

Holy hell, Batman! It's Johnny Gage and Eugene Tackleberry rolled into one, with special training from Chuck Norris (I wonder if this guy's name is James Braddock?)!

With your whopping '100 hours of combat training', OC spray and handcuffs, you're only educated enough to wind up in jail (or the local ER when someone decides to shove your handcuffs up your ass).

You are nothing more than a nusiance to society, and all of your fantastic super hero training is going to make you nothing more than a statistic.

As far as your dog bite scenario,there are MANY of us that would have handled that differently! The first order of business would be to stage until Animal Control and local Law Enforcement could secure the scene. This is the ONLY 'logical and intelligent' option!

If you're not a Law Enforcement Officer, then WHY do you feel there's a NEED to carry handcuffs in the first place?

If 'little Caylee' is the only authority needed to make some guy at a pizza place to become Judge/jury/executioner, why didn't someone shoot the Ramseys for the suspected death of little JonBonet?

I can understand an overwhelming desire to protect out children from harm, but where were these self righteous, self proclaimed executioners and great protectors of the children when it came to John Wayne Gacy, Wayne Williams and Jeffry Dahmer?

We can't be 'selective' in which child killers are singled out for vigilante style execution simply based on the notoriety of the offender. Why are we more outraged by the Susan Smiths and Adrea Yates' of the world than we are about ANYONE that harms a child?

I would type an intellegent reply, but I am only just seeing out of the left side of my eye

Scotty

I'm thinking you should have just kept the "I J K" part to yourself......just sayin'...

Emt is just the beginning. Why would I stop there

.emt-p is my goal, but emt l-b has to be first. Thanks for all the support guys I thought this was the place to seek motivational advice from other emts but I guess this isn't the place.

HOLD THE PHONE!

You came to US asking a question (which was answered very well) about becoming an EMT-B and the possible 'problems' you might encounter because of your age and the fact that you decided to quit school.

If you're looking for the 'touchy feely belly rubs and ice cream speeches', EMS ISN'T the place to find it!

You were given some really good advice on how to accomplish a goal that you want to reach, and then you act like a common chucklehead because you didn't get the rosy answers you expected.... very bad form! You can't slap the messenger simply because you don't like the content of the message.

You stated:

I appreciate the insight, but I don't believe you know where I'm coming from. The short amount of time it takes to get certified is not at all what draws me towards this career path. I'm interested in helping people and even saving lives. I wouldn't care if I got paid less tgan minimum wage and it took 5 years to get certified, this is what I want to do with my life and I'm absolutely sure of it.So no matter how you believe my attide about my future is, know that I wont stop until I'm an EMT.I DON'T CARE WHAT IT TAKES.

It appears that 'the short amount of time it takes to get certified' IS part of the equation though... There have been some very good snippets of advice that included at least two years in college (which by the way will help with your age and insurance issues); and all of a sudden you're accusing us of trying to keep you down and out of EMS....GROW UP!

Rather than piss and moan about how 'mean' everybody is being toward you, try shutting your mouth, putting your fingers on hold and actually LISTEN to those of us that have 'been there/done that'.

Many of us here have seen the 'glory hunters' and "half stepping wannabe's" come and go. This isn't a career/profession for just anyone. It takes a special breed to survive the 'uglies' that are in store for you. You came to us looking for the truth, but it appears that "YOU CAN'T HANDLE THE TRUTH!" (Thank you,Jack Nicholson!)

EMS has been noted for 'eating it's own', and you've done nothing but piss off the pirahnas in the pool!

Yes, you'll have to start at EMT-B. That's looking at around 6 months of school (even through a college). If you want to become a competent Paramedic, then your Associates Degree is the next logical step. Yes, you can go to one of those 'patch mill schools' that is flooding the market with more 'cookbook providers' than steller Paramedics; you're not only cheating yourself, you're also cheating every patient you provide care for.

EMS is a 'dog eat dog world' and right now you've let the pack know that you're wearing milkbone underwear, and drawn a big red "bulls eye" on your forehead....now is NOT the time to piss off the archer!

The best advice I can give you right now is to actually LISTEN to the advice being given, and don't start throwing temper tantrums because you don't like the fact that we're trying to tell you how much work is going to be involved in 'doing it right'!

You said:

I wont stop until I'm an EMT.I DON'T CARE WHAT IT TAKES.

With a statement like that, it's time to put up or shut up. You've been given the tools to make it happen....now prove what you said is true, and make it happen; or slink away with your tail between your legs. The ball is in your court...play it, or hit the showers!

To paraphrase what I said in another forum:

The prosecution in this case didn't meet the burden of proof in this case. Sure, they had a truck load of circumstantial evidence, but nothing concrete.

In American jurisprudence, the burden of proof lies upon the accuser (in this case, the State of Florida). The defense doesn't have to prove a thing, all they have to do is raise a REASONABLE doubt; which in this case, they did.

I don't think that the allegations of incest, extramarital affairs and any other 'dirty laundry' of the Anthony family had any bearing on the case, and should have been left out of it.

As far as all of the pundits, 'legal analysts' and 'legal experts' that have been making the rounds of the news and gossip shows....they need to turn in their crystal balls because they're obviously defective.

The jury reached the only conclusion that they could have...they acquitted Casey Anthony based upon the fact that the burden of proof wasn't met by the prosecution.

Do I think Casey Anthony is guilty? I really can't say one way or the other, simply based upon the fact that there was so much evidence that I wasn't privy to.

If I ever end up on trial for anything, I can only pray that I get a jury that is as diligent as this one was!

There is occasional talk by some regarding why s/he can't do something (going to college or continuing education is a big topic). After reading about this guy, I don't think anyone has any ground to stand on when discussing why they can't do what they want to do.

Here's the link to the NYTimes story.

Here's a teaser to the article itself:

If you want it, make it happen. No excuses.

While my story isn't as dramatic, tragic or even as remarkable as Mr. Carson's; I have a similar claim to support the whole concept:

In 1996, while returning home from work, I experienced occluded field of vision bilaterally, vertigo, left sided ataxia and left sided hemiperesis. As it turned out, I had a giant cerebral aneurysm in the right posterior communicating artery at the junction of the Circle of Willis.

I was told by my neurosurgeon that I should start looking for another line of work, as I'd NEVER go back to fighting fire or EMS ever again.

Fifty-one (51) weeks later, almost to the day; I stood in front of my neurosurgeon in my EMS uniform...on the clock, and shook his hand and thanked him for everything he had done to essentially save my life. After he reminded me that I had come 'a long way' from when he first saw me, I grinned and told him that I had one last thing to say to him. He looked perplexed and asked what was on my mind. I simply grinned more and then said, "You lied!".

He laughed because he knew that I was referring to his prognosis. I went on to fight fire and also worked and was able to maintain my EMS license for another 10 years.

When I hear people (especially able bodied and not 'intellectually challenged') bemoaning the fact that "they just can't" do something; I simply look at them and point out that it’s not that they “can’t”, they just don't want it enough to push themselves hard enough to accomplish it; and by doing so, are doing nothing more than giving up and cheating themselves in the process.

The bottom line remains: The ONLY person/thing holding you back from accomplishing your goals is YOU!

* Reposted to correct a glaring error in punctuation and grammar

Okay, I know I'm going to probably get yelled at. Let's start from the beginning. I've been doing ride time with the local ambulance service for the past month as a first responder. Last week, we responded to a female who had slit her right wrist in an apparent suicide attempt. The laceration was approximately an inch long and was bleeding minimally. Upon our arrival, she had visible dried blood on the front of her shirt. As for her hands, I did not notice any blood because I didn't look. Because she had been sitting in the back of a police patrol vehicle (the officer found her and requested us), myself and an EMT-B utilized the extremity carry to move her to the cot, as she was ETOH and wouldn't move by herself. As the EMT-B took the legs, I placed my hands under her armpits and was proceeding to grab her arms, but instead, she grabbed my bare arms with her hands. As soon as we got her moved to the cot, I inspected both of my arms and looked for any visible blood, but didn't see any (I assumed that since she was bleeding from the laceration, she might have blood on her hands). Once we arrived at the ED, I washed both arms with hot water and soap, and then covered them in alcohol sanitizer. But since I didn't see any visible blood on my arms, and didn't have any open breaks of the skin, I didn't think anything of it (which was a really stupid move on my part), and therefore didn't report it to anyone.

A couple of days ago, an EMT-B from another shift cut his finger with a shard of glass that had a patient's blood on it. He was cleaning the ambulance and didn't see it. He reported it immediately to the ED, who placed him on medication and was able to get the patient to submit to a blood test. After that occurred, I began to think that I had made a mistake by not reporting the incident that I experienced. What should I have done, and what should I do know? Is it still worth it to report this? And who do I report it to?

The biggest difference between the two situations is that your coworker actually had the integrity of the skin compromised by the laceration on the glass. Second, the glass that caused the laceration was covered in the patient's blood. This would amount to the same thing as being stuck by a needle that had been used to inject meds into the patient.

While your patient didn't get any blood on you, and didn't break the skin (you stated that you couldn't find any blood or broken skin, I would presume that your risk of exposure is negligible. Reporting this incident would amount to a 'comfort measure'. If you have strong concerns about it, find out who oversees the bloodborne pathogens exposures and have a chat with them. They will be able to decide whether or not to file a formal incident report, and co-ordinate follow up measures. In my opinion, it's always a good idea to report possible exposures, as it provides a record of the incident.

This is a 'wake up call'... it's very easy to become complacent in scene safety, as well as personal safety; in this business, carelessness can have life altering consequences.

Hello, I have been looking at this site for almost a year now and have been very interested. I am in paramedic school now at will finish my last didatetic class this fall and will have a test prep this spring and test out in May. I enjoy so being a EMT. We do our clinical and internships during the didaetic portion and I love being a paramedic. I have been a firefighter since I was 16 and an EMT since I was 17. I will graduate with my bachelors in Emergency Services Firefigher/Paramedic. I look forward to being able to talk to you and give you my advice and experience what little it may be. If I step over the line please forgive me, I am new to forums.

Welcome to the City!

We're really not as mean as some would like make us out to be. Feel free to jump into the discussions, and if you're 'called on the carpet' for something, it's nothing personal. We've all been called to task on more than one occasion and it's very rarely (if ever) a personal thing.

We may disagree with each other, but the trick is to be able to defend your postion with evidence, proof and fact as opposed to some 'knee-jerk reaction'; (which will more than likely get you called on the carpet).

So jump in, the water's fine.....and the pirahnas have been fed recently......

Lone Star

umm... wow!

Now you understand the need for a standardized national scope of practice!

Some states can vary from count to county....where some states (like GA), where each service has their own Medical Director, and subsequently their own scope of practice......

Fashion Designer...

They may not be competent providers, but they look damn good while thumbing through the protocol books!!

What is an FD list?

Dwayne

Something to do with Floral Designers?

I don't know of any school that certifies it's students. From an EMS perspective, NREMT certified me when I passed their exam. Not my school. The state in which I currently live has issued me a certification, not a license.

USALSFYRE's thoughts aren't necessarily incorrect. The idea, however, of a school certifying its graduates is just blantantly false.

edit: typo

The NREMT, registers emergency medical services providers from across the nation. It is a not-for-profit, non-governmental, free-standing agency.

REGISTRATION: The process of entering one's name and essential infomation within a particular record. In EMS, this allows the state ot verify the provider's initial certification and to monitor recertification.

By your assertion, it would be logical to conclude that once an EMT lets their NREMT lapse, they are no longer 'certified' and therefore ineligible to maintain the necessary criteria for licensure.

CERTIFICATION: The process by which an agency or association grants recognition to an individual who has met its qualifications.

LICENSURE: The process by which a governmental agency grants permission to engage in a given occupation to an applicant who has attained the degree of competency required to ensure the public's protection.

In a nutshell, you get certified by the school you attended, and licensed by the state that you're allowed to practice in.

These terms are often mistakenly used as interchangeable, but the differences between certification and licensure are distinct and clear, as delineated by the definitions above.

In most EMS systems in the United States, your authority to practice (license) is generally an extension of your Medical Director’s license.

Michigan and Georgia both issue a state license once your certification obligations are met.

Considering you can't practice in any state without a certification, and it's granted by the state, it's a defacto license (certain internet and real life hacks not withstanding). No reason to get hung up on nomenclature.

I disagree with the above statement simply based on the implication that once you're certified by your school, you're free to go forth and practice. You must be issued a license by the state in order to be granted the privileges to practice.

*Edited to add quote and response*

I was at the Dentist's office last week, and gave her a 15 minute lesson on the 'levels of EMS', significant features/differences of each level and refused to wear the title 'Medic'.

I pointed out that we were more than just 'ambulance drivers', and was even able to slip a few facts in as well. She was shocked to learn that there was 'more to it' than she had initially thought, and was just as shocked that a degree wasn't required.

I've never understood the need for one to misidentify themselves, or try to hide the true title of their position. You can 'dress up' your official title all you want, but at the end of the day; a 'sanitation engineer' is still slinging people's trash into the back of a garbage truck, or maybe sucking shit out of a porta-potty.

Especially since 9/11, there's been a huge influx of 'glory seekers' and 'hero wannabes', and it's aggrivating as hell; simply because they're out for the 'hero status' but have done NOTHING to deserve it. It diminishes the thanks and acolades that are given to those who actually EARNED it!

IF and WHEN I make it to graduation, THEN I will proudly wear the title 'Medic', because I've earned it.

The hiring process over at HVA has always been very competative. I havent heard many stories about a high turnover rate from there either.

Unlike several of the other companies in that area, HVA doesn't just take 'any warm body with a pulse' and put them in a uniform. Because of the reputation that HVA had, they could afford to be a bit 'snobbish' on who they hire.

I would have preferred the "B I T C H" response....

Beautiful

Intelligent

Talented

Charming

Humerous

Definately beats getting a 'shiner' for your troubles!

Good point, never heard the Disney case before, but I was thinking, "What if this employee was a Baptist when hired, and 3 years down the line converted to Islam ? Then what ?

The same uniform requirements would still apply. It could be presumed that if the employee was an asset to the company, then the company would try to make REASONABLE accomodations in order to retain the employee. If the employee refuses to work with the company in order to keep a job, then in an 'at will employment' situation; the company can dismiss the employee for insubordination (failure to conform to established company policies).

I had a partner who when was exposed to people that felt the need to bathe in a fragrance, would experience respiratory distress and repeated sneezing. They had a history of asthma, which was generally well controlled.

On another occasion while at school, I got into the elevator and it was quite obvious that one of the prior occupants felt that same need. It was so heavy in the air that it was almost like drowning in the stuff! By the time I went from the first floor to the third, I thought I was going to suffocate from it!

I've never understood why people feel the need to put so much perfume/aftershave/cologne on that it arrives 5 minutes before the person, and hangs around 15 minutes after they leave!

For this very reason, I either avoid the usage of aftershave/cologne or use it like it's made of gold (very sparingly) when I'm on duty.

Regularly? No. However, I do keep a few 5-hr Energy shots in my locker in case I'm up for a late night long-distance transfer. 911's I don't have a problem getting up and alert, it's the 6-hr plus road trips at 0300 that are brutal, especially when the pt is sleeping. And I have been known to drink a Monster now and then, but try to avoid it. I'm ADHD and my doc advised me to avoid them. For the most part, I drink water and the occasional Pepsi when I'm craving the taste.

Since Ritalin is the most commonly prescribed drug for the treatment of ADHD/ADD, one has to ask a couple questions:

Additionallly, Ritalin is classified as a stimulant; why would avoiding stimulants be a 'bad thing' for those with a true diagnosis of ADHD?

How is it that the true ADHD patient can turn a stimulant into a depressant?

I was at a family gathering today, and over heard the girlfriend of my nephew stating that since her children are suspected of having ADHD, that they should avoid red food coloring (as in fruit punch)...is there any evidence to support this; or is it just another "old wive's tale"?

And finally, isn't the ADHD one of the most overdiagnosed conditions? I mean when you give a kid that has been diagnosed as having ADHD a Diet Pepsi and they get wound up on caffiene (another stimulant), it kind of flies in the face of prescribing a stimulant to treat said 'condition'.

As a kid, I was diagnosed with ADHD, and put on Ritalin b.i.d. When my mother didn't feel like dealing with me, she slipped in an extra dose. She did it often enough that 30 years later, my aunt (her sister) was impressed with how far I'd come with my 'problem'. When pressed to define what 'problem' she was talking about, she stated that for many years she thought I was 'retarded' because I was so doped up. Needless to say, she was rather shocked to find that I was about as 'normal' as they come, and quite intelligent on top of that!

Yeah man, it wasn't my intention to make him sick so that I could treat him, but to try and verify what I believed needed treatment was actually happening so that I could justify treating it. Know what I mean?

When I was new I wanted to push every drug, provide every treatment, encounter every illness, so that I could add that experience to my mental toolbox. I didn't want to be a cowboy and use things just because I could, but, early on, I needed to prove to myself that I wasn't afraid to use my drug box either. Of course, long ago now I've most everything in there and have more faith that each will do what I expect of it, but early on I had no such faith.

And yeah, if a basic crew had such a case with more than a few minute transport time without toning me out, I would seriously question their competence for continuing on the ambulance. Vertigo would still be a diagnosis of exclusions.

Dwayne

With all the head bashing we've done over the years, I never would have even entertained the notion that you were the type that would be classified as 'cowoby' or 'rogue' just so that you could dip into the drug box.

I can completely understand why you did what you did, and if I were in the same place; would probably do the same thing, just for confirmation of my suspicions. Until I'm certain the nature of the illness, I can't provide adequate treatment.

Would I feel bad for the patient in this case? Without a doubt, unfortunately sometimes we have to put them in a situation that momentarily exacerbates their condition, in order to get an understanding of the full scope of their illness. Even with a patient with an isolated femur fracture who is stoned off the planet on morphine is going to scream at the top of their lungs when you put a traction splint on them. We're not putting it on them to make them scream, but in order to prevent potential further injury. Even when we see edema and potential deformation because of a wrist fracture, we still have to palpate it...it's just the nature of the beast.

After reading a little bit on BPPV and it's suspected causes, should I presume that we can expect an increase in cases among the 'headbanging crowd'?

I've never heard of BPPV or 'Top Shelf Vertigo'...definately something to tuck away for future reference!

My question is this....in the above referenced scenario, wouldn't the twists, turns and bumps of transport also initiate the response (without being medicated)?

Also, is this serious enough for a responding BLS crew to have to call for an ALS intercept (presuming that transport is more than 10 minutes)?

As an ALS provider, how pissed at the BLS crew would you be for getting 'toned out' to respond (either on scene or intercepting) for this type of call?

As far as 'messing with this guy', it could be 'justified' as trying to gather enough information to establish a differential diagnosis based on field impression. However, if your only motive was to see if you could 'cure this guy', then that's a whole different bal of wax...

I would be willing to bet that every one of those agencies had a protocol for Vertigo, they just hid it under the N/V heading. They have one for N/V, right? Spinning that is sometimes relieved but returns with even the slightest movement, uncontrollable vomiting. These people will truly be trying to become part of whatever they are laying on so that they limit their movement to the least possible. Nearly asymptomatic if motionless in between bouts of vomiting, but remaining motionless is of course nearly impossible for more than a few seconds. Give them Phenergan. If you carry it I'm guessing you have a n/v protocol for it, and these folks will fit it.

I've had several vertigo patients that I am aware of, and I can guarantee you that those that are questioning whether or not to treat them have never had one. Questioning whether to treat them is like questioning whether or not pain management is appropriate for a femur fracture. There is no question.

12.5-25 mg Phenergan IVSP/diluted and it has in each instance been akin to a miracle. Vomiting stops, pt states that they can breath and move without head spins...One of the most significant interventions I've ever provided.

Please man, tell me that you are not advocating that we withhold pain/mitigation of suffering because doing so will limit the number of fakers we have to respond to??

Dwayne

When my cerebral aneurysm presented, I felt like I was on the merry-go-round from hell!

Not only was there that 'spinning feeling' but it also felt like I was pulling barrel rolls and loop-de-loops as well. I wasn't exactly nauseated, but I would have paid any price just to get it to stop!

The biggest difference I noted between that and the ever popular 'bed spins' from drinking was that with the 'bed spins', you can put a foot on the floor and it usually goes away because you've got a solid point of reference. With vertigo, it doesn't work that way. You keep telling yourself that the floor is solid, and you're not actually spinning; but the reference point spins and tilts right along with you. It's more than just a 'scary feeling', it's down right terrifying!

If someone were to tell me that I couldn't have a certain medication to ease those feelings, simply because they thought I might be faking; well, I can almost assure you that there would be someone getting hurt!

Granted, I'm very 'uneducated' when it comes to pharmacology (that starts next week), but I can see absolutely no justification in withholding comfort/pain management measures; and the provider that DOES needs either remedial training or removal from that position.

I'm not talking about the junkie that needs 'tweaked' because it's getting close to their next fix....I'm talking about those patients that have shown a bona fide NEED for symptom alleviation (i.e. pain management, vertigo).