Lone Star

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.

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

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!!

Something to do with Floral Designers?

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. 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!

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.

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!

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...

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).

I was thinking the same thing.....if this isn't the record at almost 5 years; it's got to be close! Dwayne's last post (the one prior to revival) was 24 August 2006 - 04:47 PM (4 years, 10 months, 8 days and 1:05)....

Having only worked with the UAW, I can only speak from my experiences there. I had a 90 day 'probationary period' before the Union was even allowed to represent me. I'm presuming that this is a 'standard practice' and would apply here as well.

Georgia State Protocols (Section 1, page 6 states: 1. Brown, M.D., Stuart, Patrick O'Neal, M.D., and William M. Billings. "Adult and Pediatric Emergency Pre-Hospital Protocols." Georgia Department of Human Rsources, 11/2007. Web. 16 Jun 2011. <http://ems.ga.gov/pdfs/ems/Adult%20&%20Pediatric%20Pre-Hospital%20Protocols%201-15-08%20Web.pdf>.

Not all states are as 'generous' as NY seems to be. Secondly, for the reasons I outlined, I doubt any lawyer would touch something like that. I also stated that it would be more likely that the person never got the job, and on most applications theres the 'truth in declaration' statement just above where the applicant signs the application...

If the applicant must be in 'traditional Muslim dress every time they're in public’, we can logically conclude that they were dressed appropriately for their religious practices for the interview. We can further conclude that the issue of wearing the company uniform would then be broached, whereby any objections would be brought forward at this time. In the event that the applicant cannot wear the company uniform, they wouldn't even be offered a position, let alone be hired; only to find out on the first day that they cannot wear the uniform due to religious considerations. With that being the case, there would be no need to fire a ‘non-employee’ in the first place. Additionally, if this ‘objection to the company uniform due to religious beliefs’ came out AFTER they were hired, then they could be terminated simply for not being honest and forthcoming during the hiring process. If this were the case, then there could be no grounds for a lawsuit for wrongful termination or discrimination.

I highlighted a couple of points here. The underlined passage: we actually spent more time on the clinical exam techniques (otoscope, opthalmascope, etc) than we did on actually obtaining vitals in the field, because it WAS presumed that 'everybody should have learned how to do it in Basic class'. I agree with the bolded section. I've seen more than a few medics who refuse to do things like take vitals on their patient because"...thats a BLS skill, and I'm strictly ALS!" Far too often we draw that ALS/BLS line in the sand, and for the most part; it only causes a point of contention between EMTs and Medics (we're not even going to mention the 958 different BLS titles). Granted, not all of the calls we answer are going to require pharmalogical interventions, IVs or advanced airways; but I'm begining to believe that we should just do away with the different 'levels of licensure', and make everyone a Paramedic through a degreed course. With the exception of nursing, EMS is about the only medical care provider that has so many level delineations. How many levels of Doctor are there (I'm not referring to specialists)? How many times have you been seen by an MD-Basic, or 'Advanced DO'?

First off, I didn't realize I was going to start such a shit storm by asking that question! Here's my take on the whole deal: We know that there's certain criteria established to be able to make an informed decision to refuse medical attention. One of the first items of that list is that they be COMPETENT enough to be able to make that decision in the first place. ETOH, drugs, and certain medical conditions and trauma will negate that condition (diabetic emergency, stroke, head trauma to name a few). With these conditions present, we are free to treat them based on the concept of 'implied consent'. This means that we have to establish that they're in a predicament/situation that if an average unimpaired person of normal intelligence would ask for help and want to be treated. We know that drugs, ETOH and other chemicals taken into the body (either by inhalation, ingestion, injection or transdermally) WILL alter mental status/capactiy. What is the difference between the patient who is 'drunk off their ass' and the patient who is 'gorked out of their minds' by some other chemical? Why is it acceptable to take one in and not the other? I'm intentionally excluding the trauma and medical patients simply because of possible underlying life threatening conditions. How is it that the person at home who has a BAC of 0.18 should be treated differently than the 'urban outdoorsman' who has a similar BAC? Is it because the patient found at home HAS a 'home', and the other patient does not? If both are 'falling down drunk', do they both not present a clear danger to themselves and possibly others? Sure, the 'urban outdoorsman' could stumble into traffic, get hit by a car and be killed; but by the same token, the patient at home could stumble in to the bathroom to puke their guts up, slip on that cute little bathmat...fall, striking their head on the tile wall and die in a heap in the bathtub... We don't have the equipment to determine the level of intoxication; we can't definatively state that one is legally drunk, while the other is one of the 'walking embalmed'. If both people mentioned above are refusing treatment/transport, would you leave the both of them where you found them and simply state "they don't want to be seen; so no harm no foul"? We can throw in a list of 'what ifs' from now until next Christmas, but the point still remains that both individuals have an altered mental status, and by definition cannot make a clear and informed decision to refuse treatment based upon their similar condition. We also know that based, on the intoxicant involved; they are at least at risk of further injury.