Ridryder 911

No I don't think you went overboard.. I wish American EMS would pay more attention to safety. My philosphy is I rather be seen than felt ... Be safe, R/R 911

hmmm.... maybe we need an image consultant..? be safe, R/R 911

Were most get confused is basing Christianity and denomination and religion together, in which they are separate issues altogether. I am tolerant of other religions ( as long they have recognized purpose, and not are in cult like teachings) this does not mean that I approve, but do not criticize. Unfortunately, many place "faith" into people of beliefs, not God itself. Very few actually, study beliefs, as much as they perceive or "have feelings".. so many misinterpertation are based on ignorance or accounts of what "people" acted or behaved. When asked about Christianity, very few understand the difference in doctrine practice and true laws of Bible and why of such. So many misinterpretations have occurred, not understanding Greek or Hebrew, Doctrines are man made and are rules set by the denomination. Again, the basics and teaching is the main point... Peace, R/R 911

In the words of Dr. Phil.. would he do this in front of you or would not be ashamed of doing it in front of you ?.. If not, then there is something wrong. Behavior of flirtation, chatting with each other inappropiately can open doors that should not be explored. How would he feel if ths was you. Unfaithfulness, is in the heart as much as physical...if you can not trust, the one whom is supposed to be your best friend, whom should you trust? I suggest you to confront him, seek counseling if not for your marriage, but for your self as well.... I wish you peace and best of luck... R/R 911

I agree he needs to breathe, however one needs to understand V/Q. For the patient to breath we have to treat the etiology of the problem.. fluid and start diuresis as soon as possible. CPAP works great, if the patient is not worn out or there is not an obstruction problem Again, CPAP can usually only be used in the first few minutes when the shift from right to left side. Intubation, with PEEP and continuation of diuresis with nitrate or even a low dose of Dopamine to increase renal perfusion and messenteric dilation. Be safe, R/R 911

Actually, most anesthesiologist prefer not to place surgical candidates under anesthesia if they have ingested water or food. As well increasing motility etc.. usually as Dust describes nausea vomiting increases.. etc.. Be safe, R/R 911

NO !... clear enough ? R/R 911

A little time off, might had claerd your head and make you realize of a better perspective things. True, sometimes it is a mixed blessing. Good luck, R/R 911

I have not seen "hot saline" used in the field as of yet. Although, there are many indications, I would be very cautious of using any without a base line CMP. Be safe, R/R 911

Good questions; Actually, my Paramedic course had a requires section entitled " Introduction into Advanced EMS". This course taught what the advantages as well as disadvantages of being in EMS would be. Spouse and family studies was an integral part of it. If and when you decide to got to Paramedic school, it is really helpful to have the support of you spouse. Emotional support, will make things a lot easier. This saying, make good decisions on study habits and time management. Many students get engrossed in EMS, not the study of Paramedic ... and yes, there is a difference. Be sure, to give the family and yourself time together. There is a saying, I always tell my students.. after seeing so many choose EMS over family and even their own personal life. "You may love EMS; but EMS will never love you!"... this being; you may devote your life to this profession, but you will never receive the return. So place your time and effort into it, to become the best, but recognize the true ones that will love you back. Can you make a decent pay... it is like any other job. Dependent on location and cost of living .. yes. The number of hours is in perspective. I prefer to work 24 hour shifts so I have more days off.... in comparison to 12 hours shifts, so when I come home I actually have time to spend with family. But, again it is all dependent on your lifestyle and choice. No, you will never be rich.. but, I do know those that make comfortable living and have actually done well and provided well for their family. Again, as an EMS Educator, I cannot over emphasize good study habits, time management.. and time away to stay human and have a health emotional stability. I wish you luck, in your choice. R/R 911

Yes, I have a strong faith. Find it fascinating that more in EMS do not have faith based. Maybe, that is why there are so many measurable, lonely people in EMS. Attempt to have a quick fix of justification of proving themselves. As observed most do not look as EMS as a "calling" rather as something "neat to do" in comparison to other health care professions. Hence the short term career.. are you aware the average Paramedic goes to school for 1 1/2 years and works for only 3 in the field. Wow... the basic last a little longer, 5 years. I find it amusing most medics actually think that they have control over situations of saving life of others. Thinking they really "save' lives makes me even laugh out loud. They are an instrument to prevent death and relieve pain or further injury, but they still cannot control death or outcomes. Again, even the most educated have to accept to this . I know it is the current trend to bash Christianity, because it is the trend. Within the past 10 years, this trend has gain momentum, and our country has reflected the result of this. Sorry, if we Christians share our faith because those that really experience it are happy.. and only wish the same of others. Believe it or not,Christians are educated (yes, many Nobel winners & members of MENSA), we make up the majority of the population. Just because, we accept a loving Creator, and try to encompass his teaching to love the fellow person, and think of others before our selves, does not make us better, only understand things. Far as having a perfect life, no one ever promised that.. short & simple. How, you deal with it and the compromises, the events bad and good, makes the person you are. People are always wanting to know the purpose of life, philosophers still argue and seek such. People continually want to know if this is all life has in it. Again, thinking of short term goals. How does one really think, this life on this earth is really, all there is. That would be a very sad thing indeed. For those that do not believe.. what if .. only what if it is right, that there truly is a God ? That is the uniqueness, you have the choice... as it has been preached for years. So bash away, because I choose to inner faith, that allows me to recognize my short falls, to understand "man" will never ever be perfect. That we as people cause the consequences, and that like in life, what goes around comes around ...and suffer the consequences (look at the behavior at the world today) That I believe in some moral responsibility, to protect my integrity, trustworthiness, and do not seek current trends does not make me bad or prude. Just, because I do have faith, I am not going to allow others to bash or degrade my belief system. Far as "pushing" it on others.. no; I will tell the inner peace is fantastic, knowing what my purpose in life is great.. no, this does not prevent me from having troubles and no it is not a "get of jail card".. But, when troubles and tragic events do occur, I may not realize why such occurs, but I have inner faith to keep me going and have a clearer purpose of life. Again, the choice is yours.. you are responsible for your own destiny in life. Peace, R/R 911

Texas does not acknowledge living health wills ?.... With living wills, determination is made on each segment of care not to or to be performed... Be safe, R/R 911

Again, this topic has no relation to the performance of what we provide in the field. Of course, you may have those that want to claim . anything is against their belief system. Again, there is legal structures to have to prove such. There are many organized religions in America, than the traditional Christian base religion. Branches of sub culture, eastern beliefs, and diverse cultures can make many ethics challenged. Using the belief of saving a life, postpone of death, or preventive injuries is an adopted philosophy of most faith based cultures. Idiosyncrasy of each or fine tune can usually be performed. There are very few faiths that prohibit health care worker to function at their standard goals as I described. This discussion has left the whole statement of the post. The pharmacist was discharged wrongfully, because they participate care in something against their faith. There was a law that protected them as such. Then they were discharged. Now, the discussion on this post is to see if faith and medicine can intertwine and if faith interferes with treatment. Again, most medical care is performed by ones of faith.. especially in areas no one else participates. The general consensus of most of the population is of having some faith.. I know it is hard for agnostics/atheists to understand, but it is and should be respected as much as someones physical findings. Encompassing faith among provider and patients has been going on for centuries and still is taught and performed daily. It is also a scientific fact those with such care has a higher rate of healing, discharge, and less complications. real or not .. the facts. Let us not make up scenarios that has not occurred.. faith interfering with emergency procedures by emergency personel, or providing medical care, for those that need it. (Sorry..morning after is a form of birth control, not treatment of an injury or ailment) For more debatable ethical issues, how many medics has seen patients been refused medical (non-emergency) treatments or lower treatment due to uninsured or no pre existing health care ?....in which I see on a daily basis.. Be safe, R/R 911

Congratulatios you just killed him! WTF ? Your giving fluid to a CHF patient and then using CPAP to blow it back from the alveoli ?... WHY ? would you want to drown someone ?.. You are defeating the purpose of nitrates (vessel dialtation and morphine venous pooling) by infusing fluids... duh !...poor pump failure!..... why do you think you adminster diuretics ?... By the way late stages or progressive right sided lateral wall infarct are brady... not all right side presents in brady syndrome. I can hear Sacra shutter... R/R 911

Actually, I believe it should sometimes be perceived that many enter the health care field due to their faith. EMS is one of the few medical professions that does not address spirituality in the care of the patient. As a Christian, I am aware of certain procedures that are performed, and I avoid employment with those. Again, most of the procedures that are elective and are considered non-crucial for continuation of life. I again address that those with true understanding of Christian beliefs would never refuse to give care or treatment in those of need. Look in comparison, how many relief and medical care is provided by such organizations. Ever seen a hospital with a St. before its name?.. Those that would never provide immediate care for those that are sick and injured due to race, creed, color are doing such on their own bigotry, and using their "belief" as an excuse. There are many times I have provided care for people I do not believe in their lifestyle, behavior or events that they had participated in. If I refuse to do this, I would had seen a few patients a year...lol. Ever worked on a patient that have killed someone, or injured their children etc ? There are many other organized religions that provide care for those of certain faiths, praticing non-traditional medicine. I truly believe that having a "faith" can enhance care, and allow personal deeper insight to patient care, more than physical care, but emotional and spiritual as well. Majority of patients have these needs as well as physical, and is just important. There are several citations and research showing that whole needs of the patient needs to be addressed. So the point is .. is the care or lack of care detrimental to the patient ? Is the practitioner truly basing the lack of care or care based upon their "interpretation" of faith or personal beliefs? Be safe, R/R 911

I agree Nate. Unfortunately, since our profession is lacking in pay.. many have to choose to be able to provide for their family and yes... be able to pay bills and buy food, doing another job. I have seen many excellent Paramedics have to go to other health related professions... sometimes leaving the field all together. Many over qualified, and usually excel because of their knowledge, but the we have lost. The system lost providers, as well as patients has potentially lost capability of good care. It is a shame we can not "slap" our profession awake or get them into shape. But again, we as a whole continue to make excuses and continue to allow it. Be safe, R/R 911

As I posted, I aree with ER Doc.. part of the problem (other than not knowing how to do thorough patient assessment) is EMT's do not routinely obtain history. There is much that can be obtained while enroute. Be safe, R/R 911

Ditto... I know that most local hospitals usually require it to be an RN, and then attend a special course. Like Dust says, usually dependent on local policies.. check with your state EMS office as well............ Be safe, R/R 911

Personally, I think I have only given epi 3 or 4 times in the field. I have found there is very rarely times, I have ever seen it needed. Most of the time I have seen an adverse effects, or mild allergic reactions. Using H2 blockers and steroid, is routinely successful. Yes, epi is exceptional in true anaphylaxis, if this is the case, I prefer IV route. Since, one should already have an access, with fluids as well. Be safe, R/R 911

First let's clarify the issue... the Pharmacist was fired because they did not want to dispense the "morning after pill". A non-emergency medication. The state law, allowed them to refuse to participate in manners that they found unethical, or conflict in religious beliefs.. they were discharged because the left wing governor made a hissy about it to Walgreen's.. It was not like there was not other pharmacies, or even another pharmacist to do such.. the law suit, is that the pharmacist was following the law. Sorry, I have been in situations that went against my belief and moral stance... and YES, I refused to participate and will continue to do so. The same is true for catholic associated hospitals not performing abortions, or prescriptions on birth control pills.. they patients have a choice, seek another facility. I worked at a hospital that had a Jehovah Witness that worked in lab ( I know an oxymoron, but it is true) she would not dispense blood, so a house supervisor had to be called, to do it. Irritating at times, but when ever we start taking ones right of freedom of religion and faith, we need to start worrying as well. Should each institution be restricted to practice "secular medicine, only"? It should be the right of each institution to make those decisions as long as they patient is aware of it. This is not to say withhold or perform emergency care.. which I have not seen or heard of. FYI: It has been scientifically proven those with faith, and prayer has a better chance of outcome and less days in the hospital. Spirituality is a special concern for several patients and staff as well, and should not be ignored. Be safe, R/R 911

The only ones that makes errounous mistakes is ones that did not learn off them.... as the old saying, " doctors buries their mistakes"... yes, we all mistakes, and will continue to do so.. hopefully, nothing that will permanently harm or kill someone.. but, that happens. That is why medicine is an art not just science... If this person, is distraught of making a mistake, it might be for the better. The personality and character of a medic with continuous strive, knows they will make a mistake and will learn from each one. The time to make mistakes is in clinical phase of education, having someone to catch it, know how to resolve it, and as a student will not be penalized for it. So the time to screw up, is while in school. I know I review mentality, review each call, how I could had done better, or improve on things, even those that went extremely well; why this went so good & others don't.. I don't dwell, but try to learn...even after running several thousands of calls over the past 28 yrs... Be safe, R/R 911

HX. HX. HX.... as well as checking neuro evaluation.. I attached a link for neuro exam. It is crucial for the Paramedic to have a knowledge of how to perform the assessment and a FULL understanding of the findings of each. There are so many times I see EMT's bring in patients with unilateral hemiplegia that they described having = & full grips. Not understanding grips should be checked with the arms being held outstretched, not laying in the lap as some perform. Use the Cincinnati or L.A. Prehospital Stroke Scale, learn either one by heart. Physicians should be familiar with either one. There is a great on -line free CEU course for recognition and tx. of CVA, I will try to locate the web site. Again, we ingrain check pupils for reactivity, etc.. with no emphasis what an abnormal finding means or what to do. EMS falls very short in neuro evaluation, hopefully there will be better education on these areas. neuro exam link : http://medinfo.ufl.edu/year1/bcs/clist/neuro.html Be safe, R/R 911

Did you talk to the medic ?.. I really doubt that the medic wanted you to run in and immediately check lung sounds..without primary assessment, introduction, etc.. I suggest to pull the medic aside and introduce yourself and suggest how you want to improve and make things better. Now, for no point should you immediately "check lung sounds" on the initial arrival (unless trauma). You did not describe if your an Intermediate etc.. or if you can administer meds.. if you can't, it does not matter if you listen or not... he needs to re-assess, before tx. Again, talk to the medic himself, apparently your partner does not have a clue.. if the medic wants you to listen, tell them you will try, but of course you need a set of v.s., and oxygen of course. (Like we are supposed to, since you will have re-assess them anyway... I realize you are new, but stand your ground; otherwise, you will be like your partner........... Good luck, R/R 911

It was not in your dreams... you just stuttered.. the person below me loves to code patients that are over 100 years of age and actually likes the smell of GI bleeds.. R/R 911

I get tickled.. the nurses will call me Paramedic.. then some ambulance dirvers. When one of the EMT's asked why they said "he acts like a Paramedic... you act like an ambulance driver".... silence. R/R 911