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There's nothing wrong with saying "Chief, you might want to give a call to the police... I think one of our members got jacked up." and if he presses you just politely say "I'd rather not say, but if you want me to write a report, let me know, otherwise, PD should have all the information you need." Then you're tipping off the chain of command and not running wild with what you think happened.

I don't think its a HIPAA issue, but by the same token, its not the crew's responsibility to go reporting back to the chief or whoever when they become aware of some member not behaving well even by firefighter standards. A police report of some sort was filed. Your town should have clear guidelines about sharing information when a member is arrested or charged. This was the cops responsibility. I know it is juicy gossip fodder, but its not exactly professional to go reporting to our higher ups when we find some firefighter dressed as Wonder Woman tying up another in his golden lasso. Domestic violence is another issue, because of the nature of the offense, if you have reasonable cause to believe another paramedic/firefighter can be violent, and a domestic violence case is a pretty good cause, then you may be obligated to report this fact. But if you do, it should be an official statement, not running in and saying "We saw Firefighter Roberts whipping another man with some sort of flounder or other flatfish and he seemed a little to into it." Do things the right way. You'll never go wrong.

Dick Cheney has one of those continual flow models. Cue Darth Vader theme.

Get hired, screw up until you're docked pay, then work a couple shifts for free. Then you'll be volunteering. Just kidding. There is no program to staff FDNY EMS BLS units with volunteers. Doing so would make the good people of Local 2507 rather upset. It really depends on which way the wind is blowing, but you might be able to put in for a ride along on a BLS unit. Go to the FDNY website, find the general contact numbers, give them a call, and then have a sense of humor as you navigate the phone maze until hopefully you can find someone who can give you a straight answer. If you have a NYS EMT-B card, a valid driver's license, and a background free of crime, you can always apply for a position as an FDNY EMT. Then you can ride the BLS unit and they'll even kick you a few dollars every so often. And when I say a few dollars, I mean just that. Good luck!

Here's the judges response to the whole incident. This story certainly has legs. As you might imagine, the public is only getting the version of the story put out by the “victim” (the atheist). Many, many gross misrepresentations. Among them: I’m a Muslim, and that’s why I dismissed the harassment charge (Fact: if anyone cares, I’m actually Lutheran, and have been for at least 41 years). I also supposedly called him and threatened to throw him in jail if he released the tapes he had made in the courtroom without my knowledge/permission (Fact: HE called ME and told me that he was ready to “go public” with the tapes and was wondering what the consequences would be; I advised him again to not disseminate the recording, and that I would consider contempt charges; he then replied that he was “willing to go to jail for (his) 1st amendment rights”- I never even uttered the word “jail” in that conversation). He said that I kept a copy of the Quran on the bench (fact: I keep a Bible on the bench, but out of respect to people with faiths other than Christianity, I DO have a Quran on the bookcase BESIDE my bench, and am trying to acquire a Torah, Book of Mormon, Book of Confucius and any other artifacts which those with a faith might respect). He claims that I’m biased towards Islam, apparently because he thinks I’m Muslim. In fact, those of you who know me, know that I’m an Army reservist with 27 years of service towards our country (and still serving). I’ve done one tour in Afghanistan, and two tours in Iraq, and am scheduled to return to Afghanistan for a year this summer. During my first tour in Iraq, I was ambushed once, attacked by a mob once, sniped at once, and rocketed, bombed, and mortared so many times that I honestly don’t know how many time I’ve been attacked. Presumably by Muslim insurgents. My point: if anyone SHOULD be biased towards Muslims, one would think it would be me. I’m not, however, because I personally know or have met many good, decent people who follow Islam, and I shouldn’t characterize the actions of those who tried to kill me as characterizations of all Muslims. When I asked him why he dressed up as “Muhammad zombie,” he told me that it was because he was reflecting the Muslim belief that Muhammad rose from the dead, walked as a zombie, and then went to heaven. That was one of the reasons I tried to spend 6 whole minutes trying to explain and de-mystify Islam through my own knowledge, and in an attempt to prevent an incident like this recurring in my community. Unfortunately, the message was obviously not received in the vein that I had intended. And, in the interest of full disclosure, I did use the word “doofus,” but didn’t call him that directly; I said something akin to “ if you’re going to mock another religion or culture, you should check your facts, first- otherwise, you’ll look like a doofus.”; In short, I based my decision on the fact that the Commonwealth failed to prove to me beyond a reasonable doubt that the charge was just; I didn’t doubt that an incident occurred, but I was basically presented only with the victim’s version, the defendant’s version, and a very intact Styrofoam sign that the victim was wearing and claimed that the defendant had used to choke him. There so many inconsistencies, that there was no way that I was going to find the defendant guilty. A lesson learned here: there’s a very good reason for Rule 112 of Rules of Criminal Procedure- if someone makes an unauthorized recording in a Court not of Record, there’s no way to control how it might be manipulated later, and then passed off as the truth. We’ve received dozens upon dozens of phone calls, faxes, and e-mails. There are literally hundreds of not-so-nice posts all over the internet on at least 4 sites that have carried this story, mainly because I’ve been painted as a Muslim judge who didn’t recuse himself, and who’s trying to introduce Sharia law into Mechanicsburg.

I still say that the Westboro Baptist Church is the low water mark. I would say 98% of the Western world would like to respond to them the same way this man responded to Zombie Muhammed. The laws are very clear that we cannot. The belief in freedom of speech cannot just be applied when its something you agree with. The true test of whether you believe in free speech protections is if you defend it when its something you find reprehensible. The real problem is these low-level shit kicking county judges who run their little fiefdoms without fear of consequence. Another judge in Pennsylvania went to jail for purposely sentencing children to long stretches at juvenile facilities because he was getting kick backs. A judge is there to interpret and apply legislative code and statute. Any attempts to proselytize, preach, or pull at Judge Judy on anyone should be met with the swift removal of the judge and replacement with someone more objective. That's why I do an eye-roll any time Glenn Beck or his ilk rally against the federal government. The biggest threat to our personal freedoms isn't the federal government, its petty little men and women in powerful positions appointed in our local neighborhoods.

What ticks me off is that the Westboro Baptist Church can do their god awful crap everyday of the week with out getting their asses kicked but one guy who poked fun at the wrong thing can get assaulted with out consequence. Hopefully the wheels of politics will catch up with this guy and he will be out on his ass.

Just curious, how many divorcees do you have on your department?

You're right. Your response was very predictable. That's why I predicted it.

AHEM! In my other post about heros, I wrote "but as a general rule cops don't like firemen and paramedics don't like firemen, and if you ever bring that up, they almost unilaterally come off with something like "They're just jealous, or They couldn't pass the run." Then MontvilleFire writes: "These anti fire service threads are so lame and share one common underlying theme; jealousy. While I agree with some of the points made about sometimes, the root of these rants is jealousy. " Called it! But just so you know, EMS is evolving and growing while the fire service can only desperately hang on to skills that were once needed before smoke detectors by trying to snatch up EMS jobs. I was trained as a firefighter. I have many close friends who are firefighters. I have no problem with firefighters, usually. But that over all smug attitude is what gets you no where. Get a life.

Until you've tried the pizza I'm referring to I revoke implied face palm privileges.

A hero is a sandwich. A life saver is a candy. Yes paramedics can save a life. Its very rare, but it does happen. It depends on your definition of saving a life, I guess. Some people believe that any time they do a transport they have saved a life. Others believe that holding someone's neck still during an extrication is saving a life. Generally speaking, working someone from cardiac arrest to being discharged neurologically intact is agreed upon to be saving a life, and I don't disagree. But that doesn't mean that doing so makes you a hero above and beyond society, it means you did your job, but in this day and age doing your job is indeed something to be proud of since doing so is becoming increasingly rare. It is the height of arrogance to call your self a hero. Doing so is placing yourself on a pedestal above others, and leads you down some very dangerous roads. Look at the Fire Service. They've got the hero thing so far in their head that anyone who has any experience with them can't stand to be around them for any period of time. Police officers may have friends who are firefighters, paramedics may have friends who are firefighters, but as a general rule cops don't like firemen and paramedics don't like firemen, and if you ever bring that up, they almost unilaterally come off with something like "They're just jealous, or They couldn't pass the run." If that's being a hero, you can count me the fuck out. You go be a hero. I'll do my job and help others. You can read some stories of true heroics. Sometimes paramedics perform those actions. Sometimes even firefighters do. But it doesn't make you a hero. Generally you need to be on a memorial wall to be one of those. Which is the main reason I don't want to be a hero.

Actually some of the best pizza I have ever had was thin crust coal fired pizza from Patsy's in Harlem. The pizza slices were only crust, sauce, and cheese, but there was some sort of magic in the ingredients that made them heavenly. I am dying for some good pizza. Being in the land of salmon, wheat muffins, and Pizza hut is depriving me of the good stuff. Though I dig poutine and the roasted duck.

I'm coming to the BBQ but I'm going to talk with a New York accent for the entire time just to piss Kiwi off. Not for nothin' youse guys want a beer ovah here or what?

I agree with ERDoc. Once the patient gains mental faculties, and is aware of the health risks and the consequences of their actions, then they have the right to refuse any treatment they choose. The paramedic instructor needs to take it down a peg and maybe a refresher on patient rights and responsibilites. My M.O. would be to call medical control and get the blessing on it, then document the hell out of it and file away under 'possible shitstorms later'. My documentation would include the fact that we strongly and strenuously advised the patient to be transported to the emergency room of his or her choice in addition to performing as through as possible neurological exams and also advised him to call 911 at any time if he changed his mind. Tell the paramedic instructor we mock his value system.

Sorry to hear you're having trouble. I know job hunting is one of the most frustrating experiences you can have. Unfortunately, as previously stated, the market is flooded with people who have an EMT certification, gloves, scissors, and sometimes even stethoscopes. Quite frankly I think some EMT classes at this point are a money making scam akin to Acai berry juice or Amway. Set up shop, give a few lectures, run a few practicals, enough people manage 70% or so on the state, and make a few hundred. As you move up the ladder things get a little easier. Having your paramedic certification makes it easier to get a position but even that's not a gimme. I would not suggest picking up and moving to some geographic location on the promise of a BLS position. Trust me, some outfits out there are scary to say the least, and you don't want to end up in God knows where with a job that doesn't pay or puts you at significant risk. Usually this is the point where people suggest volunteering, and if you're in one of those areas that demands some kind of field experience before entering into a paramedic program, or the paramedic program offers 20 spots every two years and is run by the fire chief, his brother, his other brother, his brother in law, his wife, and the students who enter are coincidentally all related, then you might have to bite the bullet, volunteer a little, kiss some butt and cross your fingers. If there happens to be a more enlightened paramedic program that actually takes academic ability into account, then I suggest saying screw the volunteering, no matter how much people insist that you need EMT-B experience, and using your time to enroll in an Anatomy and Physiology course, doing really well, and then applying. I should mention that Chemistry and Biology are usually prerequisites for A&P, and if they're not, they should be. If you have the luxury of picking a program, try to find one that has rotations at a major Level I teaching facility. Its something you can put in your resume that will help you. Then after all your hard work you'll be a freshly minted paramedic and you can beg and plead for some outfit to hire you with no experience, but it will be easier to do than trying it with an EMT-B card and the chairs are nicer in their waiting rooms. Did I mention that applying for a job in EMS is a thankless, frustrating experience? I don't like to mention my background too much, but lets just say if you looked at my resume you'd be pretty impressed, I have just about every certification known that a prehospital provider can possess. Seriously, the only thing I'm missing is an FP-C designation and combat experience. I also have years of field experience at the ALS level. I have had a very difficult time securing employment. That being said there are many providers out there with an FP-C designation AND combat experience, some of them on this very board, and THEY have a hard time getting a decent position. I don't want to discourage you, I just want to try and put it into perspective of why its so tough to get a job. Oh, and for the love of God keep a clean driving record. With insurance rates being what they are having a citation for sneezing improperly can cost you a position.

Please watch this short video first: http://ca.news.yahoo.com/video/us-22424932/girl-dies-after-being-forced-to-run-for-hours-28404352.html The horrific aspects of this case can not be understated. My heart goes out to this poor little girl. However, I think it might be useful to consider this in the context of how susceptible pediatric populations can be to electrolyte derangement and dehydration. Hyponatremia occurs when serum sodium levels fall below 136 mEq/L however, children have been shown to suffer hyponatremia at levels higher than adults. I should mention that last line comes from something I scrawled in my notes a long time ago and I haven't the foggiest idea where I copied it from. If I find the article I'll post the link. According to http://emedicine.medscape.com/article/767624-overview, Hyponatremia occurs through several different types of pathologies, hypovolemic, euvolemic, hypervolemic, redistributive, and pseudohyponatremia. In this case I believe the pathology would be hypovolemic hyponatremia. The little girl had lost so much fluid, probably through sweating, that she dropped to dangerous levels of sodium. In addition to being susceptible to hyponatremia, children are also very susceptible to hypovolemia due to the lower amount of circulating fluids. If we go by the formula 80-85 ml/kg for circulating volume vs. weight, a 75 kg man will have around 6 liters of circulating fluid while an average 9 year old girl with a weight of 28 kg will have around 2.5 liters. That means an adult can lose up to 1.5 liters of fluid before entering into Stage III hemmorhagic shock, while a child can only lose .0625 liters of fluid before doing the same. Its also been shown that children can lose up 25% of circulating fluid before showing any signs of hypotension, so by the time a child's blood pressure actually begins to fall, it may be the beginning of the end. I once told by a clinician that when you sweat, you are in essence, bleeding, and should be approached the same way for fluid replacement. Whether that's 100% true or not, I'm not exactly sure, but sweating can definitely be a significant source of hypovolemia in all populations. Euvolemic hypovolemia can occur if total body water is increased while sodium levels remain the same. This, I reckon, would apply to someone who has been sweating for a long period while only drinking water. Symptoms of hyponatremia include ALOC and seizure activity. The literature I have read cautions against trying to balance out hyponatremia with a hypertonic sodium solution. If nothing else I think that when presented with a child suffering ALOC or seizures with an accompanying environmental factors should be treated with a high level suspicion for hyponatremia. Does anyone think there is a preferable isotonic crystalloid to be used in this type of situation?

Your horse mounted idea will run into the same problem that motorcycle EMS runs into. Unless you are doing almost unilaterally treat and releases, the responder will need to ride with the patient. What do you do with the horse, then? Can you like tie them to a stake and leave some water or something? I am writing this from a paramedic point of view where you really can't hand off to anyone. I guess maybe you could get ride over in a first responder role and then hand off and then ride off into the sunset with Grace Kelly. Even if you do manage to get some sort of trailer hook up to the horse, if someone is seriously injured you are going to get some very strange looks bringing them out by horse and buggy. Since it is an unorthodox approach, some bad person somewhere could get some bad lawyer to sue the pants off of your outfit for 'needlessly delaying' extraction to where ever you are meeting the ambulance. Those are the hurdles you would need to clear before trying this out.

The role of the volunteer in an established 911 system is to augment the system during high call volumes or mass casualty incidents. Next question.

The FDNY is not trying to keep volunteer services out of response. They are pushing very hard to reign in volunteer ambulance services, to keep a well ordered system. This is especially true for MCIs. After 9/11, i.e. "The clusterfuck of the century", the FDNY has gone to great lengths to standardize the use of volunteer ambulance services. I am not exactly sure of the entire procedure, but basically a volunteer ambulance service sends in a sheet about their staffing to the FDNY and then they get assigned a unit designation and respond to 911 calls. At least that's the way its supposed to happen. Usually its more the volunteer ambulance gets called by whatever system is in place for their little outfit and they respond. Volunteer systems in the greater New York (The five boroughs, Yonkers, Nassau, Suffolk, and most of New Jersey) are... special. They are not like volunteer systems in most places where volunteer services serve a population that otherwise would not have 911 services. They have more funding than God through donations, and very powerful political influences, which is why the EMS system in a good portion of the same area is beyond help. You want to volunteer and make a difference? Join the damn Red Cross or work an ER in Haiti or Somalia or some place. Be a professional or let them do their jobs. That's my opinion.

I don't let firefighter antics bother me too much anymore. This is because I noticed a trend. Tell someone they are a hero enough and they actually start to believe it. And when you're a hero, you can do no wrong. Rear end someone? You're a hero. It wasn't your fault. Get out of the car and scream at them. Want to cheat on your wife? You're a hero. Its okay. Keep it 'in house'. Want to get drunk at work? You're a hero. Your job is stressful. Its okay. So, give them a parade, give them a gift certificate and some badge bunny's phone number, then sit back and watch the fun start.

Crapmagnet, it sounds like you took a very mature look at your life and knew what changes to make. I'd just rather there were more people who could do that. Its kind of the Catch-22 of medicine, the people you want to have working with you are the ones that know when to take a break. Please accept my condolences about your brother, and if down the line you do decide that EMS isn't for you anymore, thank you for your years of service.

Specialist is generally a rank term used in military or paramilitary organizations, and in some civil service titles. A specialist is basically someone at the bottom who has training or a skill set in a certain area. So I would say the difference between a paramedic and a paramedic specialist is who they work for.

Mike, good for you for not being afraid to admit a mistake. That being said if I saw the situation you described I would have had some serious words with the paramedic. Very serious words. In a kind but firm voice. I would say to you that, you unlike the paramedic, obviously recognized this person was having trouble breathing. Part of EMT curriculum, I believe, is being able to ventilate BVM to stoma. As an EMT, you did recognize the situation, but it sounds like you failed to act accordingly. Forget liability. You knew he was having trouble breathing. You are fully trained on a BVM and should be able to ventilate a person via stoma. There really isn't any excuse for that. Being an EMT on an ICU bus is putting you in the deep end without swim lessons. You need to be on point with this stuff.

Funny, I didn't see "painful leg or other orthopaedic injury" in there. Should it should be "If they can hop, they hop!"