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Does anyone else find it annoying when someone fills in the abbreviations and then like 3 other people follow with the exact same post? I mean what are you trying to do, go "I knew it too!!!"

Jeez.

Anyway, BGL stands for Blood Gas Laboratories, the national center for the measuring of blood gases. Every phlebotomist practicing within the United States (except for Tennesee and Kentucky) must be certified through the BGL.

No offense to anybody with disabiliites out there, but the

when the hell did prehospital emergency care become the Special Olympics? Look, we are doing a job! We need to lift heavy things, move quickly, and use our senses to assess and treat our patients. I'm sorry that only 2% of the population is fit to provide emergency care (1% will actually be in emergency services, %0.5 will still be there after 5 years), but its the nature of the work. You know what, no, no, let's let the deaf guy take the BP, the blind guy drive the ambulance, the guy with the wheelchair do the lifting and the one with the speech impediment give the report. So long as everybody has fun.

Carisoprodol (Soma). Got some of that for my back round I. To rip off Denis Leary, "It said on the label 'May cause drowsiness'... it shoulda said 'Don't make any f---ing plans'! "

I remember the name of my first cardiac arrest. The initials were H.P.F., I remember her full name but I won't post it. It was Saturday, September 14th, 2001 and having been through what I had been days earlier, it was shaping up to be just one heck of a bad week. I remember the specifics, and can remember that I took comfort in the fact the code went textbook, I was BLS at the time, Ventialtion, CPR, AED, ALS arrived in about 5 minutes, but she died anyway. People die. It's about the only certainty we have in life. We can give our best effort, we can train hard, work hard, play hard, but people will die. I remember a fellow paramedic student who mentioned that before beginning class he used to take cardiac arrests really hard, needed to go and get a beer, or what not, but after about hour 6,943,216 of ER rotation (or at least it felt that way), he said that when he saw a crew going all theatrical (pounding on the chest, saying the cliches) on an asystolic arrest, he would just shake his head and mutter something about rookies.

Isn't that one of the excuses they offered up at Nuremburg?

Ve are ze Texans. Ve eleeminate zos who are not auf our standards. Texas uber alles!

Yeah, Texas is very efficient in offing their populace. They don't let silly things like innocence get in the way.

Don't worry, Rid, with us training kids on Xbox at age 5, snuff films all the rage on the internet, and reality TV hitting 'The Running Man' like depths, I'm sure it'll be very soon when we can enjoy watching people's neck's be broken and them lose control of their bowels and bladders while eating our lunches. Maybe we can bring back the witch trials, next. :roll:

It's an interesting philosphical question. Countless studies show that the death penalty had little to no effect as a deterrent to a crime. Supermax prisons have demonstrated that they can effectively contain the most dangerous of prisoners indefinitely. So really the death penalty only feeds an individual and society's need for vengence. Its the question of "When does doing something for the greater good stop being ethical?" If a heinous crime had been commited, and hundreds upon thousands of epople were crying for someone's death, and it was turning things upside down the fact no one had been executed for the crime, I mean it was really having an effect on a lot of people, would it be ethical to execute someone who if it meant people would be able to get a sense of satisfaction and go on about their daily lives? Oh yeah, before Dust throws the "loony left egghead east coast commie pinko liberal" sticker at me again, I should mention that I am actually pro death penalty. Its jsut I am not rabidly pro death death penalty, and I think its a lot more complicated an issue than its usally made out to be.

I'm with you on that, Dust. My head instructors both had MPA's and one was also an RN in addition to having many years of tried and true fireld experience in paramedicine. I was watching this show on special forces in World War II, and the program the Americans developed borrowed an important aspect in training from the British Commando program: The special forces instructors were not allowed to make any demands on the recruits that the could not demonstrate they could do themselves. Any obstacle, training regimen, course or skill they wanted their students to do they had to prove they could do themselves indvidually first. I think that is an excellent idea for training.

Because you're supposed to remove your hat when you enter a building, unless you wear it for religious reasons. Its a sign of respect, it shows you are there and you are not leaving anytime soon. But you see, this is the whole point, there has been a complete breakdown in the whole instructor/student relationship. It used to be you showed respect to your teachers, you did what they asked of you while you were in their class, it was a big mark of your character and showed you were someone who could be trusted, which is really important if you're going to be handling narcotics and putting things inside of people. In paramedicine you will be allowed to do things that only fully trained doctors are normally allowed to do, but to be allowed to you need to demonstrate that you will abide by the rules and protocols that guide you. If you can't even follow something as simple as removing your hat, what hope is there for you when the really tough situations come up? That's why a strict academic setting is necessary. But people are such self centered, lazy, cry babies anymore that the instructors with the honor and dedication to teach paramedicine the way it should be taught take it on the chin by everyone. If some people can't hack it, that's too bad, but learning medicine is not "even if you don't do it right you still are a bigger better person and that's the important thing." That's kindergarten class.

Yeah, and I know plenty of older people who stumble into EMT-B class and expect it to be like basket weaving courses at the YMCA. I remember one 40ish woman who complained to a former EMT-B instructor of mine that she was "disturbed by the gory pictures in the book."

No joke.

I've touched on my paramedic class before, so I won't go into it, but the class was not taught by firemen, it was taught by paramedics who also were nurses, administrators, or had 20+ years of experience. They were brutal, but they were right to be. I came out with an appreciation of prehospital care and its challenges that I think should be instilled in anyone who wears a star of life on their arm.

The problem is this. With more and more schools opening up, what is the incentive for a school to run a course properly? If you're too 'hard' on the students, i.e. hold them to a proper standard, they'll bitch and moan to administration, then demand a refund and go to a a school where the instructors don't put in as much effort and therefore it isn't as tough.

And as for the tests you have to pass at the end, forget it, they don't test how well you can perform in the field, if you're signed off and you can get a 75%, you're a paramedic.

Don't worry though, its not just EMS, its pervasive throughout all of higher education. There was article I read by a professor lamenting the attitudes of his students. He ended it with "Your degree is not a t-shirt. You don't get one just for showing up."

But no matter how much we bitch and moan, there isn't anything you can do to make someone understand why being in a field where you deal with human life and health means you have to put your all into it. If someone is willing to go stick needles in someone when they do not have the basis of knowledge necessary to assess and implement the correct course of action in a patient, how are you ever going to convince them of that? If they don't get why its wrong, you can't make them understand.

How are you going to take a 19 year old kid, who's been raised on microwave dinners, instant access, on demand channels, and tell them "hey, listen, if you want to be a paramedic, you have to really work at it?" You can't. Maybe you'll get the one or two wonder kids who will have that kind of epiphany, about the ramifications of their actions, as some do when they start doing their rotations, but unfortunately they are all too rare.

But what is an instructor supposed to do when he wants to throw a kid out of his class because they're an idiot? If the administrator doesn't work in medicine, they won't understand that you don't want someone who doesn't even have the sense to remove his baseball cap when he is in the classroom playing with drugs that can induce cardiac arrest. In the end, you can lead a student to a textbook, but you can't make him think.

Let's not bring administration into this.

Okay, bear with me now, I realize this may be a little tough for some, but its worthwhile.

'The Matrix' is FANTASY.

Watching movies allows us to be part of action and adventure without anyone getting hurt. It taps in for our need to watch battles between good and evil and be entertained.

We live in REALITY.

In REALITY, people getting killed is BAD. Killing someone, ending their life, and I don't mean standing across the room and taking their head off with a .357, is something not many people can do. Don't believe me? Try pushing adenosine sometime. Try sitting with some poor 78 year old woman who's SVT has gotten out of control, hold her hand, get real up close, and tell her that this is really going to hurt, watch her heart rate slow down and the monitor move towards flatline, maybe even stop (that's called asystole, where yes, my name comes from. I'm not a super ninja stealth assassin. At least not that I admit too), and hope to god the medicine will work like its supposed to and she'll come out of it in a second or two.

Don't do it on a TV screen or in a dark alley, do it in their living rooms in front of their family members who love them very much. And if they code, crack their ribs and work them in front of pictures of them when they were younger, and maybe take notice of their dog looking on anxiously at their master. That's what death is about. That's why I don't do any of those things unless its to save someone's life. So when I hear some muscle bound moron talking about the "combat mindset", I just kind of role my eyes and laugh. He's never had to stick a plastic tube down a four year old's trachea.

This is why I will only do the things I do if it means the chance for someone to live. I won't do it if it means someone will die because of my actions. That's just me, that's why I work at what I do. If you have a different understanding of it, maybe you can find the glory and righteousness of taking someone's life, go for it, apparently there are many people in the world like you. Me, I'm just going to keep on trying to keep everyone breathing using the skills that I have.

:roll:

You know, not for nothing, but even though America's Most Wanted and Nancy Grace and Oprah and Geraldo like to parade out the horror stories of child abduction and rape for ratings, the truth of the matter is that the vast majority of child molestation cases are done by relatives. Yes, pedophiles are bad, but you'll do much more good keeping an eye on your own family then looking in the bushes for the boogeyman.

Anyway, to answer the first question, part of my graduation ceremony included reciting the declaration fo Geneva, I know it isn't a regular thing for most paramedics, but everyone who works for the department is sworn in the same way. The reason the declaration of Geneva was enacted was as a response by the medical community as a whole was as a response to the Nazis perversion of medical science for their own uses. If the person isn't my patient then I have no reason to perform a medical procedure on them. If they are my patient and I am performing a medical procedure on them, I have to abide by the oath I swore too. Even if they're a pedophile.

Maybe you should become a police officer first and let your department pay for it. Just a thought.

The fact of the matter is anybody I perform a medical procedure on is a patient. Look, learn the medical arts, use them for death and destruction, its your choice. When I was sworn in I took the Declaration of Geneva, so I can't do it.

(From Wikipedia)

The Declaration of Geneva reads "AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE myself to consecrate my life to the service of humanity;

I WILL GIVE to my teachers the respect and gratitude which is their due;

I WILL PRACTICE my profession with conscience and dignity;

THE HEALTH OF MY PATIENT will be my first consideration; <--------- !!!!!!!!!!!

I WILL RESPECT the secrets which are confided in me, even after the patient has died;

I WILL MAINTAIN by all the means in my power, the honor and the noble traditions of the medical profession;

MY COLLEAGUES will be my sisters and brothers;

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient;

I WILL MAINTAIN the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity; <-------- !!!!!!!!!

I MAKE THESE PROMISES solemnly, freely and upon my honor.

See, this means "at all times" not "if the patient is innocent or the price isn't right".l

You know, in this crazy world where we pretty much accept lies from our government to go to war, and people look to Paris Hilton and Ashton Kutcher as their personal heroes, this may sound a little odd, but bear with me here...

My point about not taking part in execution is this. When I was sworn in to my position, I raised my right hand and basically said that I would never use my knowledge of medicine to cause harm to a patient. I didn't say "to any patient who has not been found guilty in a court of law..." I said "to any patient." The reason I would not take part in an execution is because I swore that I wouldn't. I took an oath, and I am sworn too it, so no matter how much money you pay me, I'm not going to do it. If 99% of the world will do whatever it takes to make a buck, let them, but not me, simply because I said I wouldn't, not because it wouldn't pay me enough or I might feel guilty about it, I said I would not ever cause harm to a patient, and that is all I need.

The whole reason we have oaths like this is because as everyone knows, medicine can be pretty darn horrible sometimes. The ethical basis of doing the things that we do in medicine is because we are always in our hearts trying to help the patient. Without that ethical tenet, medicine is no different than cruel treatment of humans. That's why these oaths are in place.

Oh please, combat mindset... whatever, no more Jean-Claude Van Damme movies for you.

The point of the matter is that at some level a central theme of medicine, at whatever level, is to do no harm. The secrets of medicine are passed on with the unspoken rule that the knowledge should never be used to knowingly cause someone's death, which is why I wouldn't participate in it. I hit someone on the head with a cinderblock because their attacking, that's self defense. I use my knowledge of medicine to directly cause someone's demise, that, in my mind is wrong. Guilt or innocence has nothing to do with it.

You shouldn't have to check the pulse if there is dependent lividity. In fact, checking the pulse and documenting it on an 'obvious DOA' can get you in trouble. An obvious DOA is just that, obvious, you have no doubt in your mind that any rescusitative efforts would be futile.

>Yeah and firetrucks!!! I'm a V though so it hasn't become a reality for me. I would assume >it'd be with a hot paramedic in the back of the ambulance, since I'm not one... I have a >paramedic/police/firefighter fetish or something.

:shock: You know, saying that on this site is akin to watching the cute little baby harp seal fall into the ocean full of killer whales. These guys can smell blood a mile away. Alright, lets have it orderly, stay behind the velvet ropes, no pushing...

>

PARAMEDICS CAN NOT PRONOUNCE DEATH.. Yea i could have called the >code. But you know that woman that he was married to for 50 yrs was watching and following >tha ambulance in to town. so as much as i wanted to call it i also wanted her to know i did all >that i could do for her husband including CPR for an hour if needed. Their was NO question in >her mind when we were done with our job that we didn't exhuast all available avenues of >treatment including transport to definitive care. One of the six points on the star of life if you >remember. Even the ED worked on him another thirty minutes before calling the code. And yes >by all means take ACLS to the PT. but ACLS is like us, Portable thats why we have ambulances >so we can work while we are being driven to the hospital.

You need to get your priorities in order. The decision to continue a code or terminate it should be based on several factors, including risk to crew and benefit to patient, and also yes, to extent, whether your actions will help the family by letting them know everything was done. But to do CPR for an hour, just to "let her know everything was done", that just doesn't cut it. Let's say that while you were doing your thing a call came in your coverage area for a 2 year old in anaphylaxis. Would it still be appropriate to tie up an ALS unit for the length of time if you knew there was no hope of succesful rescusitiation? Basically EMS is ALWAYS acting in a sort of mass casualty mode, we never have enough resources, we do the most good for the most people, so you have to weigh your decisions not only on what is beneficial for the patient, but also to the community you serve.

>We have everything we need and more in the back of our ambulances and yet so many of us >are afraid to work in it. No where in any ACLS or Textbook i have ever read has it ever said >ACLS can only be worked on scene. That is a stupid thought to have and even worse to put it >in to practice. We have Ambulances LETS USE THEM!!!! They are as much a tool of our trade as >the monitor and stethoscope. They were built to transport patients. Both stable and unstable.

Yes, and we can set up everything we need to treat a non-traumatic arrest in the house, run the arrest, and pronounce if necessary. Guys like me aren't SCARED of working in the back of the ambulance, but I would be stupid if I wasn't WARY of the risks associated with it. Let me ask you this, can ensure an appropriate titration of Dopamine in a swinging IV bag? Can you take adequate breath sounds, making the subtle distinction between coarse rales and ronchi over a diesel engine? Can you be sure of an EKG tracing with the movement associated with an ambulance? If not, then you cannot perform good ACLS in the back of an ambulance. This isn't to say you shouldn't ever play and run, but these are things that need to be considered.

>A bit of Hx. this man was a very active member of the community and had no past medical >history. No CHF, No AMI's, No cancer, No hypertention, No anything. had never been on any >prescriptions. Just led a simple farmers life. he was also my friend. that too made a difference.

I understand working on your friend must have been very difficult. That's why personally I think EMS providers should try to work in areas that are outside of where they live. I never want to have to work on a friend, I don't think anyone should have too.

>But also what good does it do a PT if they need a treatment that you can not give in the field to >remain on scene? things like Hemothorax, pericardial tamponade, things like this that we can >not or usually are not allowed to treat. there is not always tell tale signs on the outside to see >whats going on inside.

If the patient was in cardiac arrest from a hemothorax, pericardial tamponade, etc., doing CPR for an hour and then hoping appropriate intervention is going to save him is still and act of futility.

>The man collapsed and his heart stopped. well ok. I guess i ll stay here and see what happens. >If he opens his eyes and says quit jumping up and down on my chest ... well then ill take him >to he hospial. but if he doesn't in 30 minutes well then he's dead. Never mind the fact that he >was in a Minor MVA earlier in the day that his family didn't think to mention. I don't have X-ray >vision, missed that day in medic class i guess.

No, if the patient responds to ACLS intervention, then we can continue treatment and transport. If he does not, then we should consider the appropriateness of ceasing rescusitative efforts. And if he has not responded after 30 minutes, if there is no change in the rhythm or hemodynamic status, then yes, that is very good criteria for calling the doctor for a pronouncement. You said it before. We are there for the patient. And sometimes, the best thing for the patient, as hard as it is to accept, is to let them go. I'm talking here strictly from the ethical sense. Your decisions in the field are never going to be black and white, and the same is true with this call.

I think the fact that providers are doing CPR for 40 minutes anywhere speaks volumes about the need for drastic changes in EMS. Not in terms of response, but seriously, after 40 minutes of CPR you really think there is going to be any chance of saving this guy? You're going to risk a helicopter evac for a cardiac arrest on a mountain top after 40 minutes of CPR? Okay, tell me, which is more likely, a helicopter crash killing all aboard, or a person being succesfully revived with good return of function after being in cardiac arrest for over an hour?

Given my salary, I'm getting darn close.

The person below me has at least once wondered what sex in the back of an ambulance is like, and then thought about who it would be with