JPINFV

No argument, although there are a surprising number of folks who experiment. I worked with a woman who changed teams almost daily. First she said she was hetero, then she was bi, then she was a lesbian, then she went back to hetero and married a guy. Seriously screwed up in the head, but that's another story...

I do believe there is no doubt people are born with their sexual orientation. How you may chose to ACT is another issue.

A few quick probing questions regarding "sexual orientation" (quotes will make sense as you read the questions), even if not totally germane to gay marriage:

Is sexual orientation ternary (binary but with 3, yes I had to use Google to find the term, I'm not that smart) (homo, bi, hetero), or is there a spectrum?

Can sexual orientation be like other tastes? I like pizza, but I don't like pizza every day.

Is sexual orientation and romantic attraction the same thing? Can someone enjoy homosexual sex, but not want to marry someone of their own sex/gender?

Is sexual preference the same as sexual urge? Can you enjoy and engage in a type of sex (thus being a choice) without having an innate urge to engage in a type of sex (non-choice)?

If you don't experiment, can you really say you aren't ____? Ever "not liked" something up until the moment you tried it?

Here's where it gets sticky, if you ask me. As I said before, we are changing an essentially eternal definition- marriage. Up until recently, there was no question about how you define a marriage. NONE. In the traditional sense, the VAST MAJORITY of people got married to share their lives, and to start a family. Again- until very recently- in terms of mankind- the only way to have your own biological family was via heterosexual sex. We'll leave adoption out of this mix for now. Yes, many people now define marriage as more of a business arrangement, but again, I'm talking traditional definitions.

I'd argue that marriage has for much longer been more of a business and social decision than a love/share life/raise a family decision. Actually, I'd argue that, if anything, the business side has gone down drastically. When was the last time you've heard patriarchs arranging marriages for various reasons? When was the last time you've heard about a bride giving her husband's family a dowry? Even the Code of Hammurabi had laws governing dowrys. If anything, up until recently marriage was a business decision. Then there was a period where it was about love and raising a family, and now it's about legal protections and rights (imagine if you couldn't make medical decisions for your spouse who is in a coma).

However, if we want to talk about "traditional marriage," I'm up for hearing your justification for bringing back dowrys and the wife submitting to the husband. After all, those have been tradition for much longer than they have not been.

My point is- we are playing God. No, not in the religious sense but as in a mother nature way. We are tweaking life, creating it in artificial ways, and my gawd- even decided that the sex we were born with can and should be changed.

Is not the entire practice of medicine the mere act of playing God? If God is to decide who lives or dies, who are we, as health care providers, to intervene in God's will. After all, if God intended someone to die of pneumonia, who are we to deny God that by giving antibiotics? Similarly, if God decided to cure someone of pneumonia, why would he need us to give antibiotics?

Now instead of asking, "Who are we to play God," we should be asking, "To what extend should we play God?"

In regards to sexual reassignment, what happens when sex doesn't match gender? Furthermore, how do we define sex? Is it chromosomes? If so, then should we force every woman with androgen insensitivity disorder or 5-alpha reductase deficiency to get a penis (after all, they are XY, and by chromosomal definition male)? If it's about the organs an individual is born with, then what happens when they are ambiguous? Is that a small penis or an enlarged clitoris (look up pictures of congenital adrenal hyperplasia and guess the sex before looking up the disorder)?

If a person's sex doesn't match their gender, then how is sex reassignment any different than a boob job or face lift? Where is the justice in saying a woman with a penis must live with the penis, but we can fix the woman with size AA breasts? Shouldn't the woman with small breasts submit to God's will that she have small breasts?

edit: After all, is sex reassignment really anything more than cosmetic surgery? Taking a relatively fit male, and a shave, wig (or just long hair), the right clothing, the right padding, the right makeup, a little voice training, and you can probably get a relatively convincing female appearance. It would be relatively easy to legally change names to a unisex name. Besides that, names over time change from one gender to another (I had a male classmate in high school whose name was Ashley, there was no question that he was straight or that he was male), and it would be trivial to choose one of those names. So there's nothing stopping transexuals from going out and acting and dressing like the opposite sex. /edit.

Now we note the difference between us and animals. If we are biologically programmed as males NOT to be monogamous, then why are we so picky about who we copulate with? I doubt a simple social stigma would deter many folks if this was such a base desire.

Why not? Look at the Catholic Church molestation cases and the Penn State case. Look at rape. If simple social stigmas about sex means that boys who were molested (OMG, the boys are gay) and rape victims (the victim was obviously was asking for it, and doubly so in man on man rape) can force victims to not come forward, can it similarly make men and women suppress urges?

...

We make choices based on societal standards, moral and ethical concerns.

Emphasis added.

Didn't you just say that such simple social stigmas wouldn't deter folks with a base desire?

I love my wife and admit that she wears the pants (I get to wear the scrubs).

To be fair, though, I've never fully understood why skirts are seen as divinely feminine. If skirts/tunics were good enough for the roman legions, and robes good enough for Jesus...

We've gone from a more conservative norm all the way to a "if it feels good, do it, anything you say or do is OK, and nobody has the right to disagree with you" attitude.

Examples include- what we accept as appropriate language in public today, on the airwaves, in a business or social setting, or interpersonal communications. Relaxing of dress standards in the work place, relaxing of proper manners in formal and/or casual settings, etc. Sexting, sending dirty pictures via your phone or lap top, forwarding dirty jokes to a dozen people at a time- this is pretty damned bold and would be considered perverse compared to just a few years ago.

I think that there's a difference between how society should view things and what should be legal/illegal. I think that adultery is morally and ethically wrong. However, I don't believe that it should be a crime or anything that the government should regulate. Most of the examples that you used are a failure of the individuals in society to enforce their views, determine who their employees are, and determine who their associates are. Dress standards? Set and maintain a dress code and fire those who don't conform. People don't have proper manners? Don't associate with them. Forwarding dirty jokes to coworkers who you don't know for certain has a similar sense of humor? That should get discipline up to, and including, termination.

However, when dealing with what the -government- should regulate through the legal system, we now have to determine what rights individuals have. Just because someone has a right to do something doesn't mean they should, however if someone has a right to do something then they have to enjoy -legal- protection for the exercise of those rights. Otherwise they aren't rights. However, having protection from legal consequences and having protection from community consequences (boycotts, isolation, etc) are two drastically different things.

but should the "Well, it doesn't affect me directly, so why not do it" mentality really be the yardstick we use to measure acceptable behavior and/or adopt new standards? Is that all we really should expect from our fellow citizens? To me that's setting the bar pretty damned low.

I do think it's the bar that should be set for legal regulation. I think there needs to be a compelling reason for actions to be considered illegal, and many of the vice laws don't really meet that standard. Government should be in the business of protecting rights and administering public goods, not enforcing morality. There needs to be something more than religion or "I find it icky" to justify banning something. If you don't find that polygamy affects you, why should it be banned?

2 gays marrying can't be any worse than the bastardization of marriage known as Kim Kardashian.

I am quite the libertarian when it comes to what two consenting adults want to do with their free time. I'm also not opposed to gay marriage. I can even empathise somewhat as I've been on the receiving end of a bit of hate regarding my choice of lifestyle. Apparently, it's only acceptable for old fart guys to marry young woman, but a cougar-cub relationship is taboo in some circles.

Pfft. The biggest amount of stupidity is the teacher student circles. Male teacher, female student? Burn him alive for taking advantage of the poor young flower. Female teacher, male student? Give the student an award!

Well, there was that RN in Florida who gave pancuronium instead of pepcid with predictably results.

I thought a heavy pull was a obese patient on a steep incline. darn,

For the interest of those not familiar with firearms...

...but seriously, compare the pull of a double action, single action, and semiautomatic handgun. Complete difference between the double action and the others. The single action is safer than the semi because it has to be cocked first.

The bigger issue I see is, who is going to sign off as your medical director?

Issue 1. Issue 2 is would standard EMS laws, protocols, and polices also apply? I think this would be much easier using an RN than a paramedic given the practice legalities involved.

Yes croaker, EMTs/medics work in all kinds of non-ambulance roles: Sports Medicine, Urgent Cares, ERs, Nursing Homes, Private Sitters, Draw Labs and do EKGs for health/life insurance providers, prisons, fixed wing air medical, factory safety officers, so this is not out of the realm of possiblity.

However many of those positions are not working off of their EMT or paramedic license. The job description requirement is more for the knowledge base than the legal authorization to provide otherwise restricted services.

Dear thieves,

The norcuron gives a great high. Please start with this drug, it's to die for.

Sincerely,

Society.

Yes.. but does a helper monkey have cleavage?

Breast or butt cleavage?

2000 was the closest I could find on injuries alone, there are more current studies but many do not separate death from injury, or do not separate homicide, suicide, and accidental.

Of course the other question is, "How is injury defined?" I've had a firearm injury before (stupid damn slide on my Father's Beretta model 1934). No bullet holes yet, and it wasn't reported so I'm not a statistic anyways. Furthermore, what's the per capita injury rate, and how does that compare to, say, injuries and deaths due to automobiles?

P.S. We have not even broached the whole flea/tick issue. You assume that this blind patient keeps this dog spotlessly clean, there is equal chance that they do not.

Can we keep SNF patients off the ambulance since there are equal chances that they have scabies?

So if a convicted felon working at a 7-11 shows you ID and signs a piece of paper, you would give them a handgun?? WTF?

More important, if an EMS provider hands over my property to some random civilian and it gets "lost," I'm going after the provider who decided to give my property away.

23,237 accidental non-fatal gunshot injuries in the United States during 2000. During the same period there were 215,836 Active License Holders in the state of Texas alone, More than 800,000 in Florida. This is more than one million people who legally carry guns in just two states

Are those registered owners or just CCW licenses? Let's also not forget that not all states require all firearms to be registered. California, for example, only requires "concealable firearms" (e.g. handguns) to be registered and doesn't require registration (or even reporting for transfers between family members) for rifles and shotguns.

For revolvers DONT PULL THE HAMMER BACK .. sheesh no one ever watch the Lone Ranger ?

Thanks for your support

Really depends. My father's old .22 revolver requires it to be quarter cocked before you can rotate the cylinder to unload it with the push bar. Of course with revolvers I'd be a bit more comfortable storing loaded revolver than a loaded semi-automatic since revolvers either require it to be cocked (single action) or have a heavy pull (double action).

I wonder how so many "experts" end up accidentally shooting themselves, family members and friends when they have handled their gun many times.

...because they fail to follow the simple rules for handling firearms. Yes, I never fail to follow the handful of simple rules for handling firearms because I take firearms deadly serious, even though my primary purpose of using firearms is for fun (trap shooting).

Should I allow someones illegal cocaine in my bus as well because it is their property, how about their kiddie porn videos ? I would give the gun to someone and have them sign for it, not putting it in my ambulance, if it gets lost so be it. If you are dispatched to person down with gun in hand, are you going in or staging for PD ? If it is unsafe enough to keep you off-scene it is not safe in your ambulance.

Cocaine with out a DEA number or prescription (cocaine is a schedule II drug)? Illegal.

Child pornography? Illegal.

Having a firearm? Not illegal depending on the circumstances (license to carry, in one's house, firing range, etc).

What if no one is around to sign and take possession of the firearm? Do police respond to every call you get? Do you never end up responding to someone who is alone at the time of the emergency?

Gun in hand, and in possession of a gun are 2 drastically different things.

Holsters? How do they work?

No firearms in my bus ever, PERIOD. How can you claim to be a safety advocate and then put a loaded gun in your ambulance, or claim that you will handle a weapon you may have never seen, and attempt to unload it ?

1. Would that go for your "hardbody cops" as well?

2. What other objects do you not allow? If a patient has pepper spray on a key chain, do you refuse to transport them unless it gets left on the side of the road as well?

3. I'm fairly confident in my ability to safely handle all handguns in the same manner that I'm confident in my ability to handle all cars, even if I haven't been trained in driving every specific make and model ever made.

4. Finally, if you ever want to know a reason to carry a firearm, I highly suggest reading up on Warren v District of Columbia (1981).

So what is your answer to the scenario?

[biting sarcasm]

He bought his gun, he knew what he was getting himself into. Let him die.

[/biting sarcasm]

what would you do street sweeper? or what do you think would help this patient without much effort?

Amateur...

Vomiting patients get a food bag. Take 1 red bag, Put hole near top of red bag in one wall of bag. Put patient's head through hole.

Would there be enough energy passing through the firearm and resistance to heat up the bullet enough to cook it off?

EMS Myth Busters!

An external compartment would be a great idea that I hadn't though of. I was thinking of giving the gun to the driver and not allowing the grandson to ride along.

My concern with an outside compartment is that the outside compartments are often not locked, and having a firearm in an unlocked compartment is not a secured firearm.

An articulate, well thought out educated postion..

More importantly, it's what the constitution says. The president gets to run the war (as commander in chief), but he doesn't get to decide if or when we do go to war.

True, he is just too far left for me. Sitting within our own borders and hoping no one attacks us is not what i call defense

1. To be fair, Ron Paul's response at the foreign affairs debate (last night) was, "I don't go to war. Congress goes to war. If Congress wants to go to war, they can declare war and we'll go to war."

2. ...because everyone else, besides Bachmann, who was asked last night responded with a better option, sanction or invade Pakistan. After all, it isn't like Pakistan has nuclear weapons and a grudge against a neighbor who also has nuclear weapons.

3. The United States currently presents a danger to Mexico via programs like the ATF's Operation Fast and Furious. Would you feel comfortable if the Mexico military took proactive action inside the borders of the United States in order to prevent our assault weapons from making it into Mexico?

her sat was 79, but she appeared to be on O2 because she had a NC on.

You know what's worse than a patient with an SpO2 of 79? A patient with an SpO2 of 79 who's already on supplemental oxygen.

They thought the O2 wasn't necessary.

Since the patient already had a nasal cannula on, I wonder if the patient was normally on supplemental oxygen. If so, then their conduct was tantamount to malpractice.

The patient was not that serious, but had she had O2,

Assuming the SpO2 was accurate, how is a patient being profoundly, severely, and symptomatically hypoxic "not that serious"?

Two more quick comments in regards to my last post.

1. Electronic billing and ePCRs are not the same thing. If you bill medicare, you bill electronically regardless of if you use paper or ePCR.

2. HIPAA is not the end all, be all of privacy rules. State rules may be cover you regardless of if you are covered under HIPAA and may be more strict with what can or can't be shared and the conditions required to do so. This is another reason why people need to stop using "HIPAA" as meaning "privacy laws."

JPINFV - Upon review my prior response was obtuse. My interest has been resumed by your last post.

Thank you for posting the statutes.

No worries. I posted those examples in the first one because "treatment, billing, and healthcare operations" is the specific phrase used, but we've all heard or experienced the situations where someone is complaining or concerned about passing on information or getting the sealed envelope that's "for the hospital." Similarly, there's generally at least one person who's surprised that if you don't bill electronically then you don't have to follow HIPAA since you aren't a "covered entity."

We pretty much operate the same way as Ruff. We can only say if they are there or not. The pt can tell the caller all they want to, but we cannot. The problem with something as big and vague as HIPAA is that it is open to interpretation. Our lawyers have decided that it means we cannot notify the police if a pt has been assaulted, etc with certain exceptions such as child abuse or if a knife or gun was involved. We have had a few instances where the police bring someone in and say they are arresting them but will be back in 12 hours when they are sober. We've been told that we cannot notify them once they are sober. If the pt chooses to leave once they are sober we have no grounds to keep them. We are not cops so we cannot detain them against their will at that point, but it is violating their HIPAA rights if we let the police know the pt is ready to go.

....but...

"Permitted Uses and Disclosures. A covered entity is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations: ... (5) Public Interest and Benefit Activities; ... Covered entities may rely on professional ethics and best judgments in deciding which of these permissive uses and disclosures to make.

...

(5) Public Interest and Benefit Activities. The Privacy Rule permits use and disclosure of protected health information, without an individual’s authorization or permission, for 12 national priority purposes.²⁸ These disclosures are permitted, although not required, by the Rule in recognition of the important uses made of health information outside of the health care context.

...

Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.^34"

Underline added.

It would be interesting to know how your lawyers and the CMS lawyers interpreted the statute differently.

The name of the hospital where you transported your patient is not PHI, but it becomes up to a witness or a victim to cooperate with the police once they are tracked down. Unless a law mandates reporting of a crime- ie abuse, neglect, injury on public property, GSW's, etc- then it's up to the victim/patient to determine if they want police involvement- not us. We certainly can make the notification for them if they want, but that's the extent of our responsibility.

However, none of those were HIPAA violations, which was the point I was trying to make and none of those require the patient's permission to disclose.

I don’t understand why this is difficult. Just don’t disclose patient information.

[deliberately taking this out of context]

So we can't disclose patient information to hospital staff, billing, or CQI (respectively treatment, billing, healthcare operations)?

So we can't disclose patient information when we believe a crime has been committed? How about a detective asking questions regarding where you took a witness?

Just to clarify something. I wasn't necessarily suggesting those courses. Those courses were simply my college course load at the time I took my EMT course.

Personally, I had no problem taking EMT class along with several other courses (genetics, organic chem 1, and 1 or 2 other classes that I can't remember right now). Personally, I found EMT class to be very very basic and easy.

It's not something that can be stopped, and trying to stop it is normally stupid and counter productive. Don't be the two people in these videos.

http://emtmedicalstudent.wordpress.com/2011/09/13/in-the-news-ems-vs-press/

/shameless plug.

//Keep a blog so that I can post a link in threads like this.