Urbanmedic461

I'm currently working on a research paper for my advanced care training. My focus is on the need for change in prehospital treatment of CHF/Cardiogenic pulmonary edema. What I'm looking to find is if any services out there are currently using ACE inhibitors in their Cardiogenic Pulmonary edema protocols. More specifically the use of sublingual captopril, and to a lesser degree IV enalapril. If your service, or a service you know of currently uses this treatment I would like to know about it. If you could reply with some info (country, city, ACE inhibitor used, and dose) it would be much appriciated. If you could pass along a copy of the actual protocol that would be even better! Also any insight or debate on the subject would be welcomed. FYI - Main points of my paper *Obviously the inclusion of sublingual captopril *Removal of furosemide all together *Use of CPAP *Create a more systematic approach to CHF/CPE protocol all together. I may post up my paper once it has been reviewed and marked.

I fully agree with you, just thought this is what the original poster was looking for. Also to add to your last point, not just increased education but also a change in idealism in regards to what is "common pratice" vs. "intellectual practice", "the bigger picture"....not just individual skill based concentration.

OPALS Study Fails to Demonstrate Advanced Life Support in Field Better than Basic Support (April 22 CMAJ) Advanced Life Support in Field Not Beneficial in Trauma Cases (April 22 CMAJ - Interview with Dr. Ian Stiell) Videos ---> http://www.cmaj.ca/cgi/content/full/178/9/1141/DC3?ck=nck Full text article ---> http://www.cmaj.ca/cgi/content/full/178/9/1141?ck=nck

Prehospital treatment of CHF. Including: -the use (or lack of) portable Bipap units -Sublingual administration of Captopril or other ACE inhibitors vs. administration of nitrates and Lasix -Combinations of available treatments that won't buy someone an ICU bed

Believe it they can explode...see video for proof

They weren't even good at it

We've now hit 4 hour off-load delays. I've even had an active chest pain on off-load for 1 hour. Another one with stroke symptoms onset >6 hours, off load delay 1.5 hours....

Does anyone have information on pay, scope of practice, etc... for UAE (Abu Dhabi and Dubai). Anyone on here work there, or know someone who does? I found their website and others, but they really didn't have a whole lot as far as pay, scope, etc... I've had enough of these Canadian winters. From what I've researched Abu Dubai looks like a great place. Next to no crime, great climate (other then the sandstorms), friendly, cultural diversity (accepted cultural diversity I might add), etc.. **EDIT** The main reason (other than hating winter) is I see there is a huge need for medics there. And by the look of the growth they're having there will be an even greater demand coming.

From Wikipedia. Some key dates throughout. Early civilian ambulance services While communities had organized to deal with the care and transportation of the sick and dying as far back as the plague in London, England (1598, 1665), such arrangements were typically temporary. In time, however, such arrangements began to formalize and become permanent. During the American Civil War, Jonathan Letterman had devised a system of forward first aid stations at the regimental level, where principles of triage were first instituted. Letterman, with the rank of major, served as the medical director of the Army of the Potomac. He established mobile field hospitals to be located at division and corps headquarters. The United States Army had reeled from inefficient treatment of casualties, in part because of the adoption of new firearm technology such as breech-loadingrifles and Minié ball systems. Letterman established mobile field hospitals to be located at division and corps headquarters. This was all connected by an efficient ambulance corps, established by Letterman in August 1862, under the control of medical staff instead of the Quartermaster Department. Letterman also arranged an efficient system for the distribution of medical supplies. His system was adopted by other Union armies and was eventually officially established as the medical procedure for the entirety of the United States' armies by an Act of Congress in March 1864. Following the American Civil War, some veterans began to attempt to apply what had they had seen on the battlefield to their own communities, through the creation of volunteer life-saving squads and ambulance corps. This translation to civilian use did not occur in the same way everywhere; in Britain, early civilian ambulances were often operated by the local hospital or the police, while in some parts of Canada, it was common for the local undertaker (having the only transport in town in which one could lie down) to operate both the local furniture store (making coffins as a sideline) and the local ambulance service. In larger centers in various countries, such services might fall to the local Health Department, the Police, the Fire Department, or some combination of all of the above. Once again, the civilian model followed the lead of the military; although there were a handful of motorized ambulances just prior to the First World War (1914-1918), the concept of motorized ambulances was proven first on the battlefield, and spread rapidly to civilian systems immediately following the war. There is some debate as to when the first formal training of "ambulance attendants" began. The generally accepted belief is that this occurred in the United States, at Roanoke, Virginia, with the Roanoke Life Saving and First Aid Crew, under Julian Stanley Wise, in 1928. While this may have been true of the U.S., Canadian records indicate the members of the Toronto Police Ambulance Service received a mandatory five days of training, conducted by St. John, as early as 1889 [5], and well developed printed manuals, clearly beyond the scope of simple first aid, were present in England even earlier. In terms of advanced skills, it is known that, once again, the military led the way. During the Second World War (1939-1945) and the Korean Conflict, battlefield 'medics' were administering painkilling narcotics by injection, as emergency procedures, and 'pharmacists' mates' on warships without physicians were permitted to do even more. Korea also marked the first widespread use of helicopters to evacuate the wounded from forward positions to medical units, coining the phrase 'medevac'. These innovations would not find their way into the civilian sphere for nearly twenty more years. Pre-hospital medicine By the early 1960s experiments in improving care had begun in some civilian centres. The first such experiment involved the provision of pre-hospital cardiac care by physicians in Belfast, Northern Ireland, in 1966 [6]. This was repeated in Toronto, Canada in 1968, using a single ambulance called Cardiac One, staffed by a regular ambulance crew, plus a hospital intern, who was tasked with performing the advanced procedures. While both of these experiments had certain levels of success, technology had not yet reached the required level (the Toronto 'portable' defibrillator/heart monitor was powered by lead-acid car batteries and weighed nearly 100 lbs.). The required telemetry and miniaturization technologies already existed in the military, and particularly in the space program, but it would take several more years before they found their way to civilian applications. In North America, physicians were judged to be too expensive to be used in the pre-hospital setting, although such initiatives were implemented, and in some cases still operate, in the United Kingdom, Europe, and Latin America. Around 1966 in a published report entitled "Accidental Death and Disability: The Neglected Disease of Modern Society", (known in EMS trade as the White Paper) medical researchers began to reveal, to their astonishment, that soldiers who were seriously wounded on the battlefields of Vietnam had a better survival rate than those individuals who were seriously injured in motor vehicle accidents on California freeways. Early research attributed these differences in outcome to a number of factors, including comprehensive trauma care, rapid transport to designated trauma facilities, and a new type of medical corpsman, one who was trained to perform certain critical advanced medical procedures such as fluid replacement and airway management, which allowed the victim to survive the journey to definitive care. As a result, a series of grand experiments began in the United States. Almost simultaneously, and completely independent from one another, experimental programs began in three U.S. centers; Miami, Florida, Seattle, Washington, and Los Angeles, California, the first of these to go from being an experiment, to being a working unit, was in Los Angeles, with the passage of the Wedsworth-Townsend Act, other staes would soon push their own Paramedic bills through, and soon, every fire department in every major city in the country had their own paramedic squads. Each was aimed at determining the effectiveness of using firefighters to perform many of these same advanced medical skills in the pre-hospital setting in the civilian world. Many in the senior administration of the Fire Departments were initially quite opposed to this concept of 'firemen giving needles', and actively resisted and attempted to cancel pilot programs more than once. The public discovers paramedicine In a curious example of 'life imitating art,' television producer Robert A. Cinader, working for producer Jack Webb of Dragnet and Adam-12 fame, happened to be in Los Angeles' UCLA Harbor Medical Center, doing background research for a proposed new TV show about doctors, when he happened to encounter these 'firemen who spoke like doctors and worked with them'. This novel idea would eventually evolve into the Emergency! television series, which ran from 1972-1977, portraying the exploits of a new group called 'paramedics'. The show captured the imagination of emergency services personnel, the medical community, and the general public. When the show first aired in 1972, there were exactly 6 paramedic units operating in 3 pilot programs in the whole of the United States. No one had ever heard the term 'paramedic'; indeed, it is reported that one of the show's actors was initially concerned that the 'para' part of the term might involve jumping out of airplanes! By the time the program ended production in 1977, there were paramedics operating in every state. The show's technical advisor was a pioneer of paramedicine, James O. Page, then a Battalion Chief responsible for the 'paramedic' program, but who would go on to help establish other paramedic programs in the U.S., and to become the founding publisher of the Journal of Emergency Medical Services (JEMS). Evolution and growth Throughout the 1970s and 80s, the field continued to evolve, although in large measure, on a local level. In the broader scheme of things the term 'ambulance service' was replaced by 'emergency medical service' in order to reflect the change from a transportation system to a system which provided actual medical care. The training, knowledge base, and skill sets of both Paramedics and Emergency Medical Technicians (both competed for the job title, and 'EMT-Paramedic' was a common compromise) were typically determined by what local medical directors were comfortable with, what it was felt that the community needed, and what could actually be afforded. There were also tremendous local differences in the amount and type of training required, and how it would be provided. This ranged from in service training in local systems, through community colleges, and ultimately even to universities. In the U.S. the community college training model remains the most common, although university-based paramedic education models continue to evolve. These variations in both educational approaches and standards led to tremendous differences from one location to another, and at its worst, created a situation in which a group of people with 120 hours of training, and another group (in another jurisdiction) with university degrees, were both calling themselves 'paramedics'. There were some efforts made to resolve these discrepancies. The National Association of Emergency Medical Technicians (NAEMT) along with National Registry of Emergency Medical Technicians ((NREMT) attempted to create a national standard by means of a common licensing examination, but to this day, this has never been universally accepted by U.S. States, and issues of licensing reciprocity for paramedics continue, although if a EMT obtains certification through NREMT (NREMT-P, NREMT-I, NREMT-, this is accepted by 40 of the 50 states in the United States. This confusion was further complicated by the introduction of complex systems of gradation of certification, reflecting levels of training and skill, but these too were, for the most part, purely local. The only truly common trend that would evolve was the relatively universal acceptance of the term 'Emergency Medical Technician' being used to denote a lower lever of training and skill than a 'Paramedic'. During the evolution of paramedicine, a great deal of both curriculum and skill set was in a state of constant flux. Permissible skills evolved in many cases at the local level, and were based upon the preferences of physician advisers and medical directors. Treatments would go in and out of fashion, and sometimes, back in again. The use of certain drugs, Bretylium for example, illustrate this. In some respects, the development seemed almost faddish. Technologies also evolved and changed, and as medical equipment manufacturers quickly learned, the pre-hospital environment was not the same as the hospital environment; equipment standards which worked fine in hospitals could not cope well with the less controlled pre-hospital environment. Physicians began to take more interest in Paramedics from a research perspective as well. By about 1990, most of the 'trendiness' in pre-hospital emergency care had begun to disappear, and was replaced by outcome-based research; the gold standard for the rest of medicine. This research began to drive the evolution of the practice of both paramedics and the emergency physicians who oversaw their work; changes to procedures and protocols began to occur only after significant outcome-based research demonstrated their need. Such changes affected everything from simple procedures, such as CPR, to changes in drug protocols. As the profession of paramedic grew, some of its members actually went on to become not just research participants, but researchers in their own right, with their own projects and journal publications. Changes in procedures also included the manner in which the work of paramedics was overseen and managed. In the earliest days of the field, medical control and oversight was direct and immediate, with paramedics calling into a local hospital and receiving orders for every individual procedure or drug. This still occurs in some jurisdictions, but is becoming very rare. As physicians began to build a bond of trust with paramedics, and experience in working with them, their confidence levels also rose. Increasingly, in many jurisdictions day to day operations moved from direct and immediate medical control to pre-written protocols or 'standing orders', with the paramedic typically only calling in for direction after the options in the standing orders had been exhausted. Medical oversight became driven more by chart review or rounds, than by step by step control during each call. Evolution in other jurisdictions In other places, the evolution of paramedicine occurred somewhat differently. In Canada, for example, there was an early, but unsuccessful attempt to introduce paramedicine. In 1972, a pilot paramedic training program occurred at Queen's University, located in Kingston, Ontario. The program, intended to upgrade the mandatory 160 hours of training then required for 'ambulance attendants', was found to be too costly and premature. While the program operated for two years and produced a number of graduates, it would be more than a decade before the legislative authority for them to practice was put into place. The program then moved in another direction, providing 1,400 hours of training at the community college level, prior to commencing employment. This change was made mandatory in 1977, with formal certification examinations being introduced for the first time in 1978. Similar, but not identical, programs occurred at roughly the same time in the Province of Alberta, and in British Columbia, through its Justice Institute. Other Canadian provinces gradually followed, but with their own education and certification requirements. Advanced Care Paramedics were not introduced until 1984, when Toronto trained its' first group internally, and the process continued to spread across the country. The current model in Ontario calls for a two year community college based program, including both hospital and field clinical components, prior to designation as an Advanced Care Paramedic, although this is gradually evolving in the direction of a university degree-based program. Some services, such as Toronto EMS, continue to train paramedics internally (indeed, Toronto EMS is accredited in its own right by the Canadian Medical Association as an Advance Care Paramedic training academy). In the United Kingdom, ambulance services became largely municipal services, with some exceptions, shortly after the end of World War Two. Training was frequently conducted internally, although national levels of coordination led to better standardization of staff training. All public ambulance services are currently operated by regional entities, most often 'trusts', under the authority of the National Health Service. Tremendous standardization of training and permitted skills has also occurred. The English model utilizes, two levels of ambulance staff. The first of these is 'Ambulance Technician'. This role is not a paramedic, but more closely corresponds to the EMT role in the United States. Most services train these individuals internally, using a common curriculum. The second role is that of 'Paramedic'. These are practitioners of advanced life support skills, similar to U.S. paramedics. Initially, many of these individuals were trained internally by the services that employed them, with the step to Paramedic being a logical career path progression for an experienced Ambulance Technician. Increasingly, this trend has moved toward training in the University system, with the entry level for Paramedics being an Honours Bachelor of Science degree in Pre-Hospital or Paramedic Care. Some British Paramedics have been further elevated, into the role of Paramedic Practitioner, a role that practices independently in the pre-hospital environment, in a capacity similar to that of a nurse practitioner, but with more of an acute care orientation. Some Paramedic Practitioners in the U.K. hold M.Sc. degrees. The growth of a new profession Today, the field of paramedicine continues to grow and evolve into a formal profession in its' own right, complete with its own standards and body of knowledge. What began as a concept of simple 'technicians' with a couple of weeks of training, performing procedures that they didn't fully understand, has evolved into a career that in many cases (U.K., Australia, increasingly U.S. and Canada)requires a university education, and which is, in some locations actually evolving into a second tier medical practitioner. In many places, the practice of paramedics began as an extension of the supervising physician's license to practise medicine. As such, they were absolutely subject to every condition that the physician placed on their practice. More recently, however, paramedics in both the U.K. and some Canadian provinces have been granted the legal status of self-regulated health professions. When this occurs, the individual paramedics are certified and licensed by a College of Paramedicine, created by legislation but run by the paramedics themselves. This body sets standards, conducts licensing exams, deals with complaints regarding individual practitioners, and consults the government with respect to legislation, policy, and regulations. Paramedics are governing and regulating themselves; the true measure of a profession. In the U.S., paramedics are subject to regulation by individual states, and the degree and type of regulation, as well as paramedic participation in that process, varies from state to state.

Not sure where you would find that resource :? Would be interesting none the less. Happy hunting.

I'm thinking that the first "paramedics" would have been ones who went through the "Fundamentals of Casualty Care" course at Canadian Forces Base Borden. I know that Toronto, Sudbury and Sault Ste. Marie (and others that I haven't heard specifically about) had "Orderly Attendants" before this. Drop the broom and run for the truck. There is still one person I work with who had a single digit badge number from the Orderly Attendant days. Sault Ste. Marie had a pretty advanced program that was quickly disbanded once the province stepped in. IVs D-fibs etc... and this was years before D-fibs were officially put on the trucks. The military most likely had the first true medics though. To find a specific person may be difficult.

Not in all areas. With the new base hospital restructuring we'll most likely see expanded scope PCPs across the province in the next few years. Glucagon is there for this very purpose...can't get a line, stick'em with glucagon. Follow that with oral glucose or maybe some food (if they can maintain a/w). If they can't maintain a/w 100% keep attempting that line, initiate transport, prepare for emesis etc.. then repeat glucagon in 20 min if you still can't get the line. I can't believe thats what your preceptor told you...she shouldn't be preceptoring and maybe she should get a preceptor for herself. You won't kill a patient by giving them glucagon.

If I make it to 103 y/o and any dumb f**k resuscitates me they'll be in need of resuscitation themselves.

Its all about fitness for me. I'm a bodybuilder. I'm 6'5" and 250lbs with bf% around 12-15 right now. Going to cut down some bodyfat for spring and summer. Just the lifting at work alone justify working out. The amount of people in my service on light duty sickens me. How hard is it to put in at least 5 hours a week working out. I do at least 8-10 hours a week and still have a full complete life in all areas. And best of all I feel great all the time. I hate lazy people. Tired is one thing, lazy is just ignorant. No it isn't professional to be huffing and puffing just carrying your bags into a house, nor to smell of smoke, alcohol, etc...

Sorry for the size of the pic, but this is the biggest picture I could find on the internet.

Names have been released. Ornge committed to providing quality health care to Ontario patients Flight paramedics recovering from injuries sustained in Friday's accident TORONTO, Feb. 11 /CNW/ - The dedicated men and women of Ornge, and the families who support them remain committed to providing quality care to the citizens of Ontario. Each and every day, with little regard for themselves they are called upon to assist those who are critically ill and injured. Friday February 8th was no different. While en route to meet a land ambulance the helicopter from Sudbury was involved in an accident. The paramedics on board were Ornge Critical Care flight paramedic Dennis Quenneville, who has been with the air program for the past 11 years and Rob Bird, a 23 year veteran. Bird was treated and released from hospital on Saturday. Quenneville remains in hospital and is being treated for serious but non-life threatening injuries. Also on board were Canadian Helicopters Limited pilots Greg Harper and Michael Bain who also remain in hospital with non-life threatening injuries. "Our flight paramedics care for critically ill and injured patients, these hard working men and women are highly skilled and are capable of providing hospital level complex care in the transport environment," said Dr. Chris Mazza, Ornge President and CEO. "Our medical team includes flight paramedics, transport nurses and transport medicine physicians, who always put the quality care of patients first, I hold them and the pilots in very high regard," he added. "I want to commend the brave men and women of Ornge who risk their lives everyday," said George Smitherman, Deputy Premier and Minister of Health and Long-Term Care. "Our thoughts are with those paramedics and pilots who were injured and we wish them a speedy recovery." Since the air program began 30 years ago, the rotor wing operation has exceeded 150,000 hours of accident free flying. The Transportation Safety Board of Canada is currently investigating the cause of the accident. Ornge operates from a number of bases across the province and performs over 18,000 admissions annually. It coordinates all aspects of Ontario's aero medical transport system, the new critical care land transport program, and the authorization of air and land ambulance transfers between hospitals. Ornge is dedicated to the provision of high quality patient care through innovative transport medicine. For further information: Christine Bujold, Communications Officer, (416) 531-7577

One pilot is still in hospital in Sudbury. The other pilot and medic are in Toronto, this is from a medic at ornge Sudbury base.

DISREGARD THIS POST...Names released in article below.

This was in Lead II. This patient came to me because we were trouble shooting a cardiac monitor that was giving us a had time. So this patient tried on two different monitors and the same tracing on both. This patient is me. That is why I'll be trying to pull up a 12 lead. If I get back to the ER before the end of shift I'll hook myself up. If not I'll be trying tommorow. Just curious if anything was popping out at anyone. And I'll get back to you on the Brugada indications as soon as I get a 12 lead done. Thanks

Sorry I don't have a scan as of now, I am at work. I'll try and scan it in at home. I did some searching and can't seem to come up with exactly what I'm looking for. Is there any real significance to having ST depression with a flat bottom, no slope. Followed by an inverted T wave. Is this normal in younger males? (Patient in question is 24 y/o). Family Hx includes one sudden death at age 33, thought to possibly have been Brugada's syndrome. Patient states sometimes feels a skip in heart rate. Has not had EG done for PVCs. I don't have a 12 lead of this patient, I'll try to track one down. Only real physical history that stands out is a gain of 35 lbs over the last 4-6 months. Patient is a bodybuilder on a bulking up phase. No drugs, only supplements are creatine monohydrate, weight gainers, glutamine. Any ideas? Maybe an aspect I'm not thinking of? Thanks for any responses.

I'm am deeply sorry to hear that.... j/k congrats brother! Welcome to the club!

I wasn't going to post due to the 'taboo/intollerance' for these situations, as I am guilty of doubting these events myself. I am a very 'scientific thinker'. I usually can find an explanation for everything I witness and/or hear about. Now saying that I have however had two situations that I have not been able to explain. I still to this day doubt what I saw, but still can't really explain it. I believe I saw my grandfather who had past many years prior, or at least felt him with me. After replaying it in my head many times I can't be sure if I truely saw him or maybe just felt as though he was with me. Hard to explain but definitly something happened. Could have just been a memory triggering something upstairs for me. Or maybe I somehow let my brain get taken over by emotion for that moment in time and let my brain continue to lie to itself. Second one was in a far north remote hospital. It was a few hours after we worked an arrest, in which we got her back (still alive to this day). My partner and I were in a small storage room (approx. 10" X 12"). This room had two doors, one to the hall, one to the kitchen. Kitchen was closed lights out door locked. The hall we had just came from was empty with no one around. Both doors were closed after we entered. While still in the middle of a conversation I looked to the corner of the room to see an elderly native women with a white sweater and grey hair. I nodded my head to her and say "hey". Turned back to my partner who was now looking towards the same corner. He had a weird look on his face. I turned to the corner again to find no elderly woman standing there. I quickly said "what did you just see?" He says he saw an elderly native woman with a white sweater walking away from the door in the hallway. The door never opened. We both ran to the door opened it and looked around the hall....nobody around. We went down the hall both ways to find nobody. The security guard and nurse on shift never saw anybody. This hospital is very small. There would be no place for someone to walk out of the hall without being seen by the nurse or security. I began to play it down saying "must have been my imagination". Partner replied saying "you said hey and even nodded at her". It was the same description of the woman he saw in the hall. Again the door did not open, nobody was in the room when we went in. Now the family of our arrest 'save' later told us that when she was coming to in the treatment/trauma bay she told family she saw her sister in the room that had died a year ago almost to the day. My rational for that was hypoxia and reoxygenation caused a neuronal firing of some sort causing this vision for her. I however did not suffer a cardiac arrest and although I couldn't see it I bet the air in the storage room did contain oxygen. So scientific me cannot explain this occurance, but still choose to have doubts over what we really saw. I do recall both of us being tired at the time. So for now I'll stick with being tired as the culprit. Stay safe and watch out for the boogy man!

http://www.sudburystar.com/ArticleDisplay....=Carol+Mulligan Paramedics feed those in need at Grace Family Church Posted By Carol Mulligan Posted 1 day ago It was a different kind of care Greater Sudbury's paramedics dished out Saturday evening. Instead of checking vital signs and driving patients to hospital, they delivered a Christmas meal with all the trimmings to dozens of Sudbury residents. Gary Daly said he was overwhelmed with the support of the 160 paramedics who work for Greater Sudbury Emergency Services - and with the generosity of other members of the community. The dinner was Daly's brainchild after a similar event he and colleagues staged in North Bay years ago was a success. Paramedics dug deep to donate money and items for the evening meal when Daly decided to try the idea in Sudbury. So did local businesses, business leaders, churches and other groups. Daly and fellow paramedics Chris Nelson and Frank Laaper helped with the organization. Laaper is also part-time pastor at Grace Family Church and he volunteered the hall. It was decorated for Christmas and lit softly with candlelight. It was a welcoming sight for people coming in out of the cold. At least half a dozen paramedics stood at a makeshift steam table dishing out tender slices of turkey, appetizing stuffing, mashed potatoes and five gallons of hot gravy. Many of their colleagues, spouses and children welcomed guests to the dinner with tuques donated by Tim Hortons and free tickets to raffles for nine large food hampers. The paramedics quickly responded when a female shut-in phoned to see if she could receive a meal and delivered it to her doorstep. There was more than enough food for everyone. Organizers worked all day preparing a meal made up of 20 turkeys, 200 pounds of potatoes, seven huge cans of vegetables and 18 homemade meat pies, eight of them whipped up by Deputy Chief Rob Smith of Greater Sudbury Emergency Services. That massive amount of food was supplemented with several trays of pickles and cheese, 360 bread rolls provided by Weston Bakery and enough desserts to literally feed an army. Daly filled in where he was needed, but kept stopping to marvel at the outpouring of generosity from Sudburians. Staff at Poulton's Independent Grocer passed on a Kris Kringle at work this year and donated the money to paramedics instead, said Daly. Much of that money went toward purchasing sweets. Contributions helped pay for 100 grab bags for children and plenty of door prizes. About 130 people attended the dinner, but Daly hopes that number will grow when word of the event spreads in years to come. When the meal was over, there was a ton of food for people to take home. What they couldn't use was delivered to the Elgin Street Mission. Daly was worried about attendance since this was his organization's first attempt at a Christmas meal. Hearing that 450 people attended the Salvation Army's Christmas dinner "scared us," said Daly, so his group prepared for as many as 350 diners. Daly said he was proud of his colleagues, some of whom worked all day getting ready for the dinner, then had to work 12-hour shifts that night. "I'm pretty proud of how we've all come together for this great cause," said a beaming Daly. There's a saying at Tom Davies Square about the city's paramedics, and Daly said he and his friends proved that in spades with this dinner: "Paramedics are extraordinary people who go above and beyond."

I guess you wanted to see them too. I'll try to get some pics up once I get home. One on the forearm-The old band around tribal design, yes as you may have guessed I got it in highschool. My whole abdomen is done. Navel to zyfoid. I'll have to post a picture to describe it, pretty detailed. Also one on my right delt. Just a basic cultural related tattoo with meaning behind it.

I have three. Only one is visible with short sleeve shirts on. Never had an issue. Nobody really questions it. Quite frankly I don't think people care now-a-days. They're very common, very 'out there'. I may get one more done within the next five years or so, no plans yet, but an option if I feel like it. Now a swastika (for those grey's anatomy watchers) tattoo would be crossing the line. Or anything derogatory, but if they're harmless then so be it.