NREMT-Basic

I too am skeptical of the constant need to break glass and have a great deal of respect for your opinion Dust. That being said, how many vehicle extrications are you running a week over in the sandbox. The fact of the matter is that a car can roll into a ditch, making a roof roll impossible and the windows on the car may well still be intact. Now if I need to assess a patient while Fire is figuring out what they will be doing to extricate, what should I do? Stand outside the car and shout of the patient to check their own vitals? No. If it is impossible to open the doors (which in my opinion should not be done with a rolled car on its roof anyway) and the door glass is intact, it needs to be popped. Thats all. So far in one year, I have broken glass once and it was just a few days ago. The situation was as I described above. The option of waiting around is not always there. We may not be able, as EMS responders, to wait for Fire/Rescue to come up with a plan. It may be that we need immediate access to that patient. So to call anyone who breaks glass a wanker is a little ridiculous. Besides. if you spend your time standing around thinking and not getting to the patient, how exactly are you going to perform as an "adequate medic?" By the way, when I had my accident and the car ended up on its roof in the middle of the desert, the firefighter medic sorta thought it might be a good idea to break the window to gain access to me. I suppose he could have left me there until the glass disintegrated on its own, but I am much happier with my health since he decided to use his center punch. Not everyone works the way you do and yet thousands of lives are saved every year in auto accidents. The fact that everyone doesnt work the way you do does not make them a wanker and breaking glass has, I repeat, nothing to do with ones medical qualifications or skills. It was a slippery slope argument the first time you made it and now you are at the bottom. Also, the nature or severity of the patient injuries is not really an issue which necessarily follows to break or not to break. If the doors wont open and the patient cant open them for you, you need to get to that patient one way or that other, whether they have head lac or a broken neck. Just for the record, where do you stand on roof and dash rollbacks? You said you used your Big Shears to cut kevlar. How often is this necessary? Wouldnt a patient that severly injured have his kevlar blown away or would it be easier and less time consuming to cut the straps and lift the whole vest off? I am honestly asking, since I have no experience with military medicine. Im not really for dragging a patient out through a window I broke. But while Fire is setting up hydraulics to open the doors, I may wish to make initial patient contact and sometimes the only way to do that is through broken glass.

Whit- First off Im not sure who you are ranting at since we all agree, as does the DOT and the NHTSA that your safety and the safety of your partner, is your most fundamental concern. I think perhaps that if you are going to call the PD because an old lady pinches you that you may be over-reacting a touch and should probably plan on spending alot of time in court as well as being laughed at by the responding LEO. As for difficult escape routes, Im sorry to hear that you work for an ambulance company whose rigs have neither a side jump door nor back loading doors. These would certainly facilitate your hasty retreat from the amorous advances of blue haired old ladies with tummy aches. Maybe at your next job the rigs will have doors. Also, if you chose not to go home in the morning because an old lady pinches you, that sounds like a personal decision and one best kept in private. Come one here man. However much coffee you are drinking you should cut it in half. Finally, will you call the police before or after you are battered? Because honestly, laws being what they are, before would be a tad early and after may be too late. You need to find ways, such as those taught by Kip at DT4EMS to defend yourself inside the rig. I have been punched once and grabbed by the throat once and there was no available PD intervention in the back of the rig. Simple tap and escape maneuvers, and pulling over to the side of the road were what was required to regain control of the situation.

I just read Texas State Penal Code 22.01 and 22.02 and do not find the word "verbal." Your state law does however have certain tests in it. Such as, what degree of threat is sufficient to create an apprehension of receiving a battery, and what exactly is a reasonable apprehension. The penal code of your state does say "threat" but threat is also defined under the law as an action, as I say, words may be there but I dont see that written and its a dangerous thing when you begin to extrapolate out from the law in terms of what you think it says. Try this, even in Texas, where, by the way, it is legal to shoot a Law Enforcement Officer who comes onto your property in the dark of night without being previously summoned or dispatched to your address, so it is safe to assume that some of Texas state law is somewhat archane. But as I say, lets try this: You get into a shouting match with a patient in a Texas ambulance and he says, if i get out of these restraints, I am going to choke you to death. Has he, under Texas law, committed assault. No he has not. Especially since your state has decided that assault and battery are inchoate or linked offenses. That is one cannot happen without the other, which shores up the concept of act in furtherance. If he doesnt carry through, he has committed niether offense. "Assault – the attempt to commit battery, or the intent to create apprehension in the victim of imminent bodily harm." Texas State Penal Code Definition of the Term Assault...I dont see the word verbal there, nor does it mention ones spouse, though in most states throughout the country the aspect of self defense includes persons and property, taking in ones house, spouse, children or dwelling (which, under Texas state Penal code can be taken to include your pickup truck. The problem with attempting to interpret law is that when you begin to read a statue, you must start at the beginning and go through to the end, en total. You cannot pick out certain phrases to suit your argument because as soon as you do, someone will come along and point out the part of the law that you didnt bother to read which qualifies and in many cases contradicts itself. You may also carry a loaded shotgun through the city streets of San Antonio and along the river walk and it may be loaded as long as the breach of the weapon is open and its presense does not create or incite a public panic. Nuff Said. Try reading the whole statute. Sometimes you will find out it doesnt say exactly what you think it does when you skim it. And since you are arguing assault as it pertains to the state of Texas, assault must have an element of will to it, that is to say that if the patient is screaming and scared and says something in what is known as an "excited utterance" and it scares you but that was not his intent, it is not classified as an assault because he had not the formed intention of placing you in apprehension of receiving bodily harm. Read the whole law. Its says alot of things you are leaving out. And as for you distaste for legalese...get used to it. You going to hear alot of it in court during your career. I consult with attorneys, both prosecutors and defense lawyers as well as EMS agencies on these matters and have assisted in prosecuting and defending such cases hundreds of times. The fact remains, that even under your broad interpretation of 22.01-2, merely shouting at someone that you are going to hurt them is not enough. No where does your law say this. Ive just spent the last hour reading it. It does include the legal test of "sufficiency." And guess what, what is sufficient to cause you to believe that you are going to be battered will ultimately not be decided by you when you feel scared and slug someone, but rather by a judge and or jury. Your law indicates sufficent threat and while you may determine that at the time you decide to thrown a punch or shove someone, ultimately, the court decides whether that person created such a sufficient threat. And for the record, 22.01(a) defines assault directly as I have quoted it above from your own states statutes available on line. It does not include the language or intent you specify. While a law class is not really sufficient to gain a working understanding of the law, taking the information learned and putting it into practice in court does. Thats where our experience differs. And by the way, 22.01(2) as you cited it, is the portion of the law which states that assault and battery are linked offenses, not a definition of assault.

Actually Brian, assualt is not verbal, at least not solely. If I threaten, at the top of my lungs to beat someone or to shoot or stab them, this is called disorderly conduct, breech of peace, or whatever other turn of phrase your state may have chosen to define the term. Technically, and under the laws of every state, to be legally charged with an act in furtherance. For example, if I say in a very loud voice "I am going to shoot you" I have just committed disorderly conduct or possibly terroristic threatening, though that usually involves another step, say me calling you on the phone or sending you an email that says I am going kill you. For the act to be considered assault, there must be an act in furtherance...IE: I say in a very loud voice "I am going to shoot you" and then I produce a gun. That is assault. The legal definition of assault is "Conducting such action or actions as may induce a reasonable person to be placed in fear of receiving a battery." So assault in not solely verbal. There is also sexual assault, assault with a deadly weapon, etc, but those are not what we are discussing here. Battery on the other hand is usually defined as "unwanted or unlawful touching." A very broad term. Spitting on someone who has not asked you to is battery. Grabbing someones arm is battery. Shoving someone is battery. You get the idea. Battery then becomes aggravated when a weapon becomes involved, when the person is a LEO, a teacher, etc. Police Officers have a force continuum of course which involves everything from restraining a person, to less lethal options, to deadly force. The so called "civilian" self defense laws are much more complex and indeed civilian self defense is much harder to prove. So called "self-defense" is defined as "the use of such force as is necessary to mitigate an immediate threat to person or property." Mitigate...to alleviate. If a person comes at you with a pool cue, and you sock him on the jaw and he falls to the ground, you now have the oppurtunity to run, to retreat. Any further physical force used by you in the civilian world would be considered battery and would likely find you placed in jail as well, if not insted of your attacker. EMS personnel, especially if they belong to a private agency, fall into a legal grey area. The medic/LEO who has developed DT4EMS has addressed this in great length both in his courses, his videos and my personal conversations with him. If you watch his videos, you will notice that most of his work involves a double tap, a shove and most prominently, a retreat in almost all cases. This becomes dicey in the back of a moving ambulance with an EDP or otherwise combative person. I have been on the brunt end of an attack by a patient twice so far. One of the first things one should do, is tell your driving partner to pull over. It is not wise to put the patient out the ambulance as has been previously suggested, since to do so would hold you open to the civil tort action of neglect in that you have taken over medical care for this patient and then ceased that care by removing them from the environment of treatment (in this case, your rig). It is a far far better idea, to remove yourself from the rig, have your partner do the same, and call for police back up at that point. While I agree that the immediately safest option in many cases would be to put the patient out the back of the rig, this will almost certainly open up a legal can of worms, the result of which can very depending on the whim and opinion of the court. The fact is that very few states have written laws regarding how EMS personnel are to defend themselves. In one of my situations, I used Kips double take push off maneuver from DT4EMS. Our protocols in Illinois do not allow for so called "chemical restraint" without prior authorization from medical direction. To answer the "beat the crap out of the patient" question, you only have a right in terms of self defense to use as much force as will stop the attack and allow you to remove yourself from the situation. So if a patient grabs you, and a push off maneuver allows you the time and space to restrain the patient, that is reasonable force. If it requires you to strike the patient because there was no other way for you to protect yourself, you are likely to be called into court, but you are also likely to do fairly well, as long as you can clearly explain the scenario, the patients actions, your response and the outcome. If at any point, it appears that you used one ounce more force than was necessary to immediately mitigate the threat, you may well have legal trouble. Remember, the least amount of force necessary is always the benchmark. For police, EMS personnel and "civlians." Hope this helps Steven KinCannon, NREMT-B/D, Paralegal, Medical Legal Consultant PS- as for Rids theory that alot depends on what has caused the patient to react this way is irrelevant. If you are the victim of an attack, you have the legal right to defend yourself using the least amount of force necessary. As for Asysins suggestion, well its just illegal, he knows it and is trying to appear, like I dont know what. Anyone who indicates or holds that opinion that you can batter a patient and get away with it simply my covering it up is opening himself and anyone else who choses to follow such idiotic suggestions to huge problems with the law. Besides that, it assumes that the police, EMS and hospital personnel with either A)Always close ranks and stick together or that a nurse or police officer will be so stupid as to not be able to tell the difference between a person who has fallen and on who has been battered by an EMS responder. Further, it advocates the battering of patients, which I find morally reprehensible as well as just plain stupid. This may work in some situations you have found yourself in Asys, but we would all probably be best served by operating in the real world and not some fantasy realm where you batter a patient on the way to the hospital and then everyone plays dumb, even as they stare at the cuts on your knuckles.

Asys- is that an original quote? It sounds awfully Bushish/Rumsfeldian.

Doc- I didnt see the notation in the case history that this woman was a disabled marine, but perhaps I lost it in the shuffle. The case reports note quite clearly it seems that she tested negative for tuberculosis. If this was in fact the case, why was the patient started on an anti-tubercular therapy?

Doczilla- you mention getting the patients primary care doc on the phone as if it were as easy as dialing for a pizza. I assume that you may be a physician, but around here in my area, you couldnt get your doc on the phone if your hair was on fire. And if you did this at, say, 0300 and managed to actually talk to him because he happened to be on call, dont you imagine he would be a little irked by a medic or basic calling him and asking him about whether or not he wants his patient to go to the ED? A question about other areas: Here we have to take all AMS patients to the hospital if we are responding to a 911 call. Whats it like in other places?

As I recently learned after a local accident where an ambulance parked at a scene at night with all primaries on was rear ended, the problem can often be not just the lights, but the object they are attached to, being able to judge how wide it is, knowing whether one is allowed to go around or not. My city has adopted an ordinance that makes it ticketable to pass an ambulance or squad parked at a scene at night. This can definately add to scene clutter and subtract scene safety which is why the police are often out there waving people around. One of our local services is experimenting with some retrofit scrolling LED signs on the back of the ambulance that can set to run different messages from "Ambulance-Stay Back" all the way to "Patient Onboard-Stay Backor Patient Onboard-Pass Carefully" They are trying out the practice of being on scene, kicking on the secondary ambers and this sign. It makes it easy to tell what you are rolling up on in the dark, and if people do pass, they tend to do much more carefully if the know that the rig has a patient on board. The sign can even be programmed to read "Accident Scene-Drive Carefully" or the ever popular "Emergency Crew on Roadway-Please Drive Carefully" Im sure this has its detractors but they have had good success with it so far and find that people tend to pay alot more attention and be more mindful if they are able to go around the rig. Coupled with the Neon Lemon Vests with reflectors, they seem to have struck on something that is helping them, without having 3 rigs and some LEO vehicles all running their primary light sets.

No worm can opening here from this Basic. As I said, I am not entirely familiar with the use or complexity of this instrument, so I merely wondered if it could be a skill taught to Basics. What about Basics in states that allow them the extra certification to start IVs? Still no? thats ok. I just wondered if this was something that might be coming into further and wider use and whether or not it was easier than starting an IV line. Its cool with me if Basics arent qualified to use it. Even if they trained Basics to do pericardiocentesis, this is one Basic who would take a pass on that too. Thanks for you informed and honest opinion.

I know that various instruments, etc can be prohibitively expensive. In my area for instance, there are some items that are on some trucks, but not on others. But whenever I hear a group of EMTs of any level (and I dont mean about those here) complaining about the expense of a potentially lifesaving instrument, gadget or tool, I inevitably wonder: Do they take it out of your pocket? It seems to me thta a service is not going to buy a bunch of equipment only to have to fire medics and basics so that they can buy still more. Heres a good equation: you have a good, valuable, lifesaving piece of equipment+it didnt come out of your paycheck= what do you care how much it costs? If your service buys the EASY I/O's and then starts asking you to make your own uniforms out of plastic wrap and duct tape, I would complain....until then...eh... My question is this: I have only seen on video of the I/O being used and it was not a good quality video. If anyone knows where I can locate another, I would love to see this thing up close and personal. But what I wonder is, and with all sincerity, could a Basic be trained to use this device appropriately, safely and well or is this another piece of equipment kept under "lock and key" in the Medics bag of tricks. I have seen some reports, I believe from a service in Florida, that these are used a lot, many of them seem to be using the 90 second rule: no IV access in 90 seconds, I/O gets started. I had to take my mother to the ER last night and in the million hours we were there, I heard that the I/O was going to be used on a baby. I asked to be allowed to observe, but the doc said nope. But I did see it done from a rather significant distance and the baby didnt seem happy (though his response made me wonder if he had been sedated with something) but it seemed like a great option to have on hand. I would love to hear/see anything anyone has on this device. Thanks.

I recently received some requested information from the Navy about their "EMS" training. They called it Corpman training, and it really seems to go past EMT to really the level of Intermediate and a little beyond. From what I could tell they are taught all of what an Intermediate is taught, plus even a little emergency dentistry. Huh. Who knew?

We needed a policy analyst for this? When I lived in New Mexico people were practically growing the stuff on their patios. The real question is, what kinds of situations does marijuana, in and of itself (ie not as a so called gateway drug) pose for us as EMS responders. So far I have been on runs for alcohol poisoning, meth, crack and heroine overdoses, mixing of too many different drugs, usually prescribed pills and the nasty things that happen when Mr. Xanax and Mr. Vodka do the tango. I have yet to go on a run caused by marijuana, except the guy that called 911 because of paranoia and wanted to go to the hospital and when he saw through the window that we were passing fast food places, asked if we could stop and let him out. To me the only way that marijuana being a huge cash crop is relevant to EMS professionals is that it may prove that we are in the wrong business. Brownies anyone?

As the person who started this thread from hell: The medic got spanked with a letter in his service jacket. The Basic was warned that was a no-no but that her Ops Manager understood she felt she was doing what she was being told to do. Also, Whit, I learned early on not to questions anyones judgement calls if you werent on scene or in the box when the spit hit the spam. You are making some assumptions (alot of them actually) and you werent there, you dont know what was going on, the Basic is my friend and I dont know what all was going on. I asked for opinions, got more than I wanted, so....anyway, i make no judgements about this since I wasnt there. What I do know is that the medic took full responsibility, as he should have done, and the matter is closed.

Youll find over time in the city that Dust is not usually intentionally offensive and when he is, its pretty clear that he means to be. You will also find that he speaks from years of experience in civilian and military medicine. All that being said, job markets in any given area do sometimes just fall apart. I got work fairly quickly after EMT school only to have the private service I was with go all paramedic and leave me in the unemployment line. I do agree with Dust that instructors and programs that continue to turn out EMTs with no sense of concern about whether or not those folks will be able to find work its a pretty shisty thing to do. But just as a patient can be doing well one second and crunk in the very next, so go job markets and EMS is no different. The service that I was guaranteed a job with lost some of their grant money from Homeland security and so instead of hiring another basic, they decided to bump up their pay offer (not by much) and buy themselves a medic instead and I cant say that I would have done anything differently if I were them, though some choice words were had at the time since the Ops Manager that swore he would hire me was also my preceptor, so I felt a little bit like I had been left to twist in the wind. Since then I have found work off and on and do some volly work. I intend after the first of the year to do some serious uptraining and expand my job market by getting reciprocity in two neighboring states. Im sure you will do fine as a basic but after many of the spankings I have taken on thte City from people of differing opinion, I am growing myself some thicker skin, and I also know that nothing is more tender than a new Basic, desperately wanting work and not finding it. Hang in there. Unfortunately, I think that limited funding which causes services to buy another medic instead of two Basics is part and parcel of this line of work and its probably why so many inexperience Basics go straight into medic school...to find work, which is what folks like the developers of the "accelerated" medic school out of Nebraska are, in my opinion, preying on. I am using time with limited actual work available to keep training, getting CEUs etc. If your dedicated to making EMS a career, you will get there. I think you just have to be willing to get knocked around a little bit first. Im sure just about every member of this site has their stories of dues paid and lumps taken as they gain experience and made themselves more marketable.

Especially with a private service, i would think this could get confusing, at is recently has for one of our local private services who felt the need after 25 years to adopt the paramilitary model, down to chevrons on the sleeves and collar brass. They have the following structure, some of which seems based on training and level and some of which seems to be completely arbitrary. Basics with less than 3 years are "private first class" and wear the corresponding military collar brass and stripes. Basics between 3 and 5 years are corporals Basics over 5 years wear seargents insignia and carry the title "command EMT-B" Intermediates, of which they have very few, have been given the title and tidbits of MasterSeargent (chevrons with rockers) Paramedics of any experience level are lieutenants. Ops Manager (paramedic) is Captain The non-certified ambulance owner who collects all the fees is called "The Major" god help us all. I have crossed this service off my list as a potential employer. Any service that has this probably developed it out of "BOssman tell me who has to do what I say" arguments. Its idiotic, if confuses people, and gets them laughed at by LEOs and Municipal services with ranks that make sense. If it clarified the chain at an MCI i might be a little more for it, but it doesnt even have that much real world value.

what about those nifty vacuformed vinyl carriers that are meant to hold several large cigars at a time...would that work? Whats the tobacco consumption like over their anyway? Sorry if that hijacks the thread and what about a swift if sleepy end to the conflict by leaving vials of MS and syringes around for your friendly neighborhood RPG chuckers to find. Mmmmm...morphine. Kind saps you of your jihad I think.

Maybe the more accurate question isnt if these tactical medics (a terms which by now is starting to act as an emetic for me) its a)what role will they play and b)where ya gonna put em? I think the most likely permutation and the one that makes the most sense if any at all, is that they are staged at a safe distance and have comms access to the entry team. As far as I can i can see the best things that tact medics will do is provide their own patients. Doctors, medics or indian chiefs who are not FULLY trained in how combat (yes combat) and medicine come together will get people killed and their spouses will end up being handed folded flags at elaborate funerals. Can you say "Corpsman Up?" I am not military nor do I have a tactical training other than some fun with some of the companies already warned against. I think I just have to stick with Dust for President on this one when he says that unless you have dedicated your career to both of these fields simultaneously, just about all of the "uptraining" in the world isnt gonna keep you from getting shot. Maybe the real question isnt what can a tact medic contribute to the team, but rather which of the teams precious resources of speed, stealth and violence of action should they water down to prevent the teams medico from getting dead. I just think that thats a fact that is just being skated around. I went to alot of police funerals over my dads career and alot of very good, very well intentioned people lose their lives when they base their actions on the motto "I can take care of myself." More than not seeing a necessity for I just wanna know how are we going to keep them safe and keep them from getting others hurt because they are in the frigging way. Do people honestly have such a great need to put themselves in "kill zones?" I have spent my life trying to avoid such situations. Oh and from a VERY short time as an auxiliary officer with the Albuquerque PD, which is big and has a monstrous, hard-charging swat team....they dont have a team medic. What they have are ambulances and hospitals and egress plans for when plan A goes wrong. Maybe we should just leave it at that.

To my way of thinking, the only thing you could be taught in a 4-6 day so called "tactical medic" course is how to get others killed and lose your own life while doing it. And why are they called tactical medics if you only have to be a basic. Maybe the vertical hold is off on my laptop.

I think you might be oversimplifying the whole morbidly obese situation....alot. First of all, someone who cannot move out of their bed, or even off their backs, is not going to be out running hills with a personal trainer. Even if they could, it would probably kills them. Secondly, many of them cannot do medical weight loss simply because most MDs arent trained to deal with someone in that condition. Furthermore, the mental and emotional ramifications of being 1000 pounds are inconceivable to anyone who isnt there. Why do so many men that get to be that weight let their hair grow long? Because they are embarrased for anyone except their spouse or live-in caretaker to see them. Then rely on someone else for everthing? Yes, the food they eat. But also, their hygiene needs, actually figuring out a way to change their bedding and keeping them from get compression sores and just plain trying to keep them alive. Besides these folks are generally not celebs and so can afford all that goes along with supervised weight loss and arent going to be asked to on Biggest Loser, so thats just a silly comparison, like saying that we treat somebody with 95% blocked arteries the same as someone who ate the wrong thing as christmas dinner and has some treatable angina. There are so many stigmas and misunderstandings and misinformation that go along with being that heavy that most of the morbidly obese would rather die in bed due to a massive MI than call 911 because they have done that before and have heard the snickering and gotten the weight loss talks from EMS (many of who shouldnt talk about weight to anyone) and heard the insults "around the corner." They are patients. End of story. If you dont like dealing with them then get out of EMS because as sure as you are running calls, you will get a massive bariatric call one of these days soon. The one I got was during my clinicals. And guess what, you darn well better think about the complications of trying to resus a patient with morbid obesity because they are quite likely to crunk from the effor they expend trying to help the rescuers move them. These fine folks deserve out most complete compassion. Their lives are already hell. The one I have gone on so far hadnt been out of the house in 9 years. That would be enough to get most of us to put a bullet through our heads. So when you eventually roll on one of these, talk to your patient, ask them their name, and how they are doing today (besides rotten for having to call EMS). Believe me they feel bad that you have to try to get them out of there. The pt on my call kept apologizing all the way to the ER. They may be an obese person, but they are a person. Be happy that they called for help instead of laying there dying. I may be just a basic but I have a rule about patients: they all deserve our help even if they call us during a mental crisis mostly so somebody in their lives hears them and so they all deserve the best we have. Of course we all use black humor to relieve tension from time to time. We have to. But never, ever in the presense of a patient. I agree with the poster that said that he would fire somebody that made jokes or flip comments about a patient. I would go one further and say that I would find room for my morbidly obese patient by throwing a smart a** under the wheels of the rig. Keeping up on a call doesnt just mean moving fast and anticipating the needs of patient and medic. It also means re-adjusting your attitude for every single call, even if it means a boot in your butt from your Ops Manager to do it. WHen i was in EMT school, we were shown a bunch of slides of patients with embarrassing problems of all sorts (mocked up of course). My medic preceptor told us at the end, if you cant control your snickering and see the patient and not just the problem that they may or may not have gotten themselves into "leave now." A recent patient of mine had his hand stuck in a counter mounted meat grinder because he tried to push the last of the hamburger through with his thumb. Dumb move I will grant you, but I bet he knew that before we arrived. A sense of humor is vital. A sense of humor at the expense of your patients dignity is not. One of our biggest jobs is patient advocacy and you cant properly advocate if you think your patient is a circus act. Sorry for the rant and rave, but I have no tolerance for disrespect of patients. Not just a little bit, not ever. If I never advance past Basic, I will be proud to have brought respect and dignity to the work I do. Put yourselves in their position. FOr me, thats part of scene size up: ok this really sucks and even looks stupid, but how would I want to be treated if this were me, because for alot of types of calls, it could be you anyday. Remember, be kind to your webfooted friends, for a duck may be somebodys mother.

The only "severely" barriatric I have been on so far involved removing a solid core door from its frame in the pts house, using it as a not very comfortable back board and tranporting in fire/rescue. I also agree that we should watch the comments about morbidly obese patients. Even those patients who have eaten themselves into that condition deserve care and respect. That is a serverely unhappy person. And contrary to popular belief, you dont just wake up one day, start over eating and then find that you weigh 1000 pounds. Thats a severe metabolic problem of one sort or another. A recent study in the Lancet (I think) show that most people would vomit or stop eating from discomfort long before the calorie intake necessary to get them 1000+ pounds. I have a neighbor that will either soon die, or become a patient who has to have the side of their house taken off to get her out of their, or to take her to the morgue. My feeling always has been that whether its a drug OD, a gang related GSW or a 1000 lb pt, EMS responders shouldnt be in the business of making judgements. We are here to help people as they are, no judgements involved. ALL patients deserve the same respect and level of care and to be treated without the rolled eyes and whispered comments on scene. If you must say something, bit your tongue until you get back in quarters. For me the same was true of the patient I helped with that was dying from anorexia/bulemia based cardiac failure. She is still human and gets our best effort and compassion.

Just as a point of interest: Our local Level 1 hires basics as ED techs and uptrains them for such things as: phlebotomy, IV access, minor suturing, gastric lavage via NG tube and once you get that down, they will also train you toward cert in xray, mri tech, surgical tech, etc if you so desire.

1000 pardons, Sahib. But i think you get my point.

Calling a thread EMTs vs Medics and not expecting a jihad is like throwing a grenade into the room and saying "pay no attention to that, Im just dusting." We each have our own cross to bear and hopefully do it well. Besides, if it werent for EMTs who would drive when the medic cant get his belly behind the steering wheel anymore? Remember kids, before Basic or Paramedic, it always says EMT. Cant we all just get along. I dont have the energy for another holocaust before Christmas. Oh well. At least I didnt start this one.

thanks for the further information. I think one of the reasons I havent liked the Sager is all that velcro, as you pointed out. But I am going to go to the crew I volley with and practice with it, even though we dont use them all that often. Another benchmark we were taught for tensions/lbs was when the patient goes "OH MY F'ING GOD!" and then "Ahhhhh." You have pretty good idea that there pain is decreased and you can lock down the settings at that point. Thats haphazard for course, but I think what they were actually saying is that once the pain has diminished, the impingements are greatly decreased. One medic I worked with claims that he uses muscle relaxers but it seems to me that once some degree of alignment has been reached and impingement at least partially relieved, you would want the muscles to "grab" to a certain extent. Anyone have any thoughts or was this just another new medic (he never goes anywhere without something to indicate his "status") blowing smoke for an intervention ie muscle relaxers that would either be useless or contraindicated. One of my medic preceptors said that once that bone settles back in a little, the muscles will tend to tighten around it, helping to hold it somewhat steady until it can be surgically or ortho repaired. I have only run on one broken femure before with a rural service and we used towel roles and those orange splinting boards that can be cut down to size. Thanks for the info. I have alot of interest in skeletal trauma so I will take any input I can get.

Thank you. I have been asking for it to be locked for about a week.