NREMT-Basic

10 per cent of pts weight definately sounds more like it. Thanks for the info. Maybe now I will be more likely to use them and I agree with NSMedic that one of the problems with the Hare can be losing traction when you have to move the patient. Get it all nice and set with good taught traction and a patient who has stopped screaming quite so much, and then you loose it when you move them. Maybe I will have to experiment some with the Sager. I dont want to just write it off because I have had bad experiences with it...especially since some of our services carry both and the ones that dont tend to carry the Sager more often.

Thanks folks.

I personally feel that the Sager is clumsier, but that may be my lack of experience with it. I prefer the Hare. The other problem I have found with the Sager is that we were told to apply 20% of the pts body weight in traction. We applied this device to a "casuality" during a MCI drill and found that anything close to 20% damn near pulled the leg out of the socket. We kept tinkering with it and found that in average about 7-8% was what the patient could tolerate and which also provided sufficient traction. Any thoughts from those who have more experience with this device than I do. I would appreicate it. Thanks.

I would like to make it clear that I started this post to gain information about this difficult topic. I would also like to state, for the record, since there seems to be some confusion, this isnt one of those "i uh have a friend...you wouldnt know him" deals. I am talking about some who I know, and with whom I went through my Basic course. This person contacted me very distraught. Not so much I think because of being told (by the medic) to go ahead and push the MS into the IV line. From what I have been told, there was an implicit moment of trust here, and all was expected to be well. The Basic I am talking about is now worried because, of his own accord, the medic lied on/falsified the PCR. In what I am trying to re-create as my own HUMBLE opinion, here is where the breakdown of trust occurred. Should a BLS provider be pushing ALS drugs under any cirumstances. Legally, obviously the answer is no. I never meant to indicate that there was a break down in the rig and that the basic had to push the meds because the medic couldnt pull it together as I have been paraphrased as saying. The medic was doing what he was doing (whatever that was). The patient was screaming in pain. The basic made eye contact with the medic and mouthed the word "Morphine?" assuming that she was asking if the medic was planning to give morphine or if they needed to get orders for it, etc. The medic gave the basic the keys to the med box and from what I can tell, my friend the basic pulled out a pre-filled syringe of MS. I could be wrong here because I have not yet had dealings with ALS interventions in which morphine was given. She handed the syringe to the medic who checked it for the 5 rights, asked her if she knew how to push it IV and then instructed her to do so, which she did, assuming that though this was in strict violation of protocol and law, that she had a trust situation with the medic. What got her to contact me, was the fact that when she saw the run report and it listed drugs given as MS given IV by Medic, she started to get worried about what the ramifications would be if this came back to her. Thats all I have been trying to say. As I think Dust stated, the PCR could have been written as "MS administered IV" at such and such a dose and such and such a time. BUt he chose to lie about it, and so she is worried and I think rightly so. Perhaps if I had offered this much information in my initial posting, we wouldnt have had as much confustion and argument as we have had. For that I apologize and as far as I can see, the topic of this thread has burned itself out. Thanks to all that commented and gaave their opinions.

Well said Dust. Hell, I even started looking into the Blackwater training program until i find out that they will only take intermediates or medics and then only with a good dose of "tactical" experience under your belt. I have also recently done some research and found out how dangerous alot of these PMCs are. You mentioned there being opportunities for civilian contractors in the medical field over there. I would be interested to know more about who trains them, what the training consists of, etc. Thanks Dust. Good luck and keep patching up over there, while trying not to become a patchee yourself.

I do agree with you that someone with no training should definitely not be in there but we are getting training and we train with the swat team every time they train which is twice a month. We will be going to cleet and might eventually carry guns but out primary objective is to care for the members of the team. I know that just going to a week long class will not make me an expert but that and continuous training will help. I could care less about the patches the NREMT offers. I am a paramedic and have been for about 8 years and been in EMS total for 10. All the medics on out team are well experienced and had to pass and application and interview process with the swat team. I just think that people should look into all the responsiblities of the team medic before saying there is no need for them.

I cant say that there is no need for a SWAT team medic anymore than I can agree or disagree with Dust that there is no need for a SWAT team. But my concern is the very real possibility of you and your medical team getting dead. OK. Lets say you and your team are on the scene of a warrant service to protect the members of the SWAT service. They breach the door and introduce a couple of diversion devices: Bang! Bang! All hell breaks loose as they use speed and violence of action (stealth time now being over) to enter and overpower the inhabitants of the dwelling. 1. Where is your team? Are you standing outside waiting for them to clear the house? If so why dont you just stage 100 feet out of the kill zone down the street. I claim absolutely no knowledge of tactical medicine and in fact I have come to learn that that is a nebulously defined term at best. But the fact of the matter is that most SWAT operations, in terms of the breach to handcuff time frame, are over in minutes. So I just cant see how it would be worth it to say, have you and your medical team, hiding behind ballistic shields or blankets in the yard or out on the street. If a SWAT officer takes a round in the leg, you are going to be able to get there with due dilligence if you are staged at some realistic distance. If a SWAT officer takes a round in the face, if you were the guy right behind him, there wouldnt be a thing you could do. Its really alot the same as when my dad was detective. They would often go in behind SWAT to execute the actual warrant with the SWAT acting as a breach and secure team. But he WAS armed and there was still absolutely no reason that he needed to be in the broohaha that ensues in the seconds of violence right after the breach. Great, put a medical team on staff and even have them on standby staged a hundred feet away or around the corner where they drop out of of the convoy before it gets to the target site. It just seems that it would be hard for a SWAT team leader to justify more people in the way to potentially get hurt, because just as the medic on a rig is ultimately responsible for what his basic partner does, that SWAT team leader is responsible for you, no matter how many times you reassure him that you can take care of yourself and your team. In Wisconsin recently there was a SWAT action where a team member took one in the vest. Knocked him down. But he was ok and his armed team mates protected him. I dont know. Even if I were the best trained medic in the world and the SWAT team called me and said "hey, we want to put you and several of your amigos on our team to make sure we dont get dead" I think I might say, hey man, thanks for thinking of us, but that really isnt our thing. I have no doubt that you and your team are well trained and that training with SWAT is helpful. But as we can see, unarmed medics are just another target, just another breathing thing that the entry team has to protect if they are with the team on entry. If some sort of standoff occurrs, then maybe its good to have a medic or two or four hanging around down the block, staged and ready to go in the parking lot down the street. But as the Bank robbery in LA a few years ago showed us, there are times when even SWAT is outgunned...I really would hate to read a LODD notification on you and your team. I hope something works out that is satisfactory for your medics, you and the SWAT team, I really do. But when I finish medic school, I just cant see myself feeling comfortable enough to be a part of a SWAT team, as exciting as it might be, especially in the times when we might be needed. I hope it all works out for you. best of luck and stay safe. PS---i am demonstrating my ignorance of either tactical or ALS here, but what is cleet and how will it protect you?

Ghetto-

While your post was a bit rude, as have many of mine been lately and for that I take responsibility, I will do my best to take the valid points of your opinion. Contrary to what you may believe, I do not need your permission or to become a medic in order to have an opinion. There are many towns, townships, etc that have only EMT-B responders and I am sure that they are allowed to have opinions. I disagree with your assertion that a medic has control over a basic from the moment the shift starts, whether the crew is on a call or not. This is not the military. While I refer to my medic partners as sir and ma'am unless otherwise told, I do not work for them. I work with them as their assistant. If you have been paying attention to some of the more subtle points in my posts recently you will see that I am becoming comfortable with my role as basic being the medic's assistant. I am proud of that role and take it very seriously, and I do a very good job as anyone who has worked with me, rather than just read posts, will tell you. Im not sure where you are from but I would be honored to meet you. I will be working in Canada during the late winter and into spring, but it would be nice to put a face to some of the names here at the City. I dont ask for more respect from medics than is my due, but rather for equal respect as a trained EMS professional, licensed to do a job which i am honored to do. If you went back and read the whole thread here, you would see how it has degenerated from my first question, which was how should the medic/basic partnership work. The things has just been hijacked so many times that it no longer bears any resemblance to what i had in mind, which was to learn from my more experienced collegues.

Well said! Of course bls responders should not as a rule be doing things outside of their protocol. However, it situations as I described when I started the thread, there may need to be an understanding between the medic and his partner and things just have to get done. Its like my medic partner on a long transfer asking me to spike a new iv bag while he does something else. By protocol, Im not supposed to have anything more to do with IVs than handing them to my partner. But if I know how to change a bag out and do so under his supervision, this is the way that I help my partner and we gain a trusting working relationship between us.

Bravo! Well said. That is the sort of answer I had in mind when I started the thread. People's opinions and not a thread which would degenerate into bashing other people, though I dont know why that should surprise me.

What your post tells me about your education is that while you may write competently, you have not had the appropriate education to learn not to make logical fallacies and false assumptions. My family has been going to one of the country's top heart specialists for the last 20 years. He was one of the developers of the angiogram/plasty procedures. That man, for all his education and skill as a specialist and surgeon, cannot spell worth anything. What you have done is compare poorly written posts to my educational level and that is where you have made your fundamental mistake. While you are a medic, I would be willing to bet that I have at least as much formal education as you have if not more. I've had articles published in academic journals while working on my master's degree. And if you honestly believe that the way a person writes is directly linked to their abilities in EMS, then it is you who are possessed of gaps in your education. There is no correlation between the two where as you seem to want to make it a one to one relationship. I never said that I would be too tired to treat patients. What I indicated was that there may be those amongst us, who after working long shifts but still wishing to respond and share their knowledge with us, have greater concerns than spell checking. Your post is so full of faulty reasoning that it wouldn't pass muster in a high school debate. If you wish to compare educational levels, abilities to write, etc. I would be more than happy to do so. If you think that the way posts are written is indicative of the my abilities as an EMS responder or worse yet, that other posters to this site may not be worthy of "taking care of your family" then by all means do not hide behind thinly veiled insults. Have the courage to name those who you think write poorly and hence are not properly qualified to work in the field of EMS. Lets have some specifics. Lack of specifics, by the way, is also another point in which your post is lacking. Should we assume that since there are more logical holes in your post than one could shake a stick at that you are not qualified to work in the field of EMS. And if you should be worried about someone who doesn't bother to spell check working on your family, you should have them wear tags which read "if you write poorly, please do not help me if I am hit by a car." Shame on you. If you want to insult me with your logical blunderings, you are free to do so, but to bash other people while doing so is the mark of a coward...either that or one who has no real data to support his points and so instead makes broad sweeping generalizations. PS- Your grammar could use some work as well.

For what its worth, I recently learned that you can order the "tactical" subued NREMT-B,I, or P from the NREMT. As far as I know, proof that you are registered with the NREMT and the level you want the patch for is the only thing that is necessary. Someone mentioned Blackwater. I have recently been in touch with them and they run an "uptraining" course from civilian to tactical medic. There are a few catches though. You must have been military for at least 5 years, prefereably spec ops, or you have to have been SWAT for a number of years, etc....basically all of the things that would give you so called tactical experience. Also, to enter their training program, which they will only allow you to do if you sign a contract saying that you will work for them for x number of years if you complete the training. Also, you must hold at least EMT-I to start, in addition to the tactical work background. They will not uptrain Basics. Lets let the guys with the hashmarks who also have medic training do the tactical work. There are enough of them to go around. they dont need us stumbling onto their hot scene and getting in the way. I see the allure of it, but it really isnt just as easy as being SWAT and and EMT of some level. Ive done alot of talking to people on this sight about it and it can be a pretty complicated thing to achieve. While there are many schools out there that will provide you with "run and gun" and defensive driving, and there is even a company that offers a weekend long course (DOH!) in tactical medicine. But its just that, its a course. I dont think anyone interested in the field of TEMS should imagine that you could do it without first being on a tactical team of some kind like SWAT and that means being a LEO first as far as I know.

Here is something that I should have written when I started this thread that might have made by position alot more clear. To a great extent, Basics are taught to function within the BLS/BLS rig model, at least here in IL. We are not taught how to interface with Medics, even though most of us will infact end up riding on a BLS/ALS rig. The reason that the powers that be say we are taught this way is that the EMS laws in IL state that there must be at least a Basic on each rig. Well Duh! With the exception of one private agency in town that is all ALS (I used to work for them before they went that route) all rigs are BLS/ALS. But to get back to my original point, we simply are not taught how to work with medics. We are taught all BLS skills and protocols, with very little knowledge of ALS protocol except to assume that it is anything that we arent allowed to do. I wanted to make sure that this wasnt just the way my class was taught so I have checked with alot of other basics and basic programs around the state to find the same thing being taught which is, in essence: Here is you BLS model and protocol (taught as if we will alway be on a BLS/BLS rig) and if you run into anything you think you cant handle, call for ALS backup to your scene or for an ALS intercept. I will be the first one to admit that this is foolish since we have no 2 BLS rigs running, at least in the city I work in. So take an example like we were given: A 2 BLS rig is dispatched to a chest pain call. We are then taught all the things we can do, as if we werent going to need ALS assistance with a chest pain run. Of course we do. We cant run EKGs, we cant give cardiovert drugs, start IVs, nada of any true importance to that chest pain call. So its very frustrating to me and those that trained with me that we were trained as if we would be running 24 hour shifts on BLS only rigs and only calling for help when we need it only to have to turn around when we get into the real world and re-work the model we were taught because now we are told by our ALS partners dont even give ASA or nitro without checking with me, when the training didnt say that, it just said, give ASA and nitro, put the patient on 15 lpm nrb and load and go. I mean I dont know if other states are like this but it was a real disservice as far as I can see and so I am my classmates are having to re-work the way we think and operate to be secondary to the medic. We were even taught this silly idea in my class about "Command Basics" meaning the basic with the most experience is in charge of making the decisions on that rig. Since we can push 5 drugs with standing orders, one of them being oxygen, the more I learn and gain experience, the more I feel like I would like to take my Basic course again and this time have someone teach it from the standpoint of "You will be working with a Medic and here is how." Even the NREMT Basic exam re-enforces this concept with things like: at what point during a child delivery would you call for an ALS intercept, etc. I mean we were basically taught that we were autonomous until such time as an ALS intervention was needed. I hope that explains alot of where I have been coming from over the last year. Its not that I want BLS and ALS to work in isolation, but that is the way the medical system in which I was trained taught us. A great disservice obviously.

Guys...calm down for one second and read my original post. Because I ask some controversial questions and then a bunch of you get your knickers in a twist as if I was the one that pushed the drug. Read the frigging question that started the thread and if you cant be civil and answer it as it was written, why should you expect that I would be less than confrontational when responding to something that I posted as a question, that had nothing to do with me personally, that I was seeking "educated opinions" on. God for-freaking-bid. Its like I ask a question or start a thread because I am genuinely trying to learn from those with more education and training than myself, alot of responders dont bother to stay on topic, i get blasted for it and then I get blasted for blasting back. Read how this thread started. Read how the EMT/Medic relationship thread started...I asked simple, civil questions or in the case of the EMT pushing MS, asked what you guys thought and if you know if this goes on very much. Then somebody hijacks the thread to say "I wouldnt ever let an EMT take a p*** without checking with me" and I get blamed for it because I respond in kind. You guys need a new hobby.

OK. I am the one that sent you the PM, largely because I believe if I have something really disagreeable to say to someone it should be done in private. Maybe your mommy and daddy didnt teach you that. If you would like to get insulting in public, I would be perfectly happy to accomodate you. The fact is that I started this thread with the hope of meaningful dialogue which it appears that you are incapable of. That seems to be impossible given the topic with which I started the thread since this is an argument as old as the hills. What should EMT/Medics teams do? How should they function together.Obviously you cannot provide an intelligent answer to this question. This thread has been hijacked so many times by people who didnt bother to read my original post, that I dont even know whats its about anymore. Many, including you, have just run off on tangents based on the previous post and not on the intention of the thread. I have do it too, to try to maintain dicussion. Maybe its time to lock 'er down. This is just getting ridiculous. Thet next time you say something noxious, ill-informed and stupid I will just blast you in the forum instead of PM. You are right. If I am going to insult you, I should most definately do it in public. Thats the least I can do for someone of you caliber.

In the process of reading so many posts, I have found a common thread. People being criticized by other people who dont even know them. I am guilty of it myself. But maybe in the new year, it could become a practice that you dont get to criticize or bash someone until you have gotten to know them. We dont know who works for what service alot of the time, if they get paid or not, what their life circumstances are. This is part of the luxury of posting as your avatar and never having to re-visit the effects that your post might have on the person you chose to blast.

Just a thought as the new year approaches.

Short and sweet, the EMT should not have pushed the Morphine. If any remote complication would have presented, all the patient would have to do is point his finger at who gave it, and voila, both certifications gone with the wind. While the act of a EMT who is not educated in pharmacology pushing a narcotic analgesic does bother me, the bigger issue here lies with false documentation and the fact that the crew "freaked out". If I was the pt. and I saw my EMS providers "wigging", I would have very little faith in their performance. This medic, feeling hurried by the pts. screams, lost effective control of this emergency. Calmness and composure, 2 essentials for a proficient medic.................

Of course the whole legal issue of lying on a run record may also ruin their day............

Two thumbs down to both members of that crew! [-X

Legally, in the USA, no the Basic should not have pushed the drug. That being said, we have all been or at some point will be in situations where due to absolute necessity, things will need to be done by who can do them, regardless of rightness or wrongness. Second, you werent on the scene and I should think as a paramedic, a flight paramedic no less, that you have come across situations where its all hands on deck, doing what needs to be done. And as I have already said, I never said that the Medic or his Basic assistant were "wigging" or "freaking out." The freak out came after the call when my friend got off duty and contacted me. So no patient saw anyone "wigging." And if you are a patient who has a broken midshaft femur with a compromised artery, do you think you give two flips who gives you that MS where it was within protocol or not. I have since learned from talking to my pal via IM that the medic was trying to control bleeding, monitor his patient and do about 100 other ALS interventions at the same time. I am sure that we would all like to think that the Medic can do all of these things at the same time but sometimes it just isnt possible. Let me ask you this? If medical control had given the ok to the medic for 5mg MS and the medic was never able to push it because of the situation, and you were the patient, would you be screaming louder that a Basic gave you a "narcotic analgesic" or that you never got it at all because other more immediate interventions were necessitated. Sure they were 11 minutes out from ED, but just try to imagine what that patient would have said once he finally got pain meds in the hospital "They wouldnt give me anything for pain" most likely. And if that had happened once medical control gave orders to the Medic for 5 mg MS IV...well then whose neck is in the block. I find it hard to understand how someone, a flight medic no less, can say tsk tsk and wag their lttle cyber finger when you were no where near that scene, dont know the situation and are thinking sheerly out of protocol and not reality. As NSMedic seems to indicate, sometimes things need to be done as they need to be done for the benefit of the patient. Our BLS protocols here in IL allow us to do nothing during an ET intubation but hand things to the medic, but if the medic has a hard tube on his hands and asks me to do this or that, you can better believe I would do it, rather than sitting there watching the patients sats fall. There is protocol and there is what happens in the box and often, like in Vegas, what happens in the box stays in the box. I can see your concern about the one untrue sentence in the run report. Honestly in your opinion, all things happening which did, should the medic have said "I was attending to multiple interventions and gave an order for the Basic to push the MS IV?" Yeah. I think the outcome there would have been some suspensions of licenses. In my so far limited experience in comparison to so many who post here, I think that this probably occurs more often than we think. Things are done to take the patient out of pain. The medic checked the 5 rights on the drug. If you can honestly say, "No. Under no circumstances would I do that" then I have to wonder about someone who would rather let a patient suffer than make sure their BLS partner has the right med at the right dose and watches him introduce that into the IV line. As I have seen written so many times in these forums...dont say oh no thats wrong, they should have their licenses pulled, unless you were there.

If you intend to quote me, please do so correctly. I did not say that the crew freaked out during the call. I said that my friend called me and was freaking out because of what had happened.

And I know I asked for some opinions, but what I asked for was to know whether there are cases where this should ever happen. Though shown how to push drugs IV, I have never done it as it is not a BLS protocol. However, if something occurs as it did in that call and the medic was trying to control bleeding along with probably a million other things, should the EMT take the order and push the drug. The other thing that bothers me here is that we have been having this ongoing discussion here in these forums about what the BLS/ALS relationship should be. I brought up the point several times about a Basic being given what he knows to be an improper order and got from many sources that the basic does what he is told to do by the medic because the medic is in charge and if the spit hits the spam its his butt, not the basics. Would ya make up your minds? Do you want blind obedience on scene from your Basic or do you want him to say "Oh, no, that is an ALS skill and as soon as we get back to quarters I am reporting you." Lets come up with a party line a stick to it. No wonder Basic sometimes get put into positions where they dont know what to do. Should he have called medical control and said "the medic wants morphine pushed but cannot do this at this time. He has advised me to push the morphine IV...please advise?" Yeah. That would have been great.

Yes he told me that the report was altered from actual events, but I dont think that they protection of documentation will be in jeopardy because my friend told me or even talked about it all. Though I didnt tell him that the next time a report is sanitized, it stays between you and your partner. If you know a report is "sanitized for your protection" keep your mouth shut. I cant imagine being so traumatized by this as my BLS pal is that I would tell someone else that there were lies in the run report. I think more than that I was just wanting to know if this kind of thing happens often and if there are any protocols which allow for a Basic to perform an ALS intervention or push ALS drugs if ordered to do so by the medic and if there is no question of it being done correctly. That was really more the crux of my question.

Here is a BLS topic that would benefit from hearing from all of our ALS friends. This morning, I have a friend of mine call me absolutely freaking out. He and his ALS partner responded to an open femur fracture. The medic was trying to accomplish alot of things while the patient was screaming in pain bloody murder. The EMT got the medics attention and sort of mouthed the word" Morphine?" The medic nodded and handed the basic the keys to the med box, the Basic pulled out what I gather was a pre-dosed syringe and started to hand it to the medic. The medic took it, confirmed right med right dose and handed it back. From what I can understand, the medic, having just established a line, indicated that the Basic should uncap the syringe and give the doseage of MS. The run report apparently reads "Meds Given: 5.0mg MS given by IV access by Medic." My BLS pal actually pushed the drug. Is this something that happens sometimes or was the medic off his nut for telling the Basic to do it, or was the Basic off his nut to do it. As much as I know the shite that could rain down on my head if i were ever in this situation, I am pretty sure that I would do what the medic ordered, myself having been trained to use IV access to administer drugs, though this is not someting I can do under our protocols. I was just shown how to do it during by clinicals by a medic and he said, basically if there is ever a call where the patient is screaming and the medic is working and cant stop, this may happen. Anyone have any experience with it....?

I couldnt agree more. The lung sounds that I have been asked to check for at the Basic level so far could pretty much have been heard by putting you ear to the patients chest or back. But I guess that personal space thing is why stethos were invented in the first place: "Excuse me ma'am, may I listen to your chest by laying by ear on it." Thats not gonna get'er done. Often times I have heard Basics or even Medics listen to lung sounds and then report them to ED staff as "junky." So its very true that unless you are listening for finely differentiated sounds, an expensive scope is worthless. I know when my fellow Basic students were told to get them, alot of them came back with the most expensive setup they could find. For most basic auscultations, a good old Littman will work just fine. Ive even been able to get sufficient lung sound definition with the little disposeable ones they keep in the rigs in case you lose or forget yours, though those I think are really intended more for the calls where even listening to breath sounds would get your personal equipment gobbed up. In the end, its a vibrating membrane with sound that travels up a tube, into the ears. Its only need to be so good for BLS assessments.

Bushy-

who put the burr in your sattle blanket. I have lost parts of my life I will never get back reading some of your posts which are nothing but one long punch line. Pardon me for trying to say that this is a post for professionals and if they dont like what they read here, they can go back to readers digest. I dont know whats with you lately but I recommend a high colonic and five mile hike carry a full jump kit.

When I first started, I carried a Sprague Rappaport Cardio Stethoscope that was required during my ill-fated time in med school. Its got pretty decent artifact noise reduction but its heavier than heck and if I dont counter balance it with a roll of tape, it falls on the pavement everytime i get out of the rig (yes i carry mine around my neck like a whacker because the services I have worked for and with so far are full of thieves). This scope cost me about $40. But for Basics like me I agree that the gold standard should be, can you tap in the tympanum and hear the tapping, can you get decent enough sound quality to do BP, hear whether or not lung sounds are present or diminished or absent and can you tell the difference between rahls and ronchii. If you can, thats the scope for you. As I found out, expensive doesnt mean that the person the ear end can necessarily do anything with it. We had a girl in my EMT class that couldnt hear BP sounds even on an electronically amplified veternarians model. Turns out, she wasnt turning the ear pieces forward so that they were actually in her ears instead of hanging around the outer ear and blocking sound. I gave myself a gold star two days before out practical exams for licensure when I figured out this was her problem. Buy inexpensive but good, as a Basic. If you get to be a CCP or flight medic, then it might just be worth shelling out a couple hundred bucks. And if you cant hear with scope you are currently using while running hot and trying to block out sirens, equipment rattling around in the cabinets and road noise, then practice your palp BP skills. Oh crap...did I just say something that might actually make sense and apply to the thread. Rats.

PS- sorry for hijacking the post. Im down with a case of rising gorge.

As someone who once made the same sort of post about spell checking and professionalism in posts...

I know I will take ribbing for what I am about to say and well I should. When I went to my first shift as a EMT, I spent a good part of the evening before actually pressing my tac pants and uniform shirt, making sure all my buttons were sewn on tight, that my boot toes and heels were like a mirror. A process carried out with two uniforms. Next day at 0700 I showed up bright as a penny in the well water and about 0730 went on my first run with my paramedic partner. It was for uknown elderly down in her home. One of her neighbors called when they couldnt get her to come to the door. As we walked up to the screen door, the smell of vomit and fetid blood hit me like a train. the heavy screen door was locked, and when the pd arrive we were given permission to gain access by cutting the screen. As the new guy I got to to crawl in through the cut screen. About two feet inside the door i slipt and fell in the single hugest pool of bloody barf I am ever likely to see. My entire uniform was covered in it and it was in my boots, in my hair....we finished up and back to quarters where I changed uniforms and took a shower only to go out with an ALS crew around 0900 to a shooting. When we got there, a first respnder who was holding pressure on an arterial bleed decided he should let go of it since we were there. My uniform got covered in bright red blood. Baptism by body fluids. What does this have to do with postings and the professonalism thereof? It would be wonderful if the public could have an image of all of us as clean, pressed, unflappable and perfectly well written and spoken. The fact is that the work we do is messy, sloppy and ugly. Many of the people that post here and chat here on a regular basis are so tired from working for two different shifts with two different services in the same day and then being on call around the clock, its amazing that they can type at all, let alone spell everything perfectly and yet they take the time to post, answer questions, ask questions and share information that is important to us all in the EMS community whereever we are and in whatever capacity we work. This is NOT a pretty occupation. We are silly to think that it can be anything like a pretty occupation no matter how many music videos dedicated to the "EMS Angels" youtube.com broadcasts. We are lucky to get home with our arses and bellybuttons in the same place that they were when we started our tours, 12, 24, 48, 72 hours ago. So let the public see us for what we are, human beings doing often unthinkable jobs under hellish conditions without the right equipment and sometimes we lose more than one patient on a shift. It would be great if we could all respond to Code 3 ALS tones in our class As, but we cant because most of the time we are just holding it together for little or no money because we are dedicated to serving our communities. So if the Non-EMS public cant come in here and see that, see the utter professionalism reflected in the knowledge and compassion of so many posts, well then let them watch the EMS recruiting videos on youtube. If you want to read perfect posts, read Dustdevils. He has gained the composure over the years to be able to do the job he does in a place that got three stars from the International HellHole Society. And his posts are usually spell checked, well written and informative. And thats with mortars and RPGs flying over his head. You want perfection...read the Oxford English Dictionary. This post of mine is to the person or persons who says that its important that the public know we can all spell. We can. IV, AED, MI, MCI, vfib, vtach and on and on. That is all.

Side note....this post has not been spell checked as form of thumbing my nose electronically at the Martha Stewart, dont ever let em see ya sweat noobs amongst us.

Excellant point, well made and taken. Thanks. I think this is alot of what I was trying to say in my earlier posts. I have taken a few courses in tacatical ems and quite frankly at the basic ems level in which i currently operate, I have no business any closer to a tactical situtation than in an ambulance drivers seat waiting to hear "GO GO GO!" I have no delusions of myself as a tactical medical operator and honestly the only way I ended up taking tact med "courses" was becaues during training and employment with a private security company which provides everything from military base security to personal protection of dignitaries, someone came to me and said, hey, you wanna go take a one week course in tact med. And I said sure, if youre buyin'. Its great fun to imagine myself particpating in a move and shoot tact med scenario with a real outcome rather than a scenario where the safety officer says, ok, you got clear, the bleeding is moderately controlled on thta swat officers open midshaft femur but there are still two officers down. Thats an adrenaline rush. But I aint putting myself on that scene anytime soon in the real world. . If I ever go back to armed work again, I am perfectly happy to stand post outside an office door while some stuffed shirt has a meeting and then driving him home again. I mean when even in drill scenarios, you can hear the screaming over the gun fire...well...i dont need much more than that to make me know I will stick to my ambulance based work. Cheers mate.

Oh please god even if my head and my body are in seperate rigs, dont take me to a hospital with out electonic info access. I dont think our ambulances are equipped with strings long enough to connect our tin can to theirs. Excuse me while i drag my feel to stop the ambulance....I kid.

Point taken.