Leaderboard

It's going to be specific to the programme. Around here, the medics on the pedi teams are pretty much just drivers and nurses bitches anyhow, so you would never be in a position to direct patient care. If such is the case, go for it. It's a great opportunity to learn. Any hospital based position would be. They keep you focused on total patient care, and not just fifteen minutes of protocol medicine. But yeah, if we're talking about a team where they are really sending critical pedi patients out with just you and a driver, and no nurse specialist, I personally would not go or it. Not even if you crammed a "CC certification" (whatever that is) in somewhere.

Everybody should make their own decision about the vaccine. I don't believe that any vaccine should be mandatory UNLESS failure to vaccinate puts the rest of the population at risk. I remember, as a grade schooler, going to my elementary school and getting the flu vaccine in the 1960s (it was mandatory). I am taking the shot as soon as I get to Las Vegas early next week. As a group of emergency physicians (at UNSOM), we decided not to take the nasal vaccine because it is a weakened (attenuated) form of the H1N1 virus and we were afraid that we would shed some of the virus which might adversely affect some of our patents who may be immunocompromised. But, we are taking the injection. I am making sure my two kids (in their 20s) and my son's pregnant wife (also in her 20s) get the injection vaccine. I intubated two people last shift at UMC who had H1N1. I had one patient, a male in his 20s, who was in the hospital for 7 weeks, spent 5 weeks on the vent, had bilateral chest tubes, a DVT, and ARDS. He was low sick. This H1N1 is scary and if you are in your early adult years or pregnant, you should be concerned. The Obama administration has done a horrible job of providing information about the H1N1. While in Texas last Friday (I am in San Jose now), the TDSHS web site showed that two pharmacies near my Texas house was supposed to have the vaccine. I went by both to try and get the vaccine for me and my family. Neither pharmacy had the vaccine and neither knew when they would get it. It is available in Clark County, Nevada. Go figure. I was in Mexico when this H1N1 emerged several months ago. The way it affected children in the Mexico City area was scary. Although the predominant strain in the US appears to be less virulent than the one on Mexico City, it is still a bad deal. Vaccines save lives. If you give people enough of a substance, be it vaccine, drug or placebo, a few will have an adverse effect. This does not mean that the vaccine is dangerous. The links between childhood vaccines and autism are pseudoscience. Far more kids will die from not being vaccinated than will suffer ill effects from the vaccine itself. Look at the evidence and make your own decision. I, for one, will get my vaccine next Monday.

Ask: "do you really mean that"

I had the most critical call I've ever been on the other night. It seems that I missed something that would have given us a slight chance to save a life (very slight). There were multiple critical pt's so I was trying to do a million things at once, and I missed something huge. My boss, my partner, and my one friend I have told about it all stand behind me, but I can't get over the fact that I took away that .01 percent chance at life. I did. ME. "Everyone makes mistakes," or "you did your best and that's all you can do," or "most people would have missed that too," just doesn't seem to be cutting it. I'm sorry if this is repetitive, but I've read the other stress reduction polls and I'd kind of like something that addresses my situation a little more. How do you move on let alone work again after something like this? How big of a mistake is too big to make? Also, I don't really want to talk about the call specifics thanks (I know that's kind of a dick move, but please respect it).

Just reserving the spot for discussion following watching it. I'll make my commentaries roughly 20 hours after the broadcast.

Okay...I'm not sure which Topic this would go under so sorry if it belongs somewhere else! I've got a few questions I'm sure MANY a paramedic/emt has heard in his/her career!!!! Okay...numero uno! GORE! How did any of you deal with seeing the gore when you first started out? I know you must get "used" to it to a certain degree but ANYONE is gonna get a little freaked out the first few times you see someone's insides on their outside! I'm just wondering if you could share what went through your mind...how'd you react..how'd you deal with it? I keep having this thought I'm gonna faint and end up in the back of an ambulance but on the WRONG side! strapped to the guy I was there for in the first place! j/k Also...how exactly do you prepare yourself for the really nasty stuff? Thanks!!!

I love that website! I own all the books as well. The author/creator is a local to my hometown so we heard about it pretty early on before it became such a wonderful website/books. It's a great idea, although some of the secrets are so sad

For most people, you can either deal with it, or you can't Some people it doesn't bother them at all. Me for example, I have see a wide variety of "gore" and gross things. I kept my composure where it needed to be. Seeing such things doesn't always get to me, but sometimes it does. We are not statues, we are human. This is one of the many reasons there are CISD teams. So you can talk things out, or even get further help from a professional. Don't be embarrassed! Seeing pictures of things is definitely like it is in person. It kind of hits home more, but looking at pictures might prepare you for what you might see. People try grossing me out by sending me nasty pics, and quite honestly, I don't even look. I deal with this stuff in person, I don't need to go looking for it on my down time. If you come upon a scene and you don't feel good, excuse yourself and walk away. There is NO shame in it, even if some people give you a rough time for it. But it's all in good fun! You will make it through.

When I first started, I really thought it would bother me. A good friend, who is a child psychologist by day, gave me the following advice when you're on a really nasty gory scene: Label how you are feeling. So you show up and see blood and guts and vomit everywhere, recognize the emotions you are feeling and put a label to it. "I'm feeling queesy and like I could faint." By putting a label to it, you are recognizing the emotion and feeling and not letting it take over how you are feeling. You might still throw up or feel faint, but I have really found this little trick to help on all scenes. With child abuse or elder abuse it helps me keep a level head on scene and not get pissed off at the abuser. By saying to myself "I am really angry at this person" it calms me down. Not sure how it works for all but it is how I deal with it and it distracts a part of my brain from getting disgusted. Labeling the emotion tends to distract your mind from dwelling on how gross the scene is or how upset or angry you are. Hope this helps, and best of luck to you!

Rookie Ease up on yourself. You'll thank yourself for it in time. EMS practitioners are by far, the worst offenders of being one's own worst enemy when it comes to looking back and wondering what could have been. After 21 yrs in EMS (17 + as an ALS practitioner and 18 as an EMS educator) this I know; trauma patients die. A lot. And mostly in spite of what we do. Five years ago on Memorial day weekend, my brother in law suffered a cardiac arrest in the driveway. He was 43. I was with him the day before when he was complaining of palpitations and like all of us would, strongly advised him to go to to the ER. Not strongly enough. I, like you, beat myself up over it, over and over until the weeks turned into months and the months to years. In the process I began to lose my faith in my abilities as an ALS practitioner, insomnia set in, then came a couple of med errors, (strangely things continued to get worse despite my avoidance of the real issue), my long term relationship failed (not related to this incident), and my desire to care took flight. I was the poster child for EMS related stress and Accumulative Stress Disorder. I existed as a shell of myself for a little over two years, until I became seriously ill. The illness was the last straw and I ended up on stress leave. Four months later I walked away from my twenty year career without blinking an eye. After a year and a half of unemployment, some menial jobs for minumum wage, and five months on welfare, I returned to prehospital health care. I kicked my arse for a long while for not getting the help I needed when I needed it. Don't make the same mistakes many of us have made, Rookie; everyone makes a mistake or two, and most of them are not life critical. Some mistakes are, but I doubt yours was. Given the chance to do the call again, knowing what you know now, the outcome would be the same. Trauma patients die. A lot. If you need to speak with someone professionally have your service provider make the arrangements. Speak with someone outside of your service / agency. And stop beating yourself up over something that would have happened regardless of what you, I, or anyone else would have done. Also keep in mind; you weren't the only one on scene; if whatever it was had been obvious, someone else would have caught it. I don't have all the answers, just a lot of experiences of things not to do again. I wish you only the best, and then some. Take care of yourself, Paul

Everyone has had one of "Those" calls somewhere along their career. You review the textbooks, talk it over with others on the call, talk with supervisors as you feel necessary, speak with the Clergy person(s) of your choice. Believe me, you'll survive. It might take more time with one individual than with another to "get over it", but sooner or later, you will. Good luck, PM me if you feel it will help, or any of us on the city, as I feel sure we all care.

We are moving away (in my servce) from giving a D50 bolus. We tend to opt for a D10 drip in NS or (D12.5 in D5W) unless the patient is so far gone there is repiratory compromise or the pt has been down for a subtantial time with a GCS of 3 and a dramatically low BG. The untoward lasting effects of taking a diabetic pt with a glucose of say 40mg/dcl who is semiconsious and disorented and bolusing them which results in a BG now of possibly 310 mg/dcl is well documented. Specifically regarding the question of D5W or NS. I dont think the issue has anything to do with the glycemic state of the patient. I reserve D5W for medicated drips, Dopamine , Cardizem etc... If I am concerned about fluid replacement such as in case of a hyperglycemic pt with poly uria/dipsia tachypnea and a normal End tidal CO2 I would opt for Normal Saline as it is an isotonic solutiion and would hold its water in the vessel. In a hypoglycemic patient who is not hemodynamically compromised I mix D10 in a bag of D5W (it actually come out to be D12.5 but lets not go there). In the case of D50 I beleive it all has to do with the hemodynamic state of the pt and not the glycemic as to your choice of fluids. Lastly you can always push D50 through a LOK then flush and not have to worry about all this?

You can also attend some national conferences and monitor some of the critical care websites for opportunities or other classes. It also helps if you have some college especially in the sciences like A&P, Pharmacology and Pathophysiology. Do not just rely on the overview the Paramedic textbooks give you for an educational foundation. If you at least have more than just a Paramedic patch and a few weekend certs, the employer might see you are serious. You will need a very strong familiarity with the medications and calculations to where they are second nature. There is absolutely no room for guess work or errors made from not being familiar with pediatrics which can be anywhere from 1 day old to 21 y/o. The same when it comes to airway issues. You must have a strong ability to establish and manage an airway for neonates through adults. IVs will also have to be a strong point if they allow you to do invasive procedures. Critical Care Transport Medicine Conference http://www.flightparamedic.org/cctmc.htm International Association of Flight Paramedics http://www.flightparamedic.org/index.aspx Current Concepts in Neonatal & Pediatric Transport Conference http://intermountainhealthcare.org/hospitals/primarychildrens/classes/classesformedical/conferences/Pages/transport.aspx Conferences at All Children's Hospital St. Pete, FL Neonatal and Pedi conference, Austin, TX http://www.int-bio.com/userfiles/file/2010%20conference%20brochure.pdf Air & Surface Transport Nurses Association http://www.astna.org/ Great Journal: Pedi Critical Care Medicine http://journals.lww.com/pccmjournal/pages/default.aspx Where some of the guidelines originate: American Academy of Pediatrics (AAP) http://www.aap.org/ *****AAP Transport Section ***** http://www.aap.org/sections/transmed/default.cfm

My 20 hours are for, following "Trauma", watching CSI Miami, the 11 O'clock News, sleep, Tuesday activities before accessing back on line. A separate string for each episode? Well, why not! Good, bad or indifferent, why not have separate strings? Now, as to that awaited commentary... 1) The Phosphorus explosion was unexpected, but that explains the burns I didn't initially understand. 2) I note power-lift stretchers. Nice. 3) While trained in their usage, and having them in the stock aboard my ambulance, I've never used one. Has anyone in EMT City used them at First responder, BLS or ALS levels? 4) When the guy in the C-Collar didn't leave, the scene was no longer "safe", PD should have been called. Then, no window smashing on the ambulance. 5) I think I've used the "Grandma's Funeral" gimmick a few times too many. The only way would have been if the parents had divorced and remarried numerous times, or even the real grandparents. 6) The movie reference to Goldfinger's painted woman? After the "Bullett" reference in the pilot episode? Either Rabbit is way older than portrayed, or is a big time movie buff, like Tony on "NCIS". 7) The turn-down by the intern to Rabbit was nice. 8) Considering the squabbling of the parents, perhaps that is why the boy ran away so far and fast as he did, before becoming a "Pedestrian struck". 9) The man turned away from the party? Surprise, he didn't return with a Mac 10 to blow the party apart. 10) Rabbit hates kids, so why is he being so nice to the one hit by the car? It's out of character. 11) The intern was wearing a fairy costume, and Doc yelled at her for it. Perhaps it was because she was the only one in costume? 12) The child sees the intern in costume. Did this telegraph repercussions for anyone else? 13) Is Boone anti-gay? While working the Castro District, home of the late Harvey Milk? Why else did he almost punch out the obvious phony Paramedic? Actually, I view what he did as an assault. 13-A) Is it possible to buy a fully equipped and stocked ambulance from Craig's List? 14) How often does a flight crew get put into a ground unit, fog or not? Fog, and any nasty weather, can lift, and flight operations resumed. 15) With smashed windshield, that ambulance Rabbit got is probably good to be declared non-roadworthy till fixed. 16) The talky concerned wife? Nobody asked her to step into another room to allow the crew to do their job. Yes, we have all had one like that, and probably worse (leastwise, I have, several times). 17) The intern was correct in telling the divorced couple not to argue in front of the child. I have heard that hearing might still be active in an unconscious patient. I have no information on things overheard while unconscious driving anyone deeper into that state. Anyone have further information? 18) See #12. Repercussion was the boy thought he'd seen Tinkerbell. He kept saying "Tink?" when he first awakened. 19) Boone returned to behaving professionally when he treated the gay phony medic. 20) OK, referring to MY protocols: The pilot, acting as an EMT in the ground ambulance, starts an IV, an ALS protocol? I yield that some jurisdictions, perhaps a BLS person CAN start an IV, legally. 21) Boone's partner of 3 years is Gay, and Boone didn't know. While it is a big whoop, overall, I admit I never saw it coming. 22) Doc asks the intern to calm down the child by resuming the Fairy costume. That did kind of telegraph itself. 23) Despite how crazy both Rabbit and Nancy are, it was nice to see she is also human, visiting her dead partner/fiancee's grave on his favorite holiday of Halloween. 24) Re the helicopter's landings: Anyone else note the lack of safety, as the helicopter never seems to have anyone holding back traffic or bystanders when they create a landing zone? No, they just "drop in". 25) Re back to #9: The party had pyrotechnics gone haywire. Real life, we had about 100 dead at a club, when the band's pyrotechnics set the place on fire a few years ago. One of the dead was a band member. Anyone remember the club name, the band name, or the town? Sorry, I don't.

I think it's important to decide why you messed up, and why it's effecting you so severely? I mess up something on every call. I know, as I find something else I wish I would have done, or asked, or discovered while reviewing them later. That doesn't destroy me for two reasons. One, I'm never likely to be perfect, so I review each call to help guarantee that I'll be the best that I know how to be next time. Second, in my opinion, EMS is a learning environment. On the most critical calls I rarely have as much time as I'd like, nor access to the amount of competent help that would allow me to perform at the level that I would like. But you know what? It's the gig I signed on for, I don't really deserve the luxury of having people pat me on the back for my mistakes...I learn from them, make sure others have the benefit of learning from them, and then move on. Did you miss something because you don't have a good plan for running calls? Were you tunnel visioned by one thing, causing you to ignore something else? Did you trust part of care to someone else that didn't follow through? All of these are correctable, none of them should cause the kind of angst you're showing here. Why did you miss what you missed? Answer that question, and then follow Kaisu's advice and make sure you don't do it again. That's kind of how this game works brother. I'm not sure what level you're working at, medic/intermediate/basic but I'm guessing that you may be overstating things just a bit as well, and that's certainly easy to do if you don't have a lot of experience. It's a rare thing when we make a massive difference in the mortality of our patients in pre hospital environment, and even more rare when a 'slight error' (.01 % I think you said?) would have made any difference at all. Is it possible that what you're agonizing over is the difference between your treatment and following the protocols to the letter? If so, then you should stop that. It's simply making you miserable and not producing anything positive. I'm sorry I don't have more sympathetic things to say, but not discussing the call really only leaves room for general advice and shotgun sympathy. The first I gave my best shot, the second won't really do anything but make you a weaker person and less potent provider, so I'll let it alone. I hope you find whatever it is you're looking for. Dwayne

Here I had a whole long reply prepared, discussing whether or not the humor is "othering" and a whole bunch of other sociological terms and theory, and you managed to condense it down to six words. Bravo/a.

I nominate this for the "EMTcity Understatement of 2009" I came in on the tail end of this and would have to agree is was very civil, realitive to the surroundings. It seems like every debate here ends with everyone agreeing to disagree, until they don't agree again. Not many will admit it, but even the staunchest defenders of a position leave these debates learning something.

My first critical call and I missed something too. It tore me up. I got a great deal of support from my EMS family but it took time for me to feel better about it. One of the things that helped me was that I knew I would NOT make the same mistake twice. The protocol for that type of call is forever seared into my soul. I knew that I will use what I learned on that call to save someone else. I later found out that the mistake was meaningless as the patient was doomed. Perhaps if you follow up on the patient, you may find information that will put your .01 into perspective. The other thing is a psychological point. It is hard to accept that sometimes you cannot do everything right and people die. Your overall responsibility in the situation is very small. You did not create the illness/crisis and I am certain that you did the best you could at that time. By raking yourself over the coals, in a way you are trying to control what is essentially uncontrollable. It will happen. Take this as an opportunity to be a better provider and learn from it. Forgive yourself and move on.

Meh, it could always be worse. Though I was thoroughly amused tonight when my friend who knows very little about EMS or the actual reality of my job asked me - is that what it's really like? I was thinking hmmm how should I answer that - I've come across some weird stuff that would probably make a trauma episode, but that's not an every shift occurrance. I decided to be nice and say no, actually my job isn't that exciting - I get excited when I show up and my unstable patient is already packaged for me ! It's the little things people, the little things

This may seem like a silly question - but if you don't have anything to say, why start a topic? I thought this episode was okay. Once I got a chance to calibrate my expectations for the show I've found I can actually enjoy it for what it is.

I think some of the focus is due to a different in cultural values. For many of the later generation, spit-shined boots and polished chrome are not signs of being a good fire fighter. I had a Chief who demanded a full clean after EVERY time a unit left the barn. He used to say "I don't have any working trucks. All my trucks are parade trucks all the time." Who cares if you knew you had one hour before you would go out on your next call, get to scrubbing. The wheel wells had better bet clean too! Did that make us good EMTs? Did that lead to better patient care? Not only no, but HELL NO! Spending 30 minutes cleaning road grime off the ambulance in the middle of a snow storm at 0200 was not a good use of crew time. They should have been trying to rest so they could be fresher for their next call. During the day, what makes a more professional EMT? Spending 30 minutes squeegeeing and shining the rig or spending 30 minutes reviewing cardiology? The EMS mindset doesn't fit all that well with the paramilitary mindset except in those who are already instilled with it. EMS is flexible and dynamic and focused on the patient. The rig is a tool, not a decoration. The above does NOT excuse what I saw to be TRUE unprofessionalism: not caring about the patient, not caring about understanding the patient, not caring about understand what was wrong with the patient, not caring about improving ones knowledge and skills, not inventorying/stocking, not deconning, leaving things for the next crew... That was from people who were burned out, in the field for the wrong reasons, or otherwise just of poor character. I think 'crotchitymedic1986 makes excellent points.

I have read some neat opinions, and some.....well not so neat ones. I think this issue can be boiled down to this. YOU GET OUT OF IT, WHAT YOU PUT INTO IT! Meaning that if you want to present a good professional appearance....you will regardless of your agencies uniform standards or lack thereof. The same can be said for competencies. If you want to be the best, you'll study, ask questions, read more, and learn. If you just want a job, well that is what you have. Despite age, upbringing, past life experience it all goes back to work ethic..... Some of us had great parents who instilled that good work ethic into us at a young age. Some of us might of had it kicked into our heads at basic training or boot camp. And some of us might have gotten fired from a few jobs before we got with the program. In this profession you have to GET IT! If you don't. Then your in the wrong career field........ But here is the kicker.....work ethic is a personal choice. But you can inspire others to get on the train. Go to your next shift with a good positive attitude, wear clean what ever it is you wear, hair neat and combed, boots clean. Call your pt's Mr, and Mrs. Sir or Ma'am. While your at it do that for your co-workers. Peers support your peers. Supervisors and FTO's motivate your subordinates. Subordinates, hold a high standard and show the bosses that your worth the money.....Bosses get with the times......If your employees are holding a high standard, reward them, motivate them. Show them that you appreciate their hard work. If you show that you appreciate their self pride, it will instill agency loyalty (which is a whole new thread in and of itself...) I know....it is harder than it sounds. But if this was easy....Everyone would do it........Until next time....Cheers.

If you are lamenting the lack of pride and blaming it on the young and/or the absence of mentors, the culture, etc. then I have news for you. You are part of the problem. A single person can make a difference on the shift and on the station and then on the company. I am living proof. I am still a newbie medic at my company. I have not hit the magic 2 year service that qualifies me to be an FTO, a mentor in any official sense or eligible to precept anyone. (as it should be). I have no interest in advancement for the company and thus it is in no one's interests to kiss my butt or to do anything I ask of them, but I know I have made a profound difference on my shift. Once regarded the red-headed step child of the company, we are now considered the premier shift and it is acknowledged by all shift supervisors that we don't have a single "bad apple" among us. How is it done? First and foremost by example. I will not tolerate half-assed anything when it relates to the job. My rig is spit and shine and ready to run at the beginning of each shift. I come in 20 minutes early to make sure and I don't give a crap who turned over a bad rig to me - If it ain't right, I fix it. I am extremely tolerant of people's idiosyncrasies, personal likes and dislikes, sexual orientation, bad language, poor sense of humor, ever hungry ego, etc. etc. anything at all AS LONG AS IT DOESN'T IMPACT patient care. I sure don't want to sound like a know it all saint, but I am in this business for the right reasons. I also have the added bonus of financial independence, so I can pretty well take stands on anything of importance to me without fear of retaliation. I will not tolerate slipshod performance, lack of pride or professionalism or anything less the the very best from myself and anyone in my control (my EMT partner). It is done with sensitivity and tact, but 0 tolerance. It spreads. Amazing but true. If you truly care about your co-workers and your job, and take the initiative to go the extra mile, you can influence all around you and create positive change. Do not sit around and wait for someone to fix this. Take on the role yourself in whatever part of the EMS world you find yourself.

I would say that pride in the people we serve is a very large part of professional pride. I admit, I have not been a good example in this area in the past, and I still find myself sometimes slipping into the mindset, but I think it's imperative that people in EMS work undergo a major attitude shift. How many times have you heard EMTs and Paramedics groan when dispatched to an address in a predominantly immigrant area of town? What about jokes about the "trailer trash" we often find ourselves serving? Griping about going into nursing homes, even though the vast majority of our patients are elderly? Treating people who don't speak English or geriatrics as if they are children, or too stupid to know what's going on? I did quite a bit of thinking about this last night, and I came to the conclusion that lots of our EMS slang is actually very disrespectful to our patients - "frequent flyer" for example. Sure, you could argue that it is supposed to reference people who call all the time for very minor difficulties, but I've never seen it used for someone like that. In my experience, the term has been used for addicts, the poor (who have no way to get to a hospital, and no way to pay for non-emergency care), people with mental disabilities, elderly individuals with chronic conditions, in short: the forgotten of our society. Personally, I'm going to work to purge that term from my vocabulary. Here's a short list off the top of my head of things I have heart EMS and Fire Service workers either state in person or write about in various Internet media: -Joking about sexually assaulting minors in the back of the ambulance. -Joking about taking Spanish-speaking patients across the border and leaving them in Mexico. -Saying that a homeless "frequent flier" should just die already. -Saying that an incontinent elderly gay man must have been "quite a bitch" in his younger days. We all have our moments of ugliness, when a cruel thought comes into our heads (yes, it's a natural human reaction to frustration and weariness, but that doesn't mean it's right), but EMS seems to be an echo-chamber for those thoughts and words. If the industry truly had pride in who it serves, such attitudes and language would be unheard of, and regarded as utter nonsense. In addition, an attitude shift to one of service and pride would undoubtedly bring a trend of EMS/Fire clamoring for more education. After all, with pride invested in our patients, we would want to be able to give them the best care possible, not just "good enough" care.

I figured this would be interesting in light of recent education debates.

I'm not asking about specific EMS degrees, but about any higher education. My point goes more to the idea that some think higher education is too much of a burden for EMS. I hope to illustrate that many in the field already have higher education and so the leap may not be so far as some think.

51 views and only 7 survey responses... However the responses so far are interesting!

Oh, and another thing... Kevinbutnotbacon accuses me, after being notified of the assignment, delayed responding to set up taping a TV show, which he berates me for doing? I just found a posting on another string where he states that EMS in the UK ENCOURAGES the use of drugs by on duty personnel! At least we now know he is a complete fool, on both sides of the Atlantic ocean, as he now attacks his UK brethren, making them out to be "druggies". As he has, as of this posting, only 12 posts, perhaps they (UK members of EMT City) already gave him the beating he has been asking for, and gave it to him in extremis! (We can only hope). That, or his own drug habit(s) is causing his delusions of EMS superiority? Hopefully, at this time, we can resume the discussion this string was originally about, with my apologies to the OP for hijacking it, as it has been?

I just taught at an instructor retreat and here are some of my suggestions on adult education. Be happy! Truthfully, how many of us want to see an instructor that appears that they rather be doing something else ? Skip the "Why are you here?" introduction, waste of time and really nobody cares, but themselves. Everyone is there to take the course and it does not matter.... period DON'T lecture.. Notice how all AHA, and others have went to video tape/DVD teaching in lieu of lectures. Studies have shown performing and seeing is much more comprehensive than lectures alone. Skip the war stories.. they are paying or attending classes to learn on their time..not to hear how YOU did something. This class is about them not you ... they will develop their own war stories later. Anecdotal stories in a very minimum that is associated with a specific task/skill to help clarify something is allowable, but be careful. Allow your students to make mistakes: allow them to make errors then give positive correction. Many will correct on their own and learn and retain more by doing this. Get Involved! Get down on the floor with them.. Use the 3 points of demonstration, when teaching a skill. 1) Demonstrate entire skill without lecture 2) Slowly teach skill with demonstration of each step 3) Demonstrate skill entirely without interruption. Then have students return demo to you.... Skip the games.. Only apply games when you know they are successful, or the subject is complex. Many adults learners feel intimidated by games.. and feel that they are foolish and immature. Be careful and apply when applicable Use humor cautiously, and appropriately. Follow standards and keep to curriculum as much as possible, but allow exceptions and discuss application outside the class room. Positive reaffirmation! Give praise... and often, every one likes a pat on the back.. but, be sincere! Finally have confidence in your self, all the students want to succeed and at the same time want to see you succeed as well! Good luck,

My question is this, why do we need a new thread for each and every episode... is it really necessary?

It was on while I was doing other things. Rabbit ran a chest pain and it was pretty accurate. Slightly exaggerated vis-a-vis the yapping spouse, but lord knows we've had ones pretty close to that. The only nit pick I had was administration of NTG before establishing a line. That was the only scene I saw and it was mildly entertaining.

Joint Direct Attack Munition GPS Guided Bomb

SPOT uses satellite phone text messaging to communicate. It already has the ability to said predetermined custom messages like "I'm OK" and "I'll be late" in addition to "911!" They should make it 2-way. PLB's use the same system as ship beacons and the ship beacons have messaging capability. This could allow some reduction in the number of unnecessary rescues. Another option is to simply feet the coordinates of the distressed party to the Airforce who can target a JDAM and fly over. Problem solved... Another great idea is to make people take a short online course before they are allowed to register the beacon.

Yes a truly bad attitude that affects patient care must be changed, but you need to understand that offcolor humor and dark humor is a natural and healthy response to stress and keeps human beings mentally healthy instead of keeping them dwelling on difficulties. You don't say it in front of the patient or the public. THAT is unprofessional. Joking about that dead guy on the last call with your partner, that is a stress reliever and makes sure you are going to last mentally in the profession. When your mind wears out, all your other ideas of professionalism will wear out shortly thereafter.

Advanced Medical Life Support is a misnomer. There is nothing advanced about it. This is entry level information. If you attended paramedic school in the last ten years and did not receive this information there, then your school sucked. But obviously, since the majority of the medic schools in this country suck, AMLS is a very positive thing. Of all the card courses out there, it's the most valuable that I know of.

I am aghast with shock and indignation ! Am I alone in thinking that the very fact you even considered taping a purile American sit-com before going on a priority detail showed a gross lack of proffessional , moral and ethical responsibility ? I will not recant my original statement regarding your actions. What is more my colonial cousin ! In England Ambulance Services are run with military precision. Between jobs we do not lark about watching television. We are given a myriad of duties, ie cleaning vehicles,cleaning the Station,checking stocks etc,etc. In England we have no time for slacking ! I can only assume your indignation has been caused by the guilt that my wise words have provoked.

The car hit the bike tire and did no damage. If the patient would have fallen off to the right he would have hit the ground, he fell off to the left landing on the car. He did have protective equipment, but I understand the 3000 lb car vs any protective gear will win. The way the patient described the accident, he wasn't directly struck, his bike was, but he did fall off the bike. Forgive my jumbled mess. I'm a night-shifter that is having trouble sleeping right now, so I'm not as eloquent as I like to be. I'll PM you with the outcome. I really want to see more feedback before I post it. I'm really attempting to use this call to improve my assessment and comfort level with trauma patients. A person can't improve if they can't recognize that they may need to do something better.

The patient believed the sensation he was feeling in his back was a result of his riding. He was one week into a 3 month bike ride from one end of the US to the other. He is riding about 60 miles a day. He felt he might have just been physically fatigued because he was near his stopping point for the day. He had no fractures. He was diagnosed with the ever generic sprain/strain to the back in the low thoracic/high lumbar area. He was discharged a few hours after arriving to the ER. Thanks to those that replied.

I got a negative, I wonder who that was from?

Why would you question this thread? I'm pretty sure that if you are not interested, you don't need to read it, much less comment on it.

Just look for the goats & you will find AK......... Stay safe guys

My reputation for rehashing old topics should preceed me and here I am proving it lol. First aid courses I have been involved in teaching are often industry specific (line haul drivers, volunteer firefighteres, ERT memebers, forestry workers, children groups etc) and so each course is tailored to suit the individual needs. If I am dealing with responder teams like ERT that need a two day basic course with CPR, WPFA, AED and some extra skills like C-Collars and O2, I do find introductions are important as I don't work with the people, helps me identify the leaders and the shy ones that I will need to assist through the course and in some courses, you may have members from three or four different ERT teams, so its a chance to mingle with the team memebers themselves. Humour is a brilliant instructional tool, if you can laugh at yourself and with the students, personally, I've found the courses to run alot smoother. I use visual aids such as Powerpoint, video and big clear charts. The books and charts are scattered around the desks for group work of taking a medical condition each and presenting the basic - what it is, how it presents and what treatment is used and whether its time critical or not. I am not a fan of written exams, I am a person who would rather see someone succeed with the practical and verbally give the answers in a relaxed essence. Every instructors style is different and also every countries style is different, New Zealand is a very much, sweet as mate attitude whilst maintaining professionalism. Scotty

You were right on for a while... the reputation system enforces Group Think. Think like the group, get +1s. Think unpopularly, get -1. WE ought to be dealing with differences in ideas via responses with counterpoint, not votes as that is mental laziness. However, I'm not grading people on their english, either, so long as it is understandable and not painful to read. I guess you, like me, aren't sure where to comment on this since the Reputation System thread was locked for I don't know what reason. I guess it makes sense to talk about it in the thread where questionable ratings are occurring.

You better make absolutely sure you have a patent line if you do this.