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Of COURSE they back fire based EMS, it means less firing for fire departments! It's not about providing good services, it's about maintaining the bottom line, and for the IAFF and IAFC, that's firefighter job security. I love the first comment on the article: Shame on JEMS for posting this propaganda. It'll probably get deleted, but props to whoever had the balls to post that up!! Wendy CO EMT-B

I often see people quote this classic foramen magnum herniation pattern. While it can occur, and you may hear the term tonsillar herniation to describe the effect of the cerebellar mass moving in a general downward direction causing the cerebellar tonsils to compress the brain stem and upper cord, this is far from the only thing that can occur. In fact, we are neglecting a major portion of mass effect pathophysiology as it relates to this often misunderstood concept of herniation. If you recall, an invagination of the meninges exists, known as the tentorium cerebelli. In essence, the tentorium separates the cerebellar area from the superior aspects of the brain. Therefore, if you develop a supratentorial mass effect (space occupying lesion) or edema above the tentorium resulting in herniation, the herniation will in fact occur through the tentorial area. Two basic types of supratentorial or transtentorial herniations can occur. 1) Central; when the temporal lobes of the cerebrum and parts of the temporal lobes push downward through the tentorial notch. 2) Uncal; often associated with a lateral mass on one side such as an epidural hematoma, where the uncus of the temporal lobs is pushed over the tentorial shelf. Each type can has associated signs and symptoms. In addition, the exact cause of Cushing's triad seems to have many causes when looking at the literature. I have seen reflex changes, to ischemic changes, to pressure on the vagus nerve used as explanations for some or all of the exact findings. I suspect, multiple types of pathophysiology lead to these changes and perhaps attempting to identify one clear culprit is a bit myopic IMHO. Take care, chbare.

Brandon, One addition I think should be made about Cushings triad is this: The vital signs you are looking for (hypertension/bradycardia/irregular respirations) is not a singular event, but something that needs to be trended. A singular set of vital signs does not constitute as a positive Cushings. Hope this helps....

By MICHAEL GANNON Norwich Bulletin Posted Nov 05, 2009 @ 11:20 PM -------------------------------------------------------------------------------- Norwich, Conn. .Ron Alianos white 1938 Packard ambulance carried his casket in a procession through Norwich Thursday morning en route to his funeral at the Cathedral of St. Patrick. Hunderds of people gathered at the cathedral to say good-bye to Aliano, a businessman and community leader who died Saturday at age 65. His mourners included friends, first selectmen, mayors and former employees. Aliano founded American Ambulance in 1972 and grew the company into The American Group, which now includes the Marina at American Wharf, an automobile servicing business, a medical training firm and an ambulance billing service. Ambulances from across the state, including Campion in Cheshire and Hunters in Meriden, participated in the procession from the Church and Allen Funeral Home on Sachem Street to the cathedral. Led by a police escort, the procession brought Aliano past the American Group building just off West Main Street, and down past Norwich Harbor, where he built the marina and which many have credited him with saving. Mourners began arriving at the cathedral more than an hour in advance of the 10 a.m. services. The Packard ambulance, adorned with the American logo, arrived at St. Patricks to the skirl of bagpipes. His wooden casket was carried by American Ambulance employees past an honor guard of Norwich firefighters. Outside the cathedral after the funeral, many people were too overcome to talk about their friend. Others echoed the stories that have made the rounds in the days since Alianos death, about Norwich being Alianos adopted home, and how he became not only one of the citys most successful and respected businessman, but also one of its most tireless advocates. His myriad community activities included being a charter member of the Norwich Harbor Commission and a member of the board of directors of the Norwich Community Development Corporation. His involvement with Norwichs annual Fourth of July fireworks came to the fore the past two years when major sponsors pulled out, and each time Aliano led or co-directed successful efforts to raise the funds to ensure the event happened. He also was part of the group that raised money to buy back and restore the 1860 Lincoln Banner that had been missing from Norwich for more than a century when it turned up at a New York City auction house in 1997. The banner now is on permanent public display in City Hall. Rhonda Davis said her grandsons are long-time Aliano employees. She got to know Aliano through her Norwich real estate business. Dick Friedrich, of Montville, a former bank vice president in the city, knew him for more than 30 years. Im here out of respect for what he did for the city, Davis said. Im here out of respect for Ron, Friedrich said. He was depicted as a stern and demanding taskmaster on the job, but one who was generous and caring, and always ready with a funny line or story. People are here because of who he was, said Brian Filiatreault, of Baltic, who worked for American Ambulance. Ive known him since 1980, and I worked for him for 25 years. He was a good friend and a good boss. In the homily, they said he took care of his own, Filiatreault said, unable to conceal his grief. He did. Frank and Carol Dobek, now of Cape Cod, have been friends of Alianos since they lived in Bristol. Ron was the best man at our wedding, Frank Dobek said. And hes our daughters godfather, which tells you a lot, Carol Dobek said.

Hey all, I think I did a poor job of representing our QA/QI process, or it is simply different than what others are used to. No one was on my case. Where I work this is not a punitive process. We submit our reports and they are reviewed before being permanently stored and uploaded to our medical director and are encouraged to argue our points of view in order to improve future accuracy. I actually enjoy this process. I believe that intelligent documentation is a very real part of my personal mental call review as well as an awesome benchmark for my professional attitude. Poor spelling, grammar, sentence structure? I would not consider it a favor if those that know and care about me would be comfortable watching me slip day by day further from my goals. I don't believe I'm better than the medics I have no respect for. Those that have met me will tell you that I'm not packing many more brain cells than are necessary to keep me breathing. I will slip, and my intellectual/professional quality will fail, the same as theirs did. Knowing this, I have chosen to do what I can to surround myself with smart, strong people that also find joy in the process of making me stronger and smarter as well. That is why I hold so many at the City dear, and get a little cranky when others imply that this is simply a place "to hang out and chat." I abhor the thought of being one of 'those' medics, the ones that do many parts of their jobs simply to get by. I hope to one day consider dust, ak, chbare, Vent, and many others of course, my peers, yet am very confident that I will be unable to do so without the kind, yet completely honest criticism from those that surround me. Please don't misunderstand. I'm grateful to all of you that came down on my side, ready to go to the mat to defend me. But in this instance I'm fortunate to work at a service that believes that details are important, education and criticism are important, but that anger, fear and punishment are not the most efficient tools to delivering those qualities to their employees. I find great joy in times such as a few weeks ago, when my boss came into the crew area and said, "Can someone please tell me, with a chest pain patient, what is our first pharm intervention!?!" All said, "That would be O2/ASA boss!" He said, "Mr. Womack, would care to share your treatment of your "chest pain" patient yesterday??" See, I had a lady that had obvious muscle pain secondary to using her new walker. History of developing pain was clear, Bilat chest, arm pain, tender to palp, complete resolution of pain with rest and shallow respiration, perfect lungs/12 lead, no cardiac history, etc, etc. I said, "Ok, Yeah, I didn't give aspirin, that was kind of a bonehead stunt...I get it!" And it was, and I did. I was so secure in my diagnosis that I failed to do the one simple, cheap, relatively safe thing that is proved to create a more positive outcome in AMI, just in case I was wrong. (No, he wasn't implying that I should have employed my cardiac interventions despite my assesment findings, only that, in this case, I could have taken steps to mitigate the patho issues should there have been an MI hiding underneath. see? I didn't do bad, my diagnosis was spot on as verified by the hospital, but I could have done better. And better, I tend to believe is where we'll someday find outstanding.) Everyone laughed and gave me hell, but only because we all understood that the reason to celebrate this misstep was because we all learned from it, as well as it wouldn't be so funny if I didn't show pretty good judgment most times. Anyway, I didn't mean to write a book, and I know that this environment isn't for everyone, but I wanted to explain this a bit as our service's attitude on performance as well as productive criticism and education is one of the things I'm most proud of when I mentally compare 'us' to 'them.' Have a great day all, and thanks for your feedback! Dwayne Edited to repair a few typos. No significant context changes.

Facebook came to mind because it is so popular. I remember about 2 or 3 sites ago (;D) there was a collection of banners we could use to promote. I would love to have a PDF file we could print off and put up in breakrooms, or a couple of images we could put on our blogs/websites ect. Thats more of what I was getting at. Don't get me wrong, there isn't anything wrong with who is here, but, you can only preach to the chior so long, no? Phil, and Ruff, can only get into so many arguements!!! I do love the way the site has become over the last year, its a bit more drastic to me, since I was gone for a while, but none the less it has improved for the better. Take pride in what you have helped to create!

I think the site has definetly gotten better once the admins created the pay area. I am a long time member here and got frustrated a few years ago with all the crappy posts and childish antics that were going on. The site has definetly become more professional...LOOKS 100% better and hope this site really takes off but I think having facebook / myspace etc...links is not the correct direction for this site. We all know how easy it is to access the web via cell phones and PDA phones and what do most of us EMS'ers do during down time....go on the web. But boredom from the front seat of an ambulance can also cause problems with a mobile version such as facebook. It would be very easy to post pictures that we all know should not be posted and atleast if you have to wait to get to a regular computer you can think about the consequences of that picture post. I don't think a facebook link is a good idea to promote the site...I think the best promotion is word of mouth and as you stated passing emails to friends. As money rolls in from the pay chat area and maybe some site sponsorship more advertising may be something to think about in the future. The other factor you really need to think about is who is running the site, server space and speed. A sudden spike in membership could also slow and/or crash servers due to high traffic. EMTCity started out as a small hobby for someone and has really grown over the years...It takes a lot to run a web site/blog/BB and thats why it is a pay site for chat and also got rid of some trouble makers. The cost of server space and time needed to police everyone is tough. I have run BB in the past and it can get really time consuming to reset passwords, veryify information, etc.... I have over 20yrs in Emergency Services and have a lot of knowledge to pass and this site is a great medium for it where there are some real good knowledgable people. I am a member of four other EMS sites similar to this one and I think this surpasses the rest without question. I would like to see in the future here are online CME's but it costs money, time to set-up, and a EMS-I/Education team to coordinate and sign-off the CME. I am NOT an admin...I am NOT friends of admin...I am NOT even a site moderator...this is my own opinion based on the changes I have seen and hope to see in the future. Just my useless two cents...

You got me. It wasn't thought through and rereading it implies exactly what you described. Allow me to clarify. These masks have begun to show up on the trucks as a one to one replacement for standard N95's. Not universally though, not in separate cabinets and with little rhyme nor reason to when you'd find one vs. a standard NRB. No attempt has been made to draw attention to them or train on them. (I did just reconfirm this by scanning all the memos on the intranet to make sure I didn't miss anything from just before I was hired.) I did look at and open up one when I saw it doing truck check, noted the filter, but paid it little further thought until now. NRB's at the best of times provide a poor seal and when combined with the way pt's tend to fret with them filed it away as a gimmick. To say I wear an N95 as a matter of course referred more to my not counting on a filter added to a mask to mitigate my risk such that I would compromise my usual BSI precautions. I can't confirm without any doubt that we don't carry the multiple sizes of the mask as I'm not at work, but I did not see any other sizes. Certainly not within the oxygen bag. Without a properly fitting mask, I can't imagine a filter providing much benefit. Now the N95 oxygen masks that I've seen advertised seem to be a much better option and have been examined in peer-reviewed literature. Below is a link to a summary from Annals of Emergency Medicine. Unfortunately, it is not noted in this summary whether the masks were fit tested before being applied to the volunteers so while the results are encouraging, the practicality is not clear. http://www.annemergmed.com/article/S0196-0644%2806%2900942-5/abstract

I say this with all due respect as I have never taken issue with comments before and I know it is probably a comment that wasn't really thought through but to say that you 'didn't pay much attention' is a demonstration of a lackadaisical attitude of where mistakes happen. It's great that you are protected, but what about everyone else that could potentially be exposed to the patient? Hospital admin staff, general public in the waiting room, family members, etc. Our goal wherever possible should be to isolate the source while also protecting ourselves.

Despite the apparent tonal issues in this thread, I think that some very good points were raised on both sides. Now I'm certainly not trying to play impartial moderator because I clearly come down on one side more than the other. While I have, in the past, interpreted Vent's "tone" as anti EMS provider... I have come to the conclusion that I think it is more accurate to describe it as anti "bad" EMS provider. This I can not have an issue with, for I dislike bad providers as well. I still disagree with some of her arguments... just don't care whether the argument carries a tone or not. I myself have been guilty of over-toning my posts, so I suppose it would be disingenuous of me to take exception. I think that it should not be the jobs of EMS to play Monday morning social worker. We are ill equipped for it in experience, education, and not to mention the time it takes to accomplish this. However, I also agree that it is incumbent on EMS'ers to properly nudge people in the right direction. Make the proper referrals and recommendations to the patients, family, and staff. If we see something that could be fixed, and we know who is supposed to fix it, we should notify those people. I've done these things dozens of times over the years, and they can be done within the framework of the call without much effort or wasted time. That's were it should end though. We shouldn't get any more involved... I think it blurs the line of what our purpose is, provide pre-hospital emergency care. I don't want to be a social worker, so I would prefer that my job not expect me to be one. This does not make me an insensitive beast (I don't think), but it does make me someone who knows his current limitations.

But of course I voted: What do you think I am , An airheaded canuckistanian???? [just kidding]

Limiting the discussion to the the standard Mac or miller blades, the blades are "shaped" to facilitate displacing the tung to allow for visualization of the glottic opening and the landmarks. if you are adept at intubation yes you could use the right hand and get the same result while crossing your arms (if your not doing an ice pick intubation), but wouldn't it be easier just to use a right handed blade?

Let me iterate: This position of mine (that apparently warranted a minus point) is wholly based on the arguments we've had over the years here on the City. It is not a knee-jerk reaction, it is sheer frustration based on facts. Whoever had the gonads to negative-mark me without offering reply and explaining why it was given a negative, shame on you. Own your criticisms! Wendy CO EMT-B

Got the word today that H1N1 vaccines are finally arriving in sufficient volume so that starting next week we will start holding clinics at local elementary schools for the kids. No mention of when we[the EMS providers] will get the vaccines for us. So you see it's not any different here south of the border.

Actually, the trachea is somewhat to the left of midline on most of the population (Hence the BURP method Backwards-Upwards-Rightwards Pressure) And no, you don't 'have' to sweep the tongue to the left. One of my best tricks I learned was using a Mac blade like a Millar. Instead of sweeping the tongue, control it like with a Millar blade by staying close to a superior approach (close to the palate). I've found this especially helpful in the patient with C-spine precautions. The goal is to isolate and control the tongue, however you do it is up to you in a clinical (street) setting. I will admit though, you can run into push-back in the theoretical setting (class, exams, etc.) The whole sweep to the left idea is to allow for the passing of the ET tube with your right hand. If you have the tube in your left hand, it would make sense to sweep to the right, except as has been stated, a standard Mac blade generally won't work.

Brandon, Hopefully, I can clear some of this up for you. 1. When delivering a baby, NRP recommends the oropharynx to be suctioned first, followed by the nares. The theory behind this, stimulation of the nares may cause the infant to gasp and aspirate secretions which are present in the oropharynx, ( Meconium being one of them). Also, remember not to suction too vigorously, no more than 100mm HG of negative pressure to avoid common injuries. Also, too much rigorous suctioning could overstimulate the vagus nerve and thus produce profound bradycardia.. 2. Adult SYMPTOMATIC Bradycardia can be treated with the following options. Atropine ( unless 3 degree AV block), Pacing, and finally CPR.......SO, YES, you can do CPR on an adult in this situation.... 3. Cushing's Triad is when you have an increase in ICP ( Inter-cranial Pressure, ) which causes compression of the cerebral blood vessels causing ischemia to the brain. This may be represented by Increase in Blood Pressure / Decrease in HR / Decrease in Respiratory Drive. This is a real event that you can easily witness in the field, as I have seen it many times both in the field and during my days First Assisting in the Operating Room... Hope this helps. Respectfully, JW

In my country we believe a man convicted of outragous offences of criminal activity or lewd acts of sexual or moral perversity must suffer the consequences until the day he dies. A man who is a criminal or murderer or fornicator must be punished and allowed no respite from persecution. Only in the next life is he free to persue a career in emt . His past sins will only then be absolved.

Here's a news flash for you Herb, the new education standards are coming out whether you like it or not. Having 4 -7 different levels for EMS providers each state and each state different from each other is of no benefit to EMS, the patient or the individual who tries to move from state to state. I grew up, got an education and starting working with those who didn't just sit in the easy chair at the station spewing complaints about their patients, their job and their life. Read you own negative comments on this forum and use those as an example to what I am talking about. There are some secret ways to staying in a profession for over 30 years and that is not to stop learning and not to put up with crap from burnt out EMT(P)s who have long ago stopped caring. I continued my education to make a difference and some can't handle change. I think your arguments for the many different levels and that everything is fine in EMS have demonstrated that attitude greatly. It is time some in EMS decide if they want to be part of the future or it they should just get out and shut up if they have nothing productive left to offer this profession and the public they serve. Change is coming whether you like it or not. Maybe you should also broaden your reading opinions from more than just an anonymous EMS forum. Have you even been to a regional, state or national education meeting to discuss anything pertaining to EMS? You actually know a few people on this forum that have and it is a shame you consider all of them "out of touch". I'm sure Dr. Bledsoe likes hearing he is out of touch. How about Rid? What about our two ED doctors that take time to educate those in EMS and support the providers? You generalize and bash way too many things and people you know very little about.

Yes I know this is in the funny section but I have spent many hours getting patients with severe disabilities home and have tried to work with various agencies and professionals to make the transition go as smoothe as possible. It is not always a matter of "coping" but rather results of a traumatic brain injury that can bring about a personality change. Many family members are often shocked or ashamed of their loved one's different behavior when they do start responding after a traumatic injury. Some abandon their loved ones to where some of the rehabilitation is affected without their support. Let's look at this from the perspective of a rehab facility. Having our patients laughed at is one of the fears we do have when we are preparing our patients for as much independence as possible. Unfortunately services like Lifeline are not perfect and instead of notifying their appointed primary care giver, they call 911 only to put our clients through a situation like this. While the patient may seem to take this in stride, the remarks made on scene do affect them and they try to make light of it in spite of their embarrassment. When they gather for more training or group support, I am often saddened to hear how some have been treated especially when they are not always in control of who their Life Alert or LifeLine system notifies. Instead of taking it as a big joke, especially with the new EMS provider, maybe some education and some notes on how the notification system could be improved might be in order. We are always looking for suggestions to work with the various agencies such as Life Line (or whatever in the area) and EMS to make our patients' transition back into some type of independent living successful. Nothing like a bunch of snickering FFs to undo months of work toward building the confidence of someone who must live with a broken body. Do whatever you can to improve the system instead of just complaining or laughing about it at the patient's expense of possibly losing what freedom they do have because of a poor system function. We still have a lot of patients and are getting more each day that would like to have a chance at independence even when severely disabled.

In our urban service, a lot of our transports are less than 10 min, if anyone followed this nurse's policy, a great deal of our pts would not receive analgesic. I think that the nurse in question just has an axe to grind, and wouldn't pay her much mind. Our service has Morphine, Fentanyl, and Versed for pain control. The problem is our protocols state we have to give morphine first, fentayl if, and only if the pt has an allergy to morphine, and versed, only after the pt has received 20mg of morphine without pain relief. Fentanyl is mainly used along with Versed and paralytics for our RSI.

The answer is you treat them no matter how far you are from hospital, but you use the appropriate med. Fentanyl is very short acting, but works great, it is the perfect drug for your scenario. It knocks down the pain, but they are fairly alert 15-20 minutes later, when the Doc sees them. The Nurse was wrong, as LOC doesnt matter for an isolated extremity fracture. LOC is important in the multi-trauma patient where a head injury is possible (but they will get a CT either way, so maybe not). My point is that if you are giving Morphine for every patient that has pain, then that is a disservice to those patients. They should be treated with the appropriate drug. I say the same thing for Paragods that use Versed for RSI, it is the wrong drug for the scenario -- you should not overdose someone so that you can put in an ETT. If you are going to do RSI, use paralytics. Now the spinoff question, who are you, and who are you not managing pain for ? Are you medicating all sickle cell patients who claim to be in crisis ? Are you medicating your drug-seekers who are screaming in pain, but have absolutely normal vital signs ? How about severe abdominal pain ? Migraines ? Fractured finger/toe ?

I could have bet my mortgage you would respond to this with a holier-than-thou post. You did not disappoint. Do you require people to avert their gaze when they meet you? Just wondering.

From one urban ems'er to another thanks 'tsk' for giving ventmedic what for. We have a ed alarm abuser that has been know to press it 3-5 times a day. Medics have "damaged his alarm box" and used all means possible but the ems higher ups have yet to do there job and get him in a nursing home. This pt doesnt need our respect or lessons on being disabled he needs to stop abusing the system. This is just one example of abuse. Thankfully you didnt need ems tonight where we ran for 2 hrs constantly out of squads.

Woe is me. Feeling a bit persecuted? You're over the top because it's easy to talk the talk when you aren't working in the real world. What you ask are social services tasks, NOT EMS. People get advanced degrees and devote their careers to solving problems like these. If someone wishes to take it a step further and contact a company, discuss patient advocacy issues, that is far over and above the responsibilities of an EMS provider. More arrogance. I'm consistent because I'm not trying to BS anyone. What happened to you in your career that you seem to have such a dim view of EMS providers? If you started spouting your personal opinions and generalizations about EMS around 99% of the people I work with, you would be quickly shown the door- if you were lucky. Other professions have professional, paid lobbyists and arms of their groups to push their agendas. IT is also their FULL TIME JOB. Again, another generalization I completely disagree with. Based on my experiences- and from people even on this board, I see nothing to back up your claim. People here are looking to exchange ideas, obtain information, and verify things. They want to be able to do a better job and help their patients. You need to separate street level providers from administration. Very few providers have the time, resources, or connections to lobby on the behalf of their profession, especially when many work OT and second jobs just to make ends meet. The administration/leaders of the industry are the ones tasked with these functions, and many are in those positions by default- they've risen through the ranks and attained a certain level of accomplishment, but not necessarily the knowledge needed to lobby or push legislation. Often they base their opinions and efforts on experiences when they worked the streets 25 years ago or more. Every one of these folks that I have met or read opinions from is out of touch. Save you faux outrage for the people you claim to rub elbows with- the leaders and administrators. THEY make the policies, not a street level provider. It's easy to blame someone else, but in order to effect change, you need to have the proper "vehicle" to get it done. The different levels of certification are not a convenience, they are based on the needs of an individual area. You can trumpet how you think every EMS provider should have 12 years post grad under their belts before they can ever touch a patient, but yours is an unreasonable opinion, with no basis in reality. You think providers should be more educated- so do I, but I also see the value of a volunteer EMTB in an area that cannot afford anything else. Your smug claim as a "patient advocate" does not wash if you cannot see the value of having any provider vs having nothing at all, because a community cannot afford to hire an EMTP(and all the other costs associated with ALS care) with a college degree and 12 initials behind their name. That college education would be far more valuable if it concentrated on management, leadership, and business, as this is the real need if we want to move forward from here. Like it or not, EMS is in the health care BUSINESS, and needs to be treated as such. Again- talk to someone in a busy area. They could operate out of the nicest firehouse, station, garage, ER in the world, but if you run back to back calls, how much time do you have to enjoy the perks and amenities you speak of? As for busy providers being glad to have a nonemergent call like a Lifeline alert- I call more BS. Most providers in busy areas LIKE to be busy and do the jobs they were trained to do. Although nonemergent calls are part of the game, belittling an EMS PROVIDER because they haven't solved all their nonemergent patient's social service needs is nothing more than arrogance and shows a lack of understanding of the basic issues involved in this problem.

Change, for change's sake is not the answer. You have a clear bias toward providing social services to our patients. I do not agree that is an appropriate or even logical use of EMS services and resources in cash strapped communities, especially when these are best addressed by another profession that has the proper education, training, and resources. I don't care how many levels of providers there are if they can be justified. That's like saying that a small town looking for a doctor should not be satisfied with anything less than a John Hopkins trained neurosurgeon to be the town's sole Family Practitioner. It's not your material I have the problem with, it's your attitude. Everyone has their own opinions and are entitled to them, but you pontificate, belittle, and generally act superior to most here. Generalizations are fun, aren't they? I wondered if you would get that part. I also made the generalization that most here are not as lazy as you describe them to be. Why no comment on that? As for "burnt out", like many I went through a phase, but got over it years ago. Like many in busy urban areas, things beyond our control DO affect you. Some remain that way, some self medicate or engage in self destructive behaviors, some leave the profession completely, and others change their attitudes. I learned to adapt, get educated, understand how things work, and a stint in administration also opened my eyes to a lot of things most street level providers have never seen. Things are never as simple as they appear. I prefer to be proactive in my own venue and use my experience and education to effect change from within. I teach, mentor, and explain why certain policies are the way they are. I dispel common and long held myths about how public safety works, citing appropriate references from my studies. I am also not arrogant enough to claim proficiency in an area I received no formal training in.

Back off on a debate? That is now called pandemic and causing panic because of the lack of enough approved for use vaccinations, well, I for one actually trusts my National Health Care Advisors, maybe this as you put it self serving political leader was way smarter than all of us here, her staff I bet are now immunized so she most likely accomplished her goal. http://www.hc-sc.gc.ca/ahc-asc/index-eng.php Or should we just do a goggle search and check out all the real snake oil and profiteer's capitalizing with the magic cure, gogi, silver coins and a plethora of other crap and misinformation ? In this thread and others related there have been quiet a few actual evidence medicine studies been presented the use of ventolin (and delivery means) in the H1N1 patient thread presented by mobey and I saw no comments by yourself and an excellent post in this thread by one explaining for this demographic audience the immune response, perhaps you did not read that one? So if you call yourself a researcher then why would you post a link to a news article Published: April 30, 2009 when the first wave was reported in mexico (the virus has now mutated and spread at an incredibly rapid rate even beyond the projected models of WHO) the link is very dated with opinion and some conjecture by one retired MD and no where in that article does it state adverse effects short or long term with the present vaccine in production both varieties, it is quite clear in the news article cytokine storm" or hypercytokinemia that may be causing death more frequently in younger adults,(proven now in Ontario) and now even more evidence since that time in regards to increasing incidents in ARDS, again higher than expected but I would you like to discuss that item as I would be most happy to discuss that topic, although the vast majority of readers in EMT city would be scratching their heads from tying to understand Arterial Blood gases analysis alone, no offence intended. We will agree to disagree that this thread initially presented in a knee jerked manner does have more merit and in regards to another topic that we prematurely eat our own and solidarity for a cause affecting the safety of EMS and First Responders IMHO is sadly lacking, quite clearly you took the bait and responded emotionally, I have plenty of time on my hands to debate because I was not as fortunate as Siffalass and am sequestered to my home. cheers

yea I can see how you didn't interpret her intent.

I really think it is time for this to drift off into the archives of the city... it's just gone down hill and emotions seem to be running high.

Oh ya. We have those at work. Surprisingly no in-service on them and I'll have to check but I don't think we have the various sizes. I didn't pay much attention b/c I wear an N95 as a matter of course when dealing with respiratory complaints.

can a person become a emt if the crime happened over 20 yrs ago