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If I am not mistaken the penalties the government wishes to enforce for lack of health care is meant for employers. Because so many companys, like my own, REFUSE to even offer ANY kind of health care or reimbursement for the health care I carry privately. I am definitely stuck in the "middle class" here. I also can not buy a home with my credit if I do not have a substantial down payment. Even though my rent costs me more than a mortgage would. WTF?! How does that make sense? At any rate, I have medical bills, a lot. They are very expensive, because I have to carry my own coverage. My parents are about to lose their coverage. My mom developed a cancerous tumor on her kidney and had to have the kidney removed. My dad found out this year he is diabetic. They also have some other health concerns. As they should since they are getting older. My uncle who is mentally retarded, is apparently not disabled enough to have medicaid. Really? But the pyschos I pick up off the street are mentally ill enough? This has to be better. We don't have a choice but to try to make it work. What we have now does not work. I worked for Blue Cross Blue Shield, those people are the devil. And someone mentioned earlier about how other people's healthcare costs raises your premiums, absolutely. You better fucking believe it. What I have not heard is pharmaceutical reform. Ticket number 2 for your insurance premium cost. I would actually say it is more accurately number 1. When you have prescription coverage, as I do, you are lucky enough to not absorb the entire cost of that drug. But someone has to. It doesn't get written off. Your insurance pays for it. I had to get medicaid when I was pregnant. I have private insurance. I didn't have maternity coverage. Nor could I afford to spend the rest of my life paying the thousands to pay that off. I don't make as much in 1 year as that whole 9 months cost. So, yeah I pay for those leeches I pick up and take to the ER for no good reason. But at some point we have to consider everyone else. Me, I have insurance, its not great, but I fit it into my budget. My uncle is on my mom's policy, barely. They already have gotten the letters about "undertmined future coverage", she pays for coverage. PRIVATELY! How is that fair? Okay, so we pay out the nose so we can have REDUCED health bills. But the crack head with out any coverage at all, pleads with the hospital to get a reduced bill because he has no job. That does suck. Again, can this option maybe be better? Really?! It has to. I have family that travel to Mexico and Canada for health care. Because like someone else said, it is still cheaper. I don't think now is the right time either, but as our society continues to plummit uneducated into a sea of ignorance, when will there be a good time?

I'm truly glad to hear you say that, because now I don't need insurance. I simply need enough money to fly to NZ, right? Screw health insurance, I'm going to bank a few thousand dollars and then if I ever get terribly sick I'll fly over there and exercise my human right to top notch medical care despite my inability to pay. Thanks man!! Yeah, we do hope to some day claw our way out of our mud huts and rub some sticks together for fire or something... I'm a little surprised to hear about the "joy" the Aussies and Kiwis exude when describing the euphoria of giving basic human needs to all. I worked with many people from each country...and don't you both have indigenous populations that you're really not so friggin' happy to be supplying with 'basic human needs?' Seems like I might have heard something like that whispered from time to time... And I was once physically prevented from hitting a male Canadian nurse in Afg when I was told that if a double traumatic Afghani amputee wanted proper pain management four hours post op that 'perhaps he can show me his insurance card?" Easily the least compassionate medicine I witnessed there came from Canada. Is this a symptom of socialized medicine? I don't know, but if it is, then it certainly should be discussed, shouldn't it? (I have only my small little snapshot of Afg NATO medicine, so it's certainly possible that the crews I witnessed were some type of fluke. I simply know that I didn't witness like flukes from any other countries.) Now, I have friends that I love from each of these countries. My point isn't to degrade them but to suggest that if we're actually going to discuss there merits and detriments of socialized medicine then perhaps we might be better served to amputate the nonsensical Kumbaya (sp) dialog from the discussion. Throughout this discussion we've allowed the countries with socialized medicine to present it as if everyone there walks into well lit clinics and hospitals where the staff is waiting for them with a dethorned red rose just gushing over the opportunity to serve them immediately. "OOhhh that mole does look nasty. It should be removed. Well, we have an opening this afternoon if that will suit your purposes?" "Mr. Jones, you will need your knee replaced before we'll be able to get you walking without that terrible pain. Will the day after tomorrow be good for you? Awesome! We'll send someone to pick you up!" Can those of you that come from countries with socialized medicine tell me honestly if these are the conversations you're overhearing when you go to the doctor? This is not the description that I've been given by you all in the past. Why suddenly do we wish to pretend that it's the reality now? We've been through page after page of "We have socialized medicine because we hold basic human rights more dearly than you do!" Any chance we can call this thread a no bullshit zone from this point forward and talk scratch? Dwayne

No need to PM you man, I'll speak to you here where folks can offer opinions. Too bad you sent the below PM, as I actually agreed with you on some of your points above. I received the following PM today... boeingb13 sent you a new conversation Subject: ? Replies: 0 Sent: Today, 08:49 PM I love how you loud mouth internet tough guys get on here and say what ever you want knowing you can hide behind a name. If your ever in north Florida, look me up. We'll discuss your comments in person. Let me break this down for you sport. Hide behind a name? My name happens to be Dwayne. And I happen to be an EMTP. And you may have noticed that my picture is right there by my name. From your response, can I assume that you're real name is boeingb13? (For the record Hotshot, the grownup world capitalizes names.) Because certainly a man like you wouldn't hide behind a pseudonym (a pseudonym is a pretend name used in the place of a real name)...Or would you? And if you would, wouldn't that then not only make you a coward for making your bullshit threats in private, but also the worst kind of hypocrite? The good news is that you've shown yourself to be the exact kind of ignorant coward that I'd predicted you'd be when I responded to Annie. This isn't 4th grate any more shithead. You need to use logic and intelligent debate to make your points here...No one's afraid of you. Good luck with your EMS endeavors. Dwayne (My real name)

Newsflash: this doesn't cover everyone. And will result in millions of Americans who currently DO have health insurance, to lose it. And others, their jobs (and therefore their insurance too). It's always amazed me the number Europeans willing to work more for the goverment's benefit than their own. I guess it comes from centuries of being subjects instead of citizens? No adult has a right to something that by it's nature someone else has to provide for them. Life, liberty, and the pursuit (NOT necessarily the attainment) of happiness. Those are rights. Nothing that costs money is a right. (Yes, healthcare costs money, even in your little Utopia. You pointed that out better than anyone by telling us how cheerfully you hand over 52% of your income, a large portion of which is no doubt used to support- in a myriad of ways- people who don't work as hard as you do.) What it call comes down to is this- this "health care plan" (in quotations because it isn't, really- it's a national bankruptcy plan) was written by a committee whose chairman says he doesn't understand it, passed by a Congress that hasn't read it, to be signed by a president who also hasn't read it, with funding administered by a treasury chief who didn't pay his taxes, and financed by a country that's broke. Explain to me again why I'm supposed to be celebrating? Maybe you didn't know all that. I can give you the benefit of the doubt. Next time, know what the hell you're talking before you stick your nose in. We WERE building a fence and deporting illegals, until "Hope and Change" came along. Draconian? Perhaps. Will it cut down on uninsured consumers of healthcare? (Not necessarily actual "Americans.") Almost certainly. And for a lot less than $960,000,000,000. In terms of direct impact on the healthcare industry, allowing residents of one state to purchase cheaper health insurance from another state, and enacting real tort reform would both reduce the number of uninsured and overall healthcare costs for everyone. Both opposed by the current regime.

So this is the only info I have on this situation. Was George Orwell "1984" most correct when he stated in his novel the decries of a totalitarian government is bent on total manipulation ? So what next, does one get sacked for chatting on the phone between calls and can your employer record them when your working ? Isn't this an infringement on the EMTs rights to free speech and is this not what Freedom in America stands for or better against ? Whats the huge deal if one posts a picture is that some boss man believes is unprofessional or was it just developing comradeship ? Thoughts ?

Could it be that the cash strapped/economically suffering American public is finally getting tired of getting bent over by the elected representation? Elect me, and when I get to Washington, I promise not to do what all the others have been doing to you! (nudge nudge, wink wink) Clinton, on his way out of office, gave the American 'working class' a great big "Screw you!" by signing NAFTA and GATT into law. Now we're seeing the fruition of those laws, as we watch our jobs sail overseas; and the federal government is throwing us deeper and deeper in debt by coming up with these 'social reforms', and obviously no one took into account that the working class can't afford to lose any more of their piddly paychecks. Economics 101 says that if you have a 'working class' that isn't working, the economy will collapse. Add into that the corporate greed, and you've got a recipe for almost immediate disaster. The elected yahoos in Washington seem to think that by starting all these 'giveaway programs', that the economy will magically pick back up. Well, when you're only tickling 'special parts' of the economy, you can't expect some raging hard-on of a recovery. While the insurance industry needed overhauled, and the health care industry needs to be taken out behind the woodshed and given a good beating, this is NOT the way to bring the costs down and make it more accessible! *Edited for glaring grammatical errors*

LMAO Does that mean you advocate a ban on that potentially lethal silverware in steak houses? Does that mean we will have to enjoy our filet mignons pre-cut?

This is why knives should be banned. Only those that want to commit crimes carry them. Only those with specialized training should ever handle them. No Knives, No knives, No Knives.

Well, Dwayne, for starters – you should have punched that Canadian nurse, and then kicked him in the tickets while he was down. I would be ok with that. (if you were Canadian, it would also be appropriate to pull his jersey over his head and beat him with a hockey stick…) Socialized medicine is not without its problems, and those who say it has no drawbacks are wrong. I could list pages of issues we have here with our medication system… oh wait… I think I have already been involved in some of those threads… Every system has its parasites and abusers, from the addicts we have all brought in to the ER, to those who call an ambulance because they don’t want to pay for a taxi, to the regular on the Jerry Springer show “Who the Baby Daddy” with 6 kids. I don’t think that will change regardless of the health care system provided – abusers will always find the loopholes. From what I have seen, and I am sure I have mentioned it before, the thing I truly like about socialized medicine is coverage for children. If I had a child here, who needed major surgery, there would be no question of “does my insurance cover” or “can I afford it.” I have seen, as I have a good friend in the US, who does not have that comfort. Although both parents work full time (and the husband works 2 jobs), their son who had heart surgery at a very young age, again needs heart surgery. Their insurance will cover 75% of it, but they will still have to come up with $50,000+ of their own funds. They are currently able to re-mortgage their home to cover this, but what if they weren’t yet in that financial situation? What if they were a younger couple just starting out? How do you not provide care for your child because you can’t afford it? Then what? I have talked to other US members on this site, one of whom explained it to me very well. The independence from government, and self-sufficiency is every important to US citizens, and “I had that child, it is my responsibility to care for it.” I get that, and I respect and understand that position. I just don’t think it is possible to be prepared for the worst possible scenario, and the costs involved. I just wish that people didn’t have to forego medical treatment for their child because of financial reasons, when the parents are middle-class employed individuals – I couldn’t imagine how that would feel.

Well said Kiwi, I do believe I tried to say that but I may have said it in Khazakstaki or Swahili. There is a complete difference in understanding what is happening & treating the root cause. We usually develop a provisional diagnosis, we advise the hospital what we see, but it is not up to me to tell an acutely ill person who is suffering with ischaemic heart disease to lecture them on losing weight, quitting smoking & exercising as well as dietry modifications. We are called to an acute problem. We treat the symptom. We should understand what our treatment is doing, how it will benefit the patient, but the patient described doesnt need me farting about talking to someone (mass) debating over what to give them. ASA, Nitro, O2 Morphine & diesel. Minutes mean muscle. Playing around on scene could cause infarction of muscle. If me being more concerned about getting my patient to difinitive care makes me a robot, then so be it. My patient needs to be in hospital for difinitive care, regardless of it being a medical or trauma issue. Give me the tools to treat my patients sufficiently to do that. That is my job. I am not a doctor & can only offer limited treatments. I know the pathophys. I also know my limitations. Medcontrol will not help with either of those. Brent, what you are talking here is a whole of health issue. We do it here. We refer, in some cases to aged care teams. We also advise directly to the hospital of what we find. So yes, but that is not our role, it is an adjunct to it.

So, should EMS not have any role in social services? When you have an elderly who breaks a bone on a throw rug on the wood floor, are you just going to ignore that situation? When you are in a house on a public service call, and hear a smoke detector with the low battery chirp, are you ignoring that too? EMS is the closest to social services many people see, that are in need of it. While that is off the topic at hand, at the same time I think your examples are a little off and not relevant.

That is not what Phil is saying. He is saying it is not up to Ambulance Officers to fix what has caused the problem hmm, let me see if I can give you examples - You dish out some midaz to a seziure patient who had a siezure because they have a massive brain tumor; are you a neurologist? - You give O2, GTN, ASA, CPAP and a bit of morf to a CHF patient who has CHF because of his poor lifestyle and eating McDs 24/7; is it our job to give him a lecture about his lifestyle and diet, no, and don't think I don't feel like it sometimes! - An old lday who lives alone has trouble remembering when to take her insulin and becomes acutely hyperglyceamic; is it my place to make sure she complies or to deal with her her more pressing problem is massive dehydration? - Some dude tried to scale a retaining wall on his BMX after 12 beers and broke his foot; should I counsel him on not doing dumb shit when drunk? I am not saying we should be dishing out treatment willy nilly without proper knowledge of pathology and physiology (eg GTN in RVI, frusemide in CHF, suxamethonium in hyperkalemia). What I think Phil is saying, and I wholeheartedly agree, that ambo's provide a level of care (which is some cases very highly sophisticated) but that our place in the chain should be realised.

As a matter of fact, several of our ED docs here are ex-paramedics. That aside though, I disagree with your point that good medicine is something different in the field than it is in the hospital. Good medicine is good medicine, no matter where you are. I believe that our intention is to treat medical problems (pathology). Not symptoms. I took issue with you saying the following (from previous post): I think this is shortsighted, and the kind of thinking I really loathe in a coworker. It may or may not be the case with you personally, but when I read this comment I feel it smacks of a sense of contentment with ignorance. A robot can "treat symptoms." A clinician thinks about pathology and root causes (and THEN treats). How would you categorize yourself? It isn't what you said. You said that doctors only consult on critical patients and even then, only AFTER the patient had been stabilized. You say that right here: The distinction is important because I am pointing out that doctors consult THROUGHOUT the care of both critical and routine patients. It is an example, I think, of a professional humility and a responsibility that EMS shouldn't toss away lightly. Given time and available circumstances, I think we too should be consulting on a routine basis. It is a healthy feature of good medicine, not a kick to a Paramedic's ego. Yes we do! It's called on line medical control! I don't think I directly called you any names, but I guess I apologize. I feel strongly about a lot of this stuff and sometimes I get carried away.

Now I agree with SPENAC...

OUCH! Richard (I assume) negatived me even! Ohhh I struck a nerve! In all fairness, his book is a good read, if you haven't.

Worth repeating over here... I'll let the quote stand on it's own. http://www.post-gazette.com/pg/10082/1045012-100.stm#ixzz0j3pUfl47

It's called sarcasm... you people suck at having a sense of humor.

Can I just say this...I work as an investigator for a state department of health. Just because the state regulating agency says that they broke no state laws does not exonerate these medics. As a regulating authority we're bound by the language of the statutes. In my state, and I wish to remain anonymous about the state I work for, we have no laws that would cover this specific incident, but there are laws and regs that talk broadly about morality, ethics, etc... This was a senseless, needless death. Simply put, if the ambulance can't get to the patient, you get out and walk your happy butt to the patient, or you bring in an ATV or you do something. Simply walking away from the patient or making a patient work harder than they need to when they're sick is absolutely improper. One article I read on this case said that "the state exonerated" responding crews. Well that is patently false. The state exonerated nobody...they simply said they could not identify any state laws that were broken. I'm not saying the responding crew is the only ones at fault, but they were the ones that were trying to get to the patient. The circumstances of this tragedy falls squarely on their shoulders for not calling for additional resources. It was their call, ultimately.

I came across chatroulette a long time ago. After a few mins of that, I decided never to go back. Since the site was mostly guys jacking-off, it was not appealing. If these EMTs were on that site, then yea.. I could see punishment being given since it is essentially "not safe for work". Local hospital where I am, has wifi and LAN. The wifi can be used by anyone and the LAN is all the hospital computers. People frequently browse ebay, google, youtube, craigslist, various forums, etc etc all the time. They keep it clean, and never let it impede on their job. A happy work place is a good work place. Absolutely NOT!! You must sit there, and stare at the wall or windshield. If there is something on the wall like a poster or something on the street then you must open your map book or protocol book and memorize it. ps, I am being sarcastic

I don't understand why you do not understand why they were punished: 1. They were on-duty. Being hospital-based employees, I imagine they fall under the hospital's policies and procedures, which probably clearly state that you can not "play" on the computer while you are at work (especially if it was the hospital's computers). If the clerk in the billing office can not surf facebook while she is on-duty, then the EMS employees can not either. 2. They used images of the hospital property and their uniforms in the pics. Big NO-NO. And I seriously doubt that their posts on the internet were very professional, or painted the hospital in a professional light. 3. When you are at work, you should be at work. I applaud those departments who do not let you carry a cellphone or personal laptop while on-duty. Play on your own time, be a professional at work.

ATTENTION ATTENTION! All medical professionals are drones and must act as such!

The main impetus for this 'healthcare reform' was because so many Americans do not currently have health insurance (I'm one of them). Unfortunately, it's been known and documented that even if this 'reform' passed, it would still leave about 8 million people uninsured. Ok, it's cut down on the number of uninsured people by forcing everyone to buy it. It still doesn't address those that can't afford it in the first place. It DOES however list the progressive rates at which these poor people will be fined when they don't obtain insurance. I've worked places where my wages after deductions (based on 40 hours a week) couldn't even cover the co-pay for premiums, let alone the co-pay for office visits or prescriptions! Because I was working 40 hours a week, I didn't qualify for Medicaid because I made too much; and I surely wasn't old enough to draw Medicare benefits. I'm only one of how many MILLIONS of uninsured people in that position...and now the government wants to be able to fine me because I can't afford health insurance. I thought the whole 'reform package' was supposed to make it so people in this spot could afford it, not twist their arm into taking on more payments that they can't afford. "Sorry kids, we don't have money for clothes or food; but when you get sick or drop from malnourishment, we've got insurance!" WHile the impetus to get more people insured is noble, the way that they've gone about achieving that goal is reprehensible.

How many other "rights" require the work of someone else? If a physician refuses to see a patient or discharges a patient from his practice, does that mean that the physician violated the patient's civil rights? Both of those are paid for by taxes and fees. Additionally, a business owner getting a fire inspection done doesn't get it for free. A bicycle license isn't free. Plenty of other police and fire services Additionally, the police force in the US are agents of the state, not agents of the people. The courts have said countless times that there is no duty to protect any one citizen.

In your humble opinion. Take care, chbare.

Yeah Annie, I wouldn't hold my breath waiting for a reply. His type is of a common kind...They spend 2-3 minutes on a frantic mental dry hump and then shoot their verbal load all over the thread but run away before the possibility of hearing the pitter patter of the little feet of debate, and the responsibility that that entails.. It's unfortunate that the fire services, of whom we have many members here that I respect very much, is most often represented by 6th grade spelling, grammar and logic. Dwayne

I'm pretty sure that's what I said. Government hand-outs is not the answer. Everyone has a sad story and I sympathize with yours. Forcing American's to foot the bill for your problems doesn't hardly seem fair to me. Most American's are charitable almost to a flaw, but when you force us to give...charity goes right out the door. I support making it illegal to deny someone coverage because of pre-existing conditions. I support cost caps. I support tort reform (which is where huge health care savings could be found). I don't support this massive tax bill veiled as health care reform. I don't support our lawmakers overriding the will of the majority, just to save the face of the president. Ramming through a bad bill that nobody wants and at the very least that everyone thinks should have been scrapped and started over is wrong and it is costing us our freedom and will worsen this economy to the n'th degree.

Best rule to have is never give anyone a recommendation, it will bite you in the butt.

I think it is a bit early to debate as so much is still unknown about the final bill. But one thing that is definite no matter which party is in office and no matter what law is passed there will be some people benefit and yet others suffer. That is life as we stand today.

As a 22-year-old American citizen with a "pre-existing" condition who has had to fight with insurance companies to receive basic medical care throughout my life, I am happy that it passed. I no longer have to live in fear that an ER visit or doctors visit won't be covered because of a condition beyond my control. No longer will insurance companies be able to drop me without warning for needing more medical care than most, and no longer will there be caps on how much they will pay. I am very excited to see the future and where this will go.

I wasn't trying to call you (or anyone) out specifically, which is why I didn't quote you or use your name at all. Even if you have standing orders for pain control, there are likely others here who may have to call for it. My point was simply that our definition of "what is medical control" varies widely across our community here. That point stands. I don't think I said that it has to be a doctor, even though I do agree that a physician might make the most sense. Okay hot shot. The 3rd round of IM epinephrine in a status asthma is an on-line option for us here. Should we all have our "accreditation reviewed?" Things aren't the same everywhere Phil, and there certainly is a little room for thought in this scenario other than pushing the syringe down and hoping for the best. Do no harm. Epinephrine increases cardiac O2 demand. ...Or are you simply saying that nobody could definitively prove it was your epinephrine that did the damage, and therefore pushing this drug is okay? What a truly idiotic thing to say. Phil, there is more to our patients than we see at face value, and thinking in only two dimensions like this can have really negative effects. If you really believe that a patient does not exist who's presentation will exceed your abilities as a prehospital provider, you either have no experience in the field whatsoever or are a complete fool. Wrong. See above comment. Wrong again. Spend some time in the ED and follow a doctor around. You'll see. Nobody knows everything, and it is expected that individual providers will seek the advice and experience of those around them. That is part of what it means to be a professional. Doctors consult all the time. Before, during, and after both critical and routine care. I don't purport to represent all US paramedics of course, only myself. You are correct though that I am reluctant to conclude that we should "do away" with on-line medical control consultation. I'm not trying to say that paramedics should be calling doctors every day to ask for permission or help, only that they should have that option when things start to get out of scope. It may not have happened to you in a long time, but it does happen, and I feel it should be part of our professional humility to leave ourselves a lifeline if needed. Even though this was my example, I do agree with you. I feel that paramedics are quite capable of identifying STEMI on the 12 lead ECG on their own. In fact, good peer-reviewed research has shown that we can do this quite well. The problem in my area is that even though we may have gained some trust and respect from the ED physicians we deal with every day, we have almost none of that from the interventional cardiologists that we hardly ever see. To them, we are ambulance drivers, and I imagine they have a hard time answering that 3am call at the request of a technician. I only mentioned this because it is one of the main reasons I have called medical control in the recent past, and even though I feel it could be an unnecessary step, it has been successful for me and my patients.

Yeah, made an acct, tried to post..... "I, as well, don't see the problem here. Well over half of the calls that the firefighters are running are medical. They don't want to be held to professional standards and oversight like the rest of the medical community, so it's simple really. Lay off half of the firemen, replace them with ambulances carrying medical professionals. Then an ambulance will be the first vehicle to arrive when a person needs medical attention and it will be staffed with personnel that have chosen to be on a medical scene instead of someone that finds medical care and the educational and accountability burdens that that entails distasteful. Why make this more difficult than it has to be? Some people want to educate themselves and be held accountable. Those people should survive and flourish, others don't, and they should be eliminated. Of course, there is not a snow balls chance in heck that this bill will pass, so the majority of this will end up to be mental Mast....., you know, at best. But that's not always a bad thing. I'm confident however that there are many fire professionals that study, stay sharp, and have no fear at all of medical oversight. For them I'm sorry, as they'll be painted with the same brush meant for the ignorant yahoos." Got this... "You comment contains a word or words which are considered inappropriate. Please edit your comment and resubmit." Pricks!....(I added the pricks part.) So I changed "Chance in hell" to "chance in heck." Changed "Mental masturbation" to "mental Mast....., you know" changed mental Mast....., you know" to "moot" and I refuse to change ignorant Yahoos to anything else as it just has a nice flavor when speaking about these dipshits. Finally I just gave up. I'm thinking that if "heck" the offending word then I probably don't have the communication style necessary to make my point in that theater. I've discovered I'm really not very good at expressing my opinion when strict censorship is invloved.. :-) but I have no idea what the hell is wrong with the above... Dwayne

Maybe. If you are on your 3rd dose of epi and the patient is 55 years old (which makes epinephrine a dangerous proposition!), perhaps there is something else that ought to be considered. A lot of epinephrine in an elderly patient is something that isn't to be taken lightly. I agree that neither is respiratory distress, but we too abide by a "do no harm" principle. I personally feel like these kinds of "oh crap" situations deserve fresh eyes, and I don't consider it a personal insult to ask for help or a second opinion. Agreed. Although epinephrine infusions for this particular scenario haven't quite made it to the pages of our local guideline books (they actually do say "paramedic guidelines" on the front). An epinephrine infusion would definitely be the subject of my consultation with OLMC in this case. I understand that a paramedic could likely do this on standing order, but epi infusions are not yet commonplace here and it would definitely be prudent to have a talk about it with the doc before we start making things up based on what we may have read about or heard someplace. Hopefully if anyone can, its me! haha. How about: 1. Extended treatment options for field treatment of severe hyper-k without lab results. This is a dangerous condition that we can do something about in the field, but often do not for lack of definitive lab values (and reasonably so!). A conversation with a doc where the paramedic relays the pertinent clinical findings could lead to a field treatment that otherwise may not have been prudent, which could be life saving. This one is from my own experience. 2. Tox syndromes. Toxicology is a whole medical sub-specialty, and there is a lot more out there than the usual narcotic/beta blocker/TCA/organophosphate stuff we are more familiar with. A conversation with a physician in an unusual OD scenario can be extremely valuable. 3. Deep ACLS. Management of refractive brady or tachyarrhythmias (wide complex especially) can definitely benefit from a fresh set of eyes. I have absolutely no problem forwarding an ECG to medical control for a 2nd opinion if I am concerned about WPW in a patient that might otherwise get Cardizem, or a potential VT in a patient who is refractive to Amiodorone. These are tricky scenarios that even cardiologists sweat over. Why make this decision on your own if you don't have to? How about those? We talk to the ED attending that picks up the phone. Our local guidelines contain an agreement between hospitals that the receiving attending ED physician is the acting medical control doctor for that particular patient.

I think there are big differences here in what "on line medical control" means to each of us. I see some people commenting that they have to call a physician and ask about first round analgesia dosing, and I also see people referring to their protocol as "guidelines." These are two opposite ends of the spectrum, and both are represented here. Personally, I don't think we should ever be without on-line medical control for some things. Where I work, we call a physician on the radio when we truly need another opinion on a difficult topic (Should I give a third SQ epinephrine to this 55 year old woman with severe asthma? Do you agree with my assessment of this STEMI patient so that we can bypass the ED for the cath lab? I've got a difficult syndrome here in a critically ill patient and I'm not sure which path to take...). It is my feeling that these calls are open and honest consultations with colleagues, and a recognition that there is a whole lot out there that we Paramedics, or any individual for that matter, doesn't know. Even doctors call other doctors to discuss things if they get in a bind. Who's to say that we are too good for that?

No idea. It was in Jan/Feb, I wasn't here for a few days, opened up the site and was sitting at 70 something. 2 days later it was over 100. I can't find any of my posts with that many +'s. I wouldn't complain if the whole ratings thing was dropped.

Nate- did you read the original post? I think your attack on John was totally uncalled for! MedicMal

No where in this post have I stated that forcing yourself to stay awake is an acceptable solution. In fact, this whole thread is about ways to prepare yourself for night shift so that you will be rested and prepared to work nights so you do not have to force yourself to stay awake. By actually contributing to this thread instead of posting smartass comments you will be a part of helping ensure people are not driving to calls tired. Thanks to everyone for your thoughts. john

I think everyone needs to re-focus on the fact that this was NOT a routine day. It was a huge snowstorm which stretched the city's resources to the limit. I'm going back to the definition of a disaster. Normal rules DO NOT APPLY. It means that demands for service exceed available resources. It means that everyone needs to pull together as a community, be self sufficient, and help each other out, but sadly that is a foreign concept for too many people. Pardon me for sounding like a cold hearted a'hole but an entire city was up for grabs, people all over the area are seriously sick and injured. Elderly people, incapacitated, trapped- the list goes on and on. In the context of a disaster situation, exactly where does abdominal pain rank in terms of priorities and/or triage category? It has been said that this crew should have requested more help if they needed it. OK- great. A guy has abdominal pain, so how many pieces of equipment should be committed to help this one guy? What about a crew that needs a highway scene protected because of an accident? What about a fire? What about a crew that needs manpower help with CPR? What are the priorities here? Remember, a doctor actually spoke with this patient and did not seem to think this was a life threatening emergency, but now a paramedic crew is in trouble because they did not transport this guy. It's wrong. Big picture, folks. Do the most good for the most people with the resources you have. This is a disaster situation, and I honestly think one of the major problems this society has is dependence and entitlement. Despite all hell breaking loose, someone expect the same level of service they have enjoyed as well as an immediate response. Was there any other possible solution here? Family members assistance to help the patient? What about a neighbor? Friends? Extended family? NOBODY could think of an alternative solution to this problem? Isn't there any culpability on the part of this person's family? If this is my family member who I- or they felt needed immediate care, I would figure out a way to make it happen. When did we as a society become so helpless? People die. For all types of reasons. In disaster situations, more people die- and sometimes for reasons that appear especially tragic- like abdominal pain. It happens, but to vilify the crew for what I think is a systemic failure is wrong, short sighted, and as was noted, looking for an easy scapegoat. Then again, it's far easier to go after the crew than to actually address a problem with the system itself. \\\end rant

Any comments on that Bushy? How is that the comm's fault?

You should have quit there. They sure will. From the unicorns. Who do you think the 8 million still-uninsured people will be? (Btw, it'll be WAY more than 8 million.) What the fuck is that supposed to mean? Could you BE any more European? (See how that feels, wise guy?)

Since this healthcare reform has been pitched, there have been many in the US media making comparisons to "Socialist healthcare systems" Many of the analogies in the press have gone from the inaccurate to the offensive. My reply was in reference to the misconception of those systems from a US standpoint. Just as the US has its rights, so certain other countries have theirs. Believe it or not, many of the comments from Canada, the UK, Australia, and NZ are in support of the US having a better system for their people.

I think Richard is Rudy Guilliani.

You may have to go work for a company full time to receive insurance Ruff, but I am having to stay in school full time to even get the mediocre insurance I receive now. I'm willing to do that right now, but what happens to me when I graduate in 2 years? I have a major pre-existing condition as well, and an extensive medical history for a 22-year old. If I stop being a student and loose insurance, I will have to file for bankruptcy at the age of 22 as I can not afford my medical bills and neither can my parents. It is a very scary place for me to be in and while I don't agree 100% with what Obama is doing, at least he is doing SOMETHING. What was voted on isn't final, there are more steps that must be taken before it all becomes affective, so the Republicans have a chance yet again to shoot it down. My question is this though, what are the republicans willing to do to reduce the number of uninsured americans? For those who aren't willing to pay more for others insurance, do you realize that you're already paying for them in your premiums? Private insurance companies jack up their premiums because hospitals charge insurance companies more to make up for the uninsured and non-paying parties. So in your premiums, you are paying for the uninsured and non-paying patients.

I could really careless what you think, it is hard to see a close friend in a wheel chair because an EMT slammed into his car after falling asleep at the wheel and running a red light. Sorry, but I take this stuff very serious. Forcing your self to stay awake when your tired IS NOT an acceptable solution in my eyes.

We certainly needed to change things like covering preexisting conditions, but it's a HUGE leap from there to a move towards socialist type health care. This is about pushing an agenda, NOT about covering more people or saving money. Mandating insurance coverage, fining people for NOT having insurance- how does this help anyone except the insurance companies and the government? How does cutting Medicare funding help anyone? Once again, the middle class take the hit. The poor and ultra rich are the ones who always benefit most from any entitlement initiative. This is certainly historic, but not in a good way. Not a single Republican voted for this bill, 34 Democrats also thought it was a bad idea, and a whole bunch of Americans are not happy either. I hate to feel like I'm sporting a tin foil beanie, but based on recent events, you have to wonder. This isn't about health care, it's about a fundamental shift in how this country and our economy works, and our ideologies. Couple this with government take overs of student loans, auto makers, and financial institutions, and how can you not read more into this?

Not for nothing, but doesn't the tech pictured look something like Tyler on Trauma?

Healthcare is a right, not something you earn. Until the US gets that through thier head, I don't think you guys are gonna get very far.

Touche my friend. However, if your house burns down the fire department will come and put it out free of charge, the police don't send you a bill for helping you out if you need it, most local libraries are free, you don't have to pay to get US mail and so on and so on .... all of these things are regardless of income or how much you have "put into" the pot. Why is it that healthcare, one of if not the most basic and essential human services is not seen as so in your parts?

Ah so that why the US Mail don't work lol. I am not arguing that somebody has to pay and that tax is our way of paying and we get off the Govt whereas you pay for insurance. If you can pay, you should and that's just basic principle of being fair and how the world goes around. However speaking of being fair I think solidarity says those who unable to pay should not have to; we're not talking about me paying your restaurant bill or something like that but rather an essential human service. I don't mind that some of my tax dollar goes to paying for those who can't pay so they can get healthcare, welfare etc. A healthy population pays for itself over and over.

What I find odd, is that in reading the whole report that was filed from the dispatch center, I don't see anywhere that the responding units actually cancelled any of the calls. I may have to go back and reread it to be sure.... The State Department of Health has cleared the crews, but the city is going to single out two paramedics to take the fall? Following the conversations in the transcript, it would appear that a couple of the dispatchers would be more culpable in getting the calls cancelled than the medics were.