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This comes from instilling a sense of 'entitlement' to our kids. We've taught them that you don't necessarrily need to expend the effort to get the 'prize'. Couple that with the latest trend to only put forth minimal effort, and look what you get! How many times on this site alone, have you seen people wanting to know the 'quickest' or 'eaiest' way to get through EMT (or higher)? We can spend all day long extolling the virtues and benefits (not only to our patients, but to ourselves as well) of higher education, hard work and honest effort. People aren't listening, because we're not advocating the 'easy way' of doing things. There's too much focus on 'instant gratification'. Unfortunately it doesn't exist. If there's something you want to accomplish, then be prepared to WORK for it!

At a Senior Citizen's luncheon, an elderly gentleman and an elderly lady struck up a conversation and discovered that they both loved to fish. Since both of them were widowed, they decided to go fishing together the next day. The gentleman picked the lady up, and they headed to the river to his fishing boat and started out on their adventure. They were riding down the river when there was a fork in the river, and the gentleman asked the lady, 'Do you want to go up or down?' All of a sudden the lady stripped off her shirt and pants and made mad passionate love to the man right there in the boat ! When they finished, the man couldn't believe what had just happened, but he had just experienced the best sex that he'd had in years. They fished for a while and continued on down the river, when soon they came upon another fork in the river. He again asked the lady , 'Up or down ?' There she went again, stripped off her clothes, and made wild passionate love to him again. This really impressed the elderly gentleman, so he asked her to go fishing again the next day.. She said yes and there they were the next day, riding in the boat when they came upon the fork in river, and the elderly gentleman asked, 'Up or down ?' The woman replied, 'Down.' A little puzzled and disappointed, the gentleman guided the boat down the river when he came upon another fork in the river and he asked the lady,'Up or down ?' She replied, 'Up.' This really confused the gentleman so he asked, 'What's the deal? Yesterday, every time I asked you if you wanted to go up or down you made mad passionate love to me. Now today, nothing!' She replied, 'Well, yesterday I wasn't wearing my hearing aid and I thought the choices were fuck or drown.

It's so weird to think that anyone would believe I'm worth impersonating. And what do I have to gain by lying? I already lost my job and I doubt the Hospital is going to come to me and say "You know Franco, we've been seeing a lot of positive comments on the internet about you, here is your job back!". I never said what I did was professional, it was stupid. One thing I can say is, I didn't post the photos. That's not to say my partner did without my permission but there is something to be said about the fact that I didn't put them on a site as public as Flickr. I never intended for anyone outside of my close friends seeing these photos. I said nobody from the hospital saw the photos, meaning my supervisor or the administration. My close friends have seen the photos from me showing them in person on my computer when I explain what happened. I'd like to thank everyone who has had kind words for my situation as well as adding that nobody owes me an apology. I am fully aware that what I did was stupid and unprofessional, I just don't think it was deserving of such a severe punishment.

Just a quick rant here and a rhetorical question, but what compels one to cheat? Is it really that difficult to do the work and then test your knowledge? (Argh!) I needed to take a FEMA IS 700.a class for my new job. To find the website, I did a quick google search on FEMA ICS 700. Guess what the first option was that popped up? "FEMA Answers" I get the gist...and go through the course and take the test...but now my curiosity is up. After printing off my successful completion certificate, I go search. I'm appalled at the number of people who have posted something to the effect of, "I need the answers...now." I'm not naive. I saw this in school and thought it was immaturity. I decided that somewhere along the lines those people might just wash out and it wouldn't be a big deal. But, what happened to pride in one's self, in betterment of one's education, in personal integrity? Or is this simply more entitlement? I don't have to work for it because someone will just give it to me. Worse yet...the answers can be found if you look hard enough. Hey...you who posted the answers. Do you really want THAT person on your team who's not going to know what to do? Okay. I'm done with the rant.

Danny Boy, The Pipes, The Pipes . . .

I hate to repeat myself, but... The problem we have now is that we have elected the most liberal president in recent memory. If anyone knows his background, who his advisers are, and the place they all came from, they would have a better understanding of WHY this is happening. Obama has surrounded himself with far more academics and left leaning activists then veteran politicians, who could temper the violent swing to the left. As such, they BELIEVE the left's utopian ideologies that are born from the halls of academia. Social engineering, entitlements, and yes, a SOCIALIST philosophy is at the core of what they promote. Those ideas look great on paper, but look much different when put in actual real world situations. People were so angry with Bush that the pendulum HAD to swing the other way, so the left saw a perfect storm that got Obama elected. They want to vilify big business, punish the evil corporations, and anyone who has had success. Does anyone recall the "sharing the wealth" promise that Obama made? I will not argue that some businesses make obscene profits, but that will ALWAYS be the case- even in a pure communist society. The problem is, once you remove the incentive to succeed and reduce everyone to some "acceptable" level of wealth, how does this country as we know it survive and thrive? How does the current path reward or encourage the entrepreneurial spirit we were founded on? Anyone who works in a busy urban system sees the results that decades of an entitlement mentality has gotten us. Ghettos are still locked in violence, unemployment, underducation, gangs, and drugs. Little has changed there in decades. Why? Because these entitlement ideas DO NOT WORK. It's a simple human response: Why should I work to better myself, with no guarantee of success, when I can exist my entire life without doing what is expected of most people- stay in school, work hard, take responsibility for my own actions and inactions, and contribute to society? Where is the motivation to change- especially when the down side of not changing means I still have food on the table, running water, electricity, and a roof over my head? That's not real poverty if you compare it to other places on this earth, and it's clearly not bad enough to change one's situation and/or behavior. You don't motivate someone to change by removing the motivation. I believe in a safety net for people- that's simple human decency, but for far too many that "safety net" has turned into a "career" for generations of families. This is NOT the mentality that made this country great, folks. As with any social engineering type idea, the ones who shoulder the responsibility for supporting it are the middle class, and they are tired of being asked to dig deeper, make do with less, and that anger is now being expressed. This push for Obamacare is only a part of the problem, and it is radical enough to scare the hell out of people, but I think this is just the beginning. I am truly scared about the direction this country is heading- not only in terms of the policies and how they will change our lives, but in the attitudes of those that are adversely affected by them. For decades, folks complain that Congress was not doing the work of the people, and the passage of this bill- against the wishes of the majority of Americans, should cement that feeling. People say that Obama is a transformative figure in our nation's history. I will not disagree with that, but the TYPE of transformation is what I do not want.

Wow... the Advanced Paramedic website is fancy. http://www.apl4911.ca/ Now we have an idea of where the owner has been spending some of the money he's made off of exploiting those poor people who just want to fly into the blue yonder with critically ill patients under their care. On the Alberta College of Paramedics job postings I see that Advanced Paramedic is hiring for what looks like all positions. Would those who take those positions be considered "scabs"? Mind you, if you want to fly for peanuts then now is your chance to get on with them...

With the history, we need to put Fournier's gangrene on or list of differentials. Clearly we also have additional problems such as WPW. If treating the WPW is needed, it will most likely consist of cardioversion as many medications may facilitate additional use through the accessory pathway. Pronestyl or amiodarone may be considerations; however, if this patient requires immediate intervention, cardioversion will be the best bet. Digoxin is a poor choice of agents for WPW. Our treatment will be limited. This patient will require a comprehensive workup and if possible a catheter placement. We will need to be careful with medications as there may be underlying hepatic and renal issues. I would attempt to limit pre-hospital pharmacological interventions. Take care, chbare.

Phil, WM and Kiwi, The way you guys function is exactly the way we do it. We have a set of SOP's and protocols in which to operate. They are flexible and I can follow the whole algorithm or none of it or enough of it to manage the patient. On the few times that I would need to call Medical Direction is if there was something not in the protocol I wanted to do or try. I like the idea of having a Physician I can call to consult. They're the one's with the 10 years of medical education. Because I function under a MD's license, if we want to operate outside our scope for whatever reason, they must be contacted. Other than that, I have the flexibility to treat the pt. as I see fit, according to standing orders and my assessment of the patient. I hope that makes some sort of sense to you. My intention was not to get into a pissing contest. I was asking out of curiosity as to how it worked down under and over there. I hope I didn't offend as that was not my objective, I've been a fan for years! I submit to the fact the US EMS system is in dire need of a complete overhaul. I can only hope that someday the education requirements will advance to that of the rest of the modern world. And yes Kiwi, you did mention LAFD and it's ilk!

From earlier this month . . . Video - Detroit Fire Truck Hit By Train News Story Here

Wow lots of jerks giving negatives for expressing valid concerns. Sadly we all should understand what ever we post can come back to harm us. We have seen this for years in discussions about what medics have posted on space book or my face etc. We have discussed the consequences of what we post on our chances of getting jobs. So sorry that I am not sympathetic.

If you are considering digital intubation, you should have some access to the cords and therefore it would be very difficult to justify doing a cric. Digital intubation could be considered in dire situations where: 1. for some reason lack the equipment, 2. have equipment that does not work, 3 positioning of provider and patient might be an issue 4. there is a deformity either due to nature or injury that hinders the use of a regular laryngoscope scope or 5. using the BVM is no longer or not an option. Digital intubation has it place but less often now in the adult world since there are LMAs, King tubes and even the OPA that can be used if ETI is not immediately possible. NTI may even be a consideration but only not always the best. Of course the Tomahawk method should still be a technique taught as an option as well. However, for neonates and pediatrics, digital intubation may be a necessary option. Any RRT or RN that does intubation in the hospital or on transport has probably been taught this procedure if they work in the neo/pedi population. That includes the big male nurses and RRTs with large hands and fingers. It does not matter what size your fingers are, you learn to perfect the technique. Your technique may vary slightly from someone who has tiny hands but the goal is the same. Most of the procedures done in that population require a delicate touch which can be acquired through practice and a desire to work with infants as a health care provider. That should also include the Paramedic. Most pediatrics can be effectively maintained with the use of an OPA and BVM which is another technique that should be taught well, but often isn't, since pedi ETI is now removed from the protocols of several EMS agencies. But, they also seem to forget to teach OG/NG placement which then only gives you limited bagging time before the abdomen takes over the tiny chest cavity and the BVM becomes useless where even a tube placed now will be ineffective until the belly can be decompressed. There will also be infants and pediatrics that have deformities either present at birth which have yet to be repaired or may be with them for the rest of their life. This might include some cleft palate malformations or even the Down's Syndrome child whose tongue may require some manipulation. If a neonate is being born with a known congenital defect like a diaphragmatic hernia, the intubator can not dick around looking for another scope if the one he/she is using fails. That baby must be intubated and the BVM is not an option. There was also a discussion here a few months ago where someone said they used or saw/heard someone use an adult MAC 4 in the field in an attempt to intubate a baby. I would rather use my fingers if I had no other appropriately sized equipment and very little experience intubating babies before I would use a large piece of metal and risk damaging the airway to where a cric might then be a necessity or the blood from the traumatic attempt would asphyxiate the baby. Someone with a thousand infant tubes to their credit might be able to pull off just about anything with any type of equipment but then they are intimately familiar with the anatomy of a baby. Thus, learn, practice and perfect as many different intubation techniques as you can for every age group. Know how to score a difficult airway to help you choose the correct device and technique for the patient. Do not become one that says "I always use curved because I like it better" which is something that is too often learned from the classroom by playing with the manikins under poor supervision or listening to instructors who know little about educating for airway emergencies and spout off their own style as "always worked for me" rather than explain the purpose of each blade and/or method. Of course there are a few words of caution no matter what technique you use. Even if you have given a paralytic to a patient, teeth or no teeth, have a bite block in place preferably on both sides of the mouth so you don't get taken by surprise if you plan on putting your fingers into someone's mouth. This can include trying to get a better grip on a FBO. Even those without teeth can leave a nasty bruise on your finger.

First, the obvious: Remove the dead mice. Second, use a good bleach wash of the area where the mice were found. Third, heavy area ventilation, at minimum, open the windows, at best, operate a window fan on exhaust to pull air through the area. Forth, after completing the above, suspect the mice might be dead in the walls. You might have to get the assistance of a carpentry contractor, to knock out wall sections and replace them after removal of the dead critters.

We now have had death threats against elected officials and their families, and actual attacks on their offices with thrown bricks and pellet gunshots through windows and doors, and powder suspected originally to be anthrax delivered through the mail. We have a former candidate for vice president telling folks to "reload", which to some might be interpreted as a request for sniper attacks to those who supported the bill's passage. Hey, people, both in this forum and beyond! Can we simply agree to disagree, and tell our elected officials to work out compromises that, while neither side will be satisfied, would actually do the least hurt and most good for the majority of US citizens?

If it comes in sets of three I wonder what's next? Firemonkey Shows His Monkey!

I blew up the video as best I could, looking for the collar tacks on the shirt. EMS has silver Star of Life with an overlay of FDNY on it, and most FDNY members, but not all, have the number of their apparatus, example, L171 or E267, on one side of the collar. Some of us FDNY EMS Command wear, as kind of a reminder of who we were prior to St. Patrick's Day 1996, the old tie bar, with a miniature of the old EMS patch, flanked by the letters, NYC EMS. If the woman had shown the man's right shoulder, it might have shown a Station Patch, an EMT, Paramedic, or Certified First Responder patch. If this individual was wearing anything, the quality was not enough to identify it on my Dell PC. I have to mention that the CFR patch is strictly worn by firefighters, but depending on what fire house, or EMS station, the FDNY member is from, an ID by that "house/station" would identify them. The man's shirt if light blue. All that signifies is that he is either an EMS or Fire fighter "Grunt", and not a lieutenant or higher rank, as they'd be wearing a white shirt. FYI, EMS officers have large circular Star of Life pin devices on the class "A" jackets like the device on our hats, fire guys have speaking horn or "scramble" pins indicating rank. In a way, I an happy that, with no regard if he's an EMSer or Fire Fighter, I don't recognize him at all. I like my plausible deniability.

Per the article, Firefighters and EMS wear the same uniform. Rather than automatically slam the Firefighters, wouldn't it be prudent to find out which division they're with before casting aspersions? Yes, it looks bad on FDNY as a whole, but according to the article, it could have just as easily been an EMT/Paramedic. *Edited for gramatical errors

Most systems can't afford to have a EMS based "refuse transport" protocol. Take for example this morning I transported a 30's male with a laceration to this finger, presented to us with the bleeding controlled with bandages and only needing a ride. He had insurance and would likely pay the bill for service. So if we were to refuse transportation we would not only miss making money, but lose money for generating a response with no income. As much as we don't like things we need to look at them through the $ sometimes to. Also don't forget most people don't have primary care and the ER is there source for medical care. As well as the fact that everyone knows that if "the cat gets out of the bag" and they call 911 somebody will show up and likely solve the problem for them. Basically the biggest and most successful government program ever put together, and in systems where 'call screening' from what seemed like 'minor' calls have only turned into major litigation nightmares.

As much as I hate to say it, I'm almost expecting a civil uprising in this country. During his campaign, Barack Obama made the comment: "You go into these small towns in Pennsylvania and, like a lot of small towns in the Midwest, the jobs have been gone now for 25 years and nothing's replaced them," Obama said. "And they fell through the Clinton Administration, and the Bush Administration, and each successive administration has said that somehow these communities are gonna regenerate and they have not. And it's not surprising then they get bitter, they cling to guns or religion or antipathy to people who aren't like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations." Unfortunately, our present Presidnent is pushing the American people to fulfill this 'prophecy'. With the Obama Democrats willing to give this country and everything we've worked for to this point to every illegal immigrant, it's no wonder that the American public is getting fed up! Even those that were so happy to suupport his 'Yes We Can' campaign because of the hope for change are now sorry they cast their vote in his favor. I was very vocal about my opinion on how Obama wasn't what this country needed, and was ridiculed as a 'reactionist' and accused of trying to 'stir the pot' when it wasn't necessary. Unfortunately, I've been proven right, he is 'no good for this country'! Obama spent the at least the first six months trying to undo any positive changes that Bush made, so that he could appear to have 'done more', but about the only thing he's done is run us deeper in debt, and has stuck it deeper into the American public than any other President before him. Now that he's done more damage than any President before him, I'm curious to see how he thinks he's going to reverse it, and start actually doing something GOOD for the American public! I've posted it before, but it still seems relevant and applicable:

i think a lma/combitube would be more effective in these situations besides going straight for the cric. Especially where space and access might be an issue. That's just me though.

I have never done a digital intubation on anything but a dummy. I wouldn't see myself doing it--I'd rather throw a combitube in rather then lose my fingers in a entrapped person. Just my two cents.

1st no apology as 1. No proof he is who he claims. 2. No proof he is telling the truth if he is who he claims, just his word vs someone else's word, odds are truth is more in the middle. 2nd we should learn from this, even if it is true what he said, and avoid certain actions and sites. Never post anything that identifies you being at work or even who you work for. Most companies do have policies against doing anything that reflects on the company. So in this case even by what is written by misspelled name person claiming to be the individual in question you could tell they were in an ambulance and so everyone that knows this person would associate his actions with his service even if no service name were seen. If you are the person I hope you learn and move forward.

Yahoo finally a chance to bust out the old school reconstitute-required vial of funny yellow powder and give cerftriaxone! Wait, should I call medical control first? Not in Los Angeles are we? Did I mention Los Angeles recently?