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That's what the Nazis said. Nobody's blaming the EMT. They're blaming the volunteer EMTs, whose very existence is the reason that the administration is forty years behind most of the world. You're not just working with what you have. You are perpetuating what you have, rather than progressing to something better.

Matt, Since you seem intent on picking apart my original post and analyzing it, let me do it for you, so that my meanings are clarified: Simply stated, I’ve seen children that respond simply to a tone of voice used by the parents to convey their displeasure with the child’s actions. I’ve also seen children who have had corporal punishment used for every ‘offense’, and not get the intended results. I wasn’t offering any advice either way. Simply stated, it opens a line of dialogue. This was included to show that I’ve been exposed to both concepts of child discipline. I’ve been exposed to the excessive use of it (to the point of being abusive), and where it was only used as a ‘last resort’, because other methods of discipline were used. Here, I have done nothing more than state a fact. Since I’ve been exposed to both corporal punishment and other forms of discipline; I cannot attribute this fact to either form of discipline. To say that one form or the other kept me from becoming a drug addict/alcoholic/convict would be advocating one form or the other. I believe that there are other forms of discipline, and I don’t need to ‘throw the book at them’ every time they break the rules. I also believe that corporal punishment isn’t the only effective form of discipline available to parents. The responsibility that I’m alluding to here is the responsibility to take care of the discipline of my child. It’s not the job of the school district or their employees to decide which form of discipline is appropriate for my child. The statement “My views on corporal punishment aside” simply means that whether or not I advocate its use is irrelevant in this statement. My point of the fact that it’s the responsibility of the parent, not the teachers/school staff to discipline the child was the main point of that paragraph. I’ve seen the effect of having a parent that knew where I was, what I was doing and who I was running with. I’ve seen far too many ‘parents’ that would rather just park their kid in front of the television/VCR/computer and just ‘let them be’. To explore this topic further requires a new thread. Just as a mechanic would have an assortment of different sized and types of wrenches and other tools in their tool box, as a parent, we cannot rely only on corporal punishment to keep our kids ‘in line’. When the mechanic retires from working on cars, the tool box will be passed onto the children, so that they may take those tools and be able to repair their vehicles properly. By the same token, when we limit the ‘parenting tools’, we’re actually limiting our children’s ability to be effective parents. If all we have in the ‘parenting toolbox’ is corporal punishment, then we have in fact been limited ourselves; by our parents. By not expanding the tools a parent uses, we perpetuate the cycle of ill prepared parents who only have limited means to discipline their children. While I was exposed to corporal punishment, I know that it’s not the ONLY way to discipline a child. Even though I was exposed to an abusive parent, I know that there are other ways to raise a child without having to abuse them, and thereby breaking the cycle of ill prepared parents referenced above. I didn't join this conversation to advocate corporal punishment, or to condemn those people that advocate it's use. My contribution was simply my observations and a statement of my views based on those observations. I'm not going to get into the whole 'judgement' scene, it's not my place to judge.

I am getting the impression from all the information being given so far that the gentleman has heart disease. Walk with me here, please... Patient present with hypertension, causing stress and probably some degree of ischemia on the heart. The EKG shows left bundle branch block and strain pattern. After the patient receives anti hypertensive agents, Metoprolol and Nitroglycerin, his symptoms of chest pain, Left Bundle Branch Block and Strain pattern disappear. I am assuming the abnormal EKG finding for this patient is the lack of hypertrophy of the heart after the treatment is provided. Although the coagulation panels are normal, this patient still has risk factors for clots, those being sedentary, overweight, and a smoker. I think pulmonary embolism could still be a possibility, even in the face of a normal coagulation panel, but sudden onset C/P, Shortness of Breath, and transient LBBB (seen during ischemia). Of course, for pulmonary embolism, the interesting EKG finding is the lack of tachycardia. I think the treatment provided by the health care provider and the findings afterwards points more towards heart disease rather than pulmonary embolism. Just my thoughts, eat me alive ! LOL Matt.

sure that article is real? I didn't see anything about putting EMS down or wanting to hang a provider... in all seriousness... good job

I agree 100% that the level of training needs to be raised. But that is our standard currently, unfortunatly. Touche' Sorry about that. Im haveing "one of those days" While attending school, even before that, by being a driver I was exposed to the field of EMS, got a feel for the dynamic nature of it. I found out if I liked it before commiting to a squad. While in school as I progressed I was able to do more at the scene. As I got further along and began more patient interaction I began loveing the field even more and striving to learn as much as I could to help patients more (within scope of practice of course) Again I think driver only is good, does it have draw backs yes. What doesn't but I see advatages. I had to take a course for driving the rig. Learning how to drive properly, when to use L&S effectivly. Driving in winter conditions on less than ideal road surfaces. All the while keeping my crew and pt safe and comfortable in the back. It left the 2 EMTs in the back free to treat the patient and not worry about the driver. As far as doing CPR, yes at least in my area all are CPR/AED certified. Then can help with extrications yes, usually that is left to the FD in my area. EMT in the vehicle monitoring the patient but the actual extrication is FD. I can see your point there. It is a burden if the driver is just a driver and has no experience and the EMT has to tell him or her what to do while also tending to the patient. kiwi you make all valid points and thank you for them. Guess I am just overly sensitive today and spouted off. I appologize for that and too anyone I may have offended, POed, slaped in the face, or gave the finger too during my not so bright rants earlier

This is the crux of my issue. Your driver has "at least" the same training as a Wal-Mart or McDonald's employee. They're essentially an untrained bystanders whose competence as an assistant is only gained by exposure and guidance by another provider whose training is inadequate for the job they have to do.

Even more reason to have ALS on every ambulance. This is exactly what we're talking about. You shouldn't have to "work with what you have". Time to come into the '80's and have paramedics on all ambulances. It may hurt some people's feelings, but whatever. It is supposed to be about the patient. If a provider doesn't want to step up a few levels then step aside.

With that rationale, and the same reasons you cited, then why resuscitate anyone over the age of, say 75? After all, they probably only have a couple more good years left anyway.

I can't treat a patient I don't have yet. It's a dispatcher's job to send them a truck. I have a patient in front of me. This is the one I treat, or don't, based on THIS PATIENT. Not some imaginary one across town.

Thanks for the clarification. Still would work it. Intubation, Epi, Atropine, possible bi-lat decompression, work him till we get to the hospital. The guy deserves that much of a chance. At least I'm to assume so since I don't personally know him. I'm sure his wife and kids think so. Oh, his mom and dad would probably appreciate it too.

I'm only an intermediate student so obviously I don't have a lot of experience. And I would definately get the input of my crew and med control(assuming I'm the medic on this code charged with making this decision). However, I would want to work it. I've got a couple of reasons for this. 1.-The Medical Reason- On my most recent ER rotation we had a patient come in that everyone knew had pretty much zero chance of making it. He was a 52yo bicicylist had been hit from the rear by an SUV going approx 45 mph. Despite wearing a helmet, the back of his skull was shattered with gray matter coming out and large amounts of blood. They did everything they could think of to save him, including getting a head ct. When they arrived on scene he was pulseless with agonal respirations and they could have called it right there. But they started cpr and actually got an organized sinus rhythm back. He eventually died 3 hours after arriving at the ER. Now, I'm not sure who decided to work it or why. But if nothing else maybe something was learned from this by someone. Other than me, because I learned a lot that night. 2.-The Personal Reason- May 2005, my father(an alcoholic) was taken to the ER by my mother because "he wasn't acting right." He was evaluated, found to be ETOH, and was about to be discharged when he went pulseless and apneic. A ct showed extensive bilateral subdural hematomas. They could have called it there. Instead, they revived him. I'm not sure on the details as I wasn't there and my mother says it's a blur at that point. He was then taken to the ICU in a coma on life support. It was 4 days before they could get his clotting factors high enough to go to the OR for them to drain it for burr holes. He spent another 4 weeks in a coma, suffering another bleed a week into it. He ended up with permanent compression to his brain and we were told he may not wake up, which he did. We were told at this point he'd be lucky to walk, speak, feed himself, etc, again. He did all those things. He's actually driving again, doing his own yard work, tinkering with his gadgets, etc. His neurologist says the compression is still there but that he has full cognitive and reflexive abilities, with the only memory loss being a 5 yr gap when he was at his worst with the alcohol but they think it's more of a psychological thing as he can still recall events from his childhood. It took over a year of rehab but I have my dad back even though by all medical standards he should be dead. I can't imagine my life right now if someone had not made the decision to at least try. Even if it was only so that the ball would be in someone else's court.

Sounds like you need to spend some time with Hospice. I suggest you volunteer some time with them and get a better understanding. As to why did they call? Maybe they need lifting assist. Maybe they paniced. Not your place to disregard the wishes of the patient. Sometimes familys call because they need assistance as they do not know how to do something and the hospice nurse or volunteer is unavailable. Go be a help not a sorce of stress in an already trying time.

Were you dispatched just as a lift assist? If so, who asked for further medical intervention? What were the famiy's expectation the care to be provided by you? If it was for a lift assist and the patient is in hospice, that should be honored. A DNR is applied when the patient codes. It doesn't mean "do not treat" prior to that. Hospice and Comfort care orders go beyond a DNR. Vitals are rarely if ever done on comfort care or hospice patients even in the hospital since many of their meds are maintenance and the others are titrated purely by comfort level...not BP or HR. Any form of treatment to prolong life has been discussed and decided against. We have had ambulances transporting to LTC facilities or home fail to understand these orders. Thus, they turn around and run L&S back to the hospital ED because they found the SpO2 to be 80% on 2 L NC and have placed the patient on a NRBM or will be bagging them. Orders usually consist of 2 - 4 L only with no SpO2 monitoring. The respiratory comfort is done by medications, not SpO2 checks since there is little way to adequately oxygenate the body with a failing heart without a lot of technology and drips. If they revoked his hospice status, he could become a full code which would mean intubation and what remains of his life will be full of technology,little privacy and pain since the comfort meds will take a back seat to stabilizing blood pressure. Once the initial resuscitation is done, the doctors and family will then have to go through the withdrawal of life support, probably for the second time, and attempt to make hospice arrangements again or just have the patient die on med-surg in a room with 1 to 3 other patients. If you are unsure what to do, contact hospice and your med control before aggressively resuscitating espeically if they have hospice papers or the equipment of hospice attached to the patient.

In my opinion, I would not have worked this code, first off its a trauma code so that to me is red flag number one, second is the PEA,yes it can be converted into a better rhythm but overall, who knows, third is how the patient was presenting so again, nope; tell the family some BS story of how we tried yada yada yada but overall its a no go.

OK, kiddies, here I, and us, go again! 1) The child steals a cigarette from his fall down drunk dad. At least he didn't like the cigarette. 2) When he tossed the smoke, it started a fire, on the end of the trailer where the propane tanks are. The explosion kind of telegraphed that it was going to happen. 3) He runs as quick as a "Rabbit". Leastwise we now know the origin of the name, and it wasn't due to sexual proclivities of how rabbits multiply. 4) The Paramedic who "named" Rabbit was named Johnny, on an episode featuring Kevin Tighe, who portrayed Roy on "Emergency!". I wonder if they did that, as Randolph (Johnny) Mantooth, depending on the varied reports, either was unavailable, or flat out told the production team, "I am not doing that show"? 5) The psychiatrist says Rabbit does not have PTSD, Rabbit says he does. I believe if it looks, walks and quacks like a duck... 6) Boone, like most of us on the paid side of both EMS and Fire, is having budget problems. His marital problems seem to stem from him doing all the extra shifts already, but at least this time he's discussing it with the wife and kids. 7) Nancy, who is involved with Rabbit, is convinced that Greg is involved with someone. Does she suspect, or know, that it is with Doctor Dianne? 8) "Captain Cal", wether intentionally or not, is "pouring gasoline on the fire" of FD based EMS discussions. 9) Junk yard crane operator distracted while working. What happened is another good argument of not talking or texting on a cell phone while driving or operating heavy equipment. 10) Rabbit just walks in and tells the scheduled guy that he's taking over. I don't believe any of our agencies would allow that, especially after 9-11-01. 11) That look on Marisa's face when Rabbit just walks in to return to work is priceless. 12) The look on Captain Cal's face, when he realizes Tyler is "Gay" is priceless. 13) Marisa asks Rabbit if he's really ready to return to work. Rabbit gives the best answer that he doesn't know. For him, brutal honesty, at least as I understand his character. 14) Nancy figured out the Greg/Dianne relationship. 15) Is Tyler avoiding advancement to Paramedic? 16) Tyler and Boone's patient is a "former" Paramedic? I heard that, and was wondering if it was going to be Rabbit's "Johnny". It turned out not to be the case. 17) EMS, and Fire Fighting, is definitely more the younger man's game. I'm 55 years old (2 months shy of my 56th birthday) and I am almost out of my "box" 18) Domestic violence calls are never nice calls, and this one was in the Knife and Gun club. They gave the impression that both sides of the argument were not transported in the same ambulance (or to the same facility), which is in line with the protocols I operate under. However, wouldn't the LEOs be riding along, due to the man having shot his wife? 19) Nancy openly stated that the stabbed man was a "Load And Go" status. Anyone disagree? 20) Nancy cannot remember if she is working as a Paramedic or as a surgical student doctor, although she qualifies as both. 21) Dianne is correct in telling her, "You might do that with Doctor Joe, but not on MY watch." 22) Captain Cal is seemingly dumbfounded, on finding out that Rabbit, who to the captain seems to be the only one with his head on straight, is just returning to work from a psychiatric leave. "This is a Madhouse!" 23) Going back to item 10, does anybody we know just jump back onto their rig without first telling their commanding officer? After doing at least one call, that was when Rabbit turned in his "Doctor's Line" to the Captain. 24) Dianne defends herself, although she doesn't have to, to Nancy on her decision not to let Nancy do field surgery. 25) Captain Cal seems to be entertaining the troops with tales of "Back In The Day..." I guess Rabbit was around long enough to know of the tales, too, like the Pre-Cardial Thump (I used to do that, but protocols changed for me over the last 37 years). 26) We've all had "Don't Drop Me!" patients, from lightweights to heavyweights. Do we tell them we only drop patients on days ending in the letter "Y"? They didn't use that line, but my partners have. I don't. 27) Great, Tyler made Paramedic. He just didn't want to break up his teaming with Boone. 28) Could the burned out old Paramedic be Tyler's future? 29) Nancy admits to Glen that Dianne was right. 30) Seeing Glen and Dianne waking up from the same bed confirms that they are an item. 31) Boone makes the decision to remain a Paramedic, and remain working with Tyler as a "Pair-a-Medic" (my old, bad joke). 32) Marisa had been dangerously influenced by working with Rabbit, hence her original plan to complete a flight with the helicopter low on oil. Yet, it was Rabbit who told her not to complete the assignment, only later with both being told how dangerous the mechanical problems had actually been. Kind of strange, Rabbit being the one on an even keel, and Marisa being the one acting dangerously.

My comments and observations, both medically related, and otherwise, for the "Trauma" episode shown on April 5 are as follows: 1) One cheerleader falls from the pyramid. Per outside sources, I have been led to believe that there are more injuries within the ranks of cheerleaders than the football players they are cheering on. Anyone have documentation either supporting or denying this? 2) Did I misunderstand? I thought Nancy got permission to do the intubation. 3) The seven "P"s? They went too fast for me. What are they, again? 4) Nancy straightened the cheerleader's neck and head out. This is against the protocol of "Splint it as it lays", at least as far as the NY State protocols go. Comments? 5) Tyler plays guitar? Perhaps they'll explore this in some later episode. 6) Tyler takes in Boone for an overnight stay, due to Boone being temporarily evicted due to fumigating of his apartment. Nice partner! 7) Is Asher going to be a fixture, as Tyler's significant other? 8) This cheerleader is definitely not Claire Bennett, of "Heroes", as it is obvious she is hurting (Claire can heal from almost any injury within seconds, for those who don't follow Heroes). 9) Tyler and Asher seem to be too deliberately loud in "getting it on", in Boone's presence. Is it real? 10) Good call on the Sepsis and/or Infection as being Meningitis. 11) Marisa and Rabbit are together in Isolation. What will develop from them being together? 12) The cheerleader is getting worse, to the point of Dr Diane ordering surgery. 13) Either Rabbit was reviewing signs and symptoms of Meningitis for himself, or trying to scare Marisa. If he was trying to scare her, he did a good job of it. 14) Make it official, the cheerleader is paralyzed. Who is going to get sued, Nancy, the SFFD, Doctor Joe, the hospital, or some combination of all of them? 15) Boone was a visitor in Tyler's home. Would that give him any right to complain about Tyler's home activities in Tyler's home in Boone's presence? Something doesn't seem right, here. 16) Patron at strip club hit accidentally by pole dancer's shoe. Patron doesn't want to be known as being a strip club customer, and signs the RMA, then deliberately crashed his car across the street. OK, different address, but it had me thinking the guy might have left the scene and suffered a late developing concussion. Leastwise, he is going to be seen for the MVA, and use it to explain the original head injury. 17) Has Nancy finally been caught for operating outside of her scope of practice as a Paramedic? As argued, she is kind of adrift between Para-Medicine and being a Medical doctor. 18) Nancy's actions seem to be getting between Dr Diane and Glen, they are arguing. 19) Rabbit is not infected, but the question remains if Marisa is or not. Rabbit becomes protective of Marisa, like a good partner should be of whomever their partner should be. 20) Is Nancy suspended? 21) Are Tyler's antics with Asher going to break up the partnership with Boone? 22) I can understand Nancy being interrogated on the "out of scope" practices, but as Rabbit was not on that call, why are they attempting to go after him using her? 23) Neither Rabbit or Marisa has been portrayed as being particularly religious, but it was an interesting touch for her to ask him to pray with her. 24) Nancy's father recuses himself, but instead of leaving, then verbally attacks Dr Joe. What gives? 25) The review panel is attempting blackmail, threatening suspension of Dr. Joe if he doesn't help take Rabbit down. 26) Dr. Joe refuses, and gets the suspension. 27) Dr Diane plays with Marisa's emotions before telling her she doesn't have Meningitis. 28) Asher and Tyler apologize to Boone, their interaction was a bad joke they tried playing on Boone. Asher is just the next door neighbor, and married, to boot! 29) First, Dr. Joe finds out about Glen and Dr Diane, but makes no issue of it, then visits Nancy, and not caring that he's also found out about her and Rabbit, thanks Nancy for turning him in. THIS ain't over.

Come on, Richard! Let's have it! I missed the episode tonight, and it won't be online to watch til tomorrow.

Dust ED is 45 min ride away, ALS is responding from said ED, no waiting just intercept along the way. BTW ALS responds to most calls as per protocol, we are just far from the ED so usually BLS is onscene, packaged and in route before ALS gets half way. Dont knock the NJ vollies in their entirety, we do make good decisions, we just work with what we got.

HUH? An EMT-B is inadequatly trained to do their job? Sorry but thats just plain wrong on so many levels! Weren't you a B at some point in your profession? Not everyone has to be a paramedic to be a quality prehospital care provider!! Sorry but..... Sorry I was a disgrace while attending school at least I got a great learning experience before becoming certified.

What is "Lulz"? 1) Glen is apparently at a writing class, discussing his book. 2) Rabbit is yelling at the traffic ahead of him that is not moving out of the way. Even if not out loud, don't we all do that? (Don't lie, I know you do!) 3) Referencing to the Jackson, MS crew staging too close to the shooting, and Scene Safety, Rabbit and Nancy had a "Save" of their shooting victim, until the gunman followed them to the hospital ambulance dock, and shot him dead on their stretcher. When the black limo pulled up in the ambulance dock, it telegraphed what was to happen. It just reinforces my pessimistic view that there ain't no place safe. 4) Can anyone confirm if San Francisco is a "Safe Haven Law" town? For the uninformed, this means a newborn to 2 week old can be brought to an Emergency Services station or house, questioned only as to any special needs of the baby, and no legal actions taken against whoever brings the baby there. Kind of what happened with the woman dropping the baby off to Glen in front of the station. 5) Unusual paring of Tyler and Nancy doing BVM on the baby to bring up the heart rate, while Glen drove, but I usually don't argue with what works. 6) The blind leading the blind: Rabbit asking Marisa relationship questions? 7) Tyler's dad is in town. Is Tyler going to "Out" himself? 8) Nancy's weirdest call? A violent, self destructive EDP tearing up his own apartment. Standard stuff for most of us, but the EDP turns out to not only be a station-mate, but her future boyfriend, Rabbit! Then he berates her for saving his life in the helicopter crash that killed all aboard except Rabbit, including Nancy's fiancee. It does at least explain why, in a previous episode, Rabbit trashed the closet doors in Nancy's apartment. 9) One punch knockout of Nancy's partner? 2 cops and chemical restraint to temporarily calm down Rabbit? The EMT didn't press charges, due to embarrassment at being knocked out? 10) I need chemical information. Codeine slows down body systems? The "He dead" patient may have also had Mammalian Diving Reflex, even though the water may not have been all that cold. 11) When Tyler's dad announced he had Lymphoma, it was the correct decision, for that moment, not to advise dad that Tyler is gay. 12) Nancy unknowingly blows off the home made dinner with Rabbit to "bond" with the baby she, Tyler and Glen saved. So many rules these EMSers break, and she has her telephone turned off in the hospital? 13) At least she had the decency, on finding out what had transpired, attempted to call Rabbit to apologize. 14) Tyler incorrectly using the radio, as he "Trolls" for calls. AGAIN! At least he caught one. 15) Marisa was married? She goes stereotype "Latin Spitfire" at the "other woman", threatening to kill her, then, as "other woman" runs away and falls down the stairs, Marisa renders aid? 16) See 15. This causes her to sign back up for another tour of duty in the sandbox? While I may joke a lot about Military "Intelligence", the folks in the Pentagon can't be that dumb to allow her back in, so soon, for that reason. 17) I agree with the statement, "Normal ain't what it's cracked up to be." 18) Suspend reality, we got a script here! Would any of us flat out ask a patient questions about someone in the crew's personal relationships? 19) Apparently, the first time Dr Diane saw Glen, her current paramour, he was bringing in a child with more gunshots (14) than he had years of age. She misidentifies him, an EMT, as a Paramedic. At least we know that happens, as us EMTs are either Drivers or Paramedics to the public, as seemingly nobody knows what an EMT is. (Rant over.) 20) Nancy doesn't have to bond anymore with the baby, seems there's at least 10 families want to adopt. Good for "Baby Jane". 21) While Tyler's dad has Lymphoma, they "caught" it in time to treat fully, good prognosis towards full recovery. 22) Dad had suspected Tyler was Gay, but accepts this fact, while saying many from back home wouldn't. 23) Can fog be so invasive through open windows as to prevent rescuers from seeing a large pet python? 24) Glen, again reading from his "book", comments on Nancy. Despite how tough she can be, figuratively, the baby brought Nancy down to her knees. 25) Nancy set off by Glen's revealing the chink in her armor, calmed down by Rabbit. She questions if the two of them can achieve "normalcy".

This is currently a holding pattern, as it is 40 minutes to showtime, and I'll probably do the point by point posting sometime tomorrow morning or early afternoon. Until then, Hey! Let's be careful out there!