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What is flail chest? What caused it? What are your primary short term concerns? Longer term concerns? Load and go/stay and play? Why? Treatment? Please folks, if you know all of the above answers, please don't ruin it for those that can learn by asking and exploring. We already know you're smart. To the rest that are familiar with this, please feel free to jump into this thread in a mentor-ish way and help it move along if you would. I have no info on this patient so we're going to deal with him in gross terms only, OK? Dwayne

Yup, around here it is the Native reserves. Those responding to a reserve usually don a trauma vest they carry hanging on the back of thier seat. Racist? I don't believe so. Just read the newspapers.... or studies! A racist would generalize that ALL First nations people are of low social stature, and a threat to the community. A realist would generalize that when responding to densly populated first nations areas, you should take extra precautions (Police, vest, big flashlight etc). However would not generalize ALL first nations into a catagory. An idiot would look past the obvious and get killed. Insert whatever race you want into this formula.

Glad you had a good experience with your preceptors. I never understood the mentality of some providers who did not like having riders or students. Most of the time these types were clowns, cutting corners, and not providing proper care. I would much rather teach someone the right way to do the job than for them to learn bad habits from day one. The didactic part of the learning process is "easy"- it all depends on how much you are willing to absorb and retain. The hard part comes when someone needs to show you how and.when to apply that knowledge, and the little things that make you a good provider. To me, a good trainer/preceptor/field training officer is worth their weight in gold. They determine the caliber of the future providers, and whether or not we will eventually gain the respect and pay we all deserve.

The article made no mention of race. Do you know something else about this story? Clearly it would depend on the demographics of your particular situation, and where the high crime areas happen to be . In my case, the most violent, crime ridden areas ARE black. The last stat I heard was that around 95% of the homicides here are in these areas, committed by blacks, against other blacks. You area may be different. Maybe it's hispanics the comprise the worst areas. Maybe it's white trailer park folks. It's based on the call AND the neighborhood. If I get a call for a shooting, I don't care if it's in the most expensive part of town, I go on high alert- especially if I don't know if the scene is secure yet. If I am in a ghetto area, I'm already on a higher alert because there is a pervasive issue with safety every single day. I don't care if it's a call for an OB, asthma, or belly ache, if the area is swamped with crime, ANY call can be dangerous if you aren't paying attention to your surroundings. LIke I said, the scariest incidents I have been involved with had nothing to do with the type of call I was on, and they were NOT for shootings , beatings, or stabbings. This isn't racism, it's just common sense.

After the past couple of years, I would have to say that you need to have an understanding of chemical principles and reactivity to truly appreciate the anatomy and physiology and even the core paramedic courses. Even a seemingly simple question such as "why do we need oxygen" is not apparent unless we have an understanding of the atomic structure and function. Then, concepts such as electronegativity and an electron acceptor will make sense. Otherwise, these become forgettable phrases said during an anatomy and physiology class. Since I have gone back to college, the courses that have been truly beneficial to my understanding of, well, pretty much everything have been chemistry and physics. Perhaps this is why I enjoyed the first year so much, while everything is simply a drag currently. In any even, I have had to revise my idea of what whould be included as prerequisite course work. I understand many may disagree with my newer assumptions however. Yet, I think it is a crime to not even have rudimentary comprehension of basic concepts such as the role oxygen plays in oxidative phosphorylation. Take care, chbare.

Crotchity, in the original article, at the start of the second paragraph, it states “City Councilman Kenneth Stokes has threatened to reverse the contract American Medical Response has to serve in the area if the company doesn't send its workers into violent crime scenes, even before police arrive.” I think that makes the intent of Councilman Stokes’ comments very clear. As much as you want it to be, since you have brought it up in other threads, this Councilman is not basing his comments on race, and the replies from EMS are not either. It is a question of “is the scene violent? Yes or No.” End of story. Using race as an excuse, or a crutch in situations like this is just that, and excuse or a crutch. The true issue is that this idiot wants EMS to respond prior to police to violent scenes. Race is only an issue when we allow it to be, and instead of looking at the sins of the past, how about looking to the future, and trying to solve problems instead of creating problems where none exist. Let's keep this thread on topic - that this councilman has his head up his *** and needs to be educated about scene safety and the role of EMS.

AMR sucks, tries to take over EMS everywhere they go.......they failed in PA....

LOL! I take it they haven't found a way to get reimbursed for it yet to pay off their purchase cost, training, retraining or maintenance fees. Usually a good assessment can determine which facility is best for the patient. I seriously doubt if most of these Paramedics pull our the US unless the BP is dropping which should clue in even the clueless that a higher level of care might be needed. There are also many things that won't be picked up by the EMS version of US assessment that could give a false sense of security that all is just fine when their physical assessment might be telling them something different. Again, it depends on whether you are ruling in or ruling out as it pertains to the accuracy and confidence factor of the findings. We could use the pulse ox and the ETCO2 as EMS "toys" that are under or over used as well as inappropriately and very much misunderstood rather than for the value both of these devices are intended. Some need to master basic (not as in EMT- assessment knowledge and skills before jumping in. Finding 3 organs on a normal 75 kg young male should not be very difficult and probably not very practical. Now if they were to do 100+ exams on a variety of patients just for practice, that might be more credible. Even 50 exams would be somewhat reasonable.