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THE BLONDE MORTICIAN A man who'd just died is delivered to a local mortuary wearing an expensive, expertly tailored black suit. The female blonde mortician asks the deceased's wife how she would like the body dressed. She points out that the man does look good in the black suit he is already wearing. The widow, however, says that she always thought her husband looked his best in blue, and that she wants him in a blue suit. She gives the blonde mortician a blank check and says, 'I don't care what it costs, but please have my husband in a blue suit for the viewing.' The woman returns the next day for the wake. To her delight, she finds her husband dressed in a gorgeous blue suit with a subtle chalk stripe; the suit fits him perfectly. She says to the blonde mortician, 'Whatever this cost, I'm very satisfied. You did an excellent job and I'm very grateful. How much did you spend?' To her astonishment, the blonde mortician presents her with the blank check. 'There's no charge,' she says. 'No, really, I must compensate you for the cost of that exquisite blue suit!' she says. 'Honestly, ma'am,' the blonde says, 'it cost nothing. You see, a deceased gentleman of about your husband's size was brought in shortly after you left yesterday, and he was wearing an attractive blue suit. I asked his wife if she minded him going to his grave wearing a black suit instead, and she said it made no difference as long as he looked nice.' 'So I just switched their heads.' ( I BET YOU DIDN'T SEE THAT COMING !!!)

46young, I get what Bieber is saying, that this is a war of efficiency, productivity and evolution not an exercise in unemployment management. Fire, unfortunately as a national union wishes to draw EMS backwards, make it more ignorant where everyone can play without too much effort, like back in the 'good ol' days' as they may see it. That is not what's good and/or healthy for EMS. I was talking to a fireman the other day and we were having this argument, in an amazingly good matured way, (Meaning not once did he imply that I held my opinions because I was rejected by the fire dept, or that a fireman had slept with my wife.) and he made a really great point. His original argument was that there was no way to stop fire from taking over EMS, but later theorized that either fire would leave EMS or would begin to be pro education as the 'old guard' that defends ignorance (an unfair generalization. All respect to those that don't fit this but we all know that many do) are retiring now, and the young up and commers are those that were forced to go to at least medic school and many to college, so their respect for education will likely be different. I thought that that was an awesome point and the first inspiring thing in the EMS/Fire conflict that I've heard in years. Young master Bieber is the future my friend. He's smart, and he knows it, and intends to get smarter. He's tough and he knows it, and is pissed of at the status quo, so the old guys are going to have to figure out how to deal with him. Dwayne

Would having a tourniquet on for several hours bear any similarity to crush syndrome? Should we worry about admin. IV fluids, bicarb, an albuterol neb if signs of hyperkalemia? Obviously this would apply to an entire limb, not a hand tied off at the lower forearm, or some other insignificant amount of tissue. I'd worry about renal failure, to for starters..

Competent patients have the right to refuse any treatment no matter how detrimental it may be to their wellbeing. I'm not going to learn about every religious custom out there and intentionally adhere to them to avoid offending my patients, and if a patient requests me to withhold a treatment that I think they need I am going to do my best to change their mind, but ultimately if they request that I withhold a certain treatment in observance of their customs that's their right. It's no different than those folks (the Mormons?) who don't believe in blood transfusions, or (the Jews?) who refuse to get a pig valve. Now, with regards to taking my boots off before I enter a facility, or as far as me or my partner not entering based on our gender, that's just not going to happen unless I am specifically barred by the owner of the place. We've got a job to do, period. And I'll explain that to them. And it's not an anti-Muslim or anti-Hindu thing, because I've got no more problem with them than I do with Christianity. I'll even pray with anyone that asks me to, Muslim, Hindu, Christian, Buddhist, Pastafarian--whatever. Not because I believe in any of their gods but because it seems the decent thing to do. You've got a job to do and you got to do it, but we shouldn't ever forget that we are only permitted to do as much to our patients as they allow us to. If you can go the extra mile for them without damaging patient care, there's nothing wrong with that.

First let me complement you on your thorough and diligent assessment. A lot of people never realize that the "paramedic assessment" is *much* more about diligence than it is about diagnosis. As far as your questions: No. ST elevation means the condition is acute. With rare exception (like in the days following a CABG), there is no such thing as "old ST elevation." Keep your STEMI mimickers in mind (LBBB, BER, LVH, pacers, etc etc etc), but real ST elevation is something to be considered as cardiac injury. Depression can be a number of things, but "cardiac depression" is caused by ischemia or is a reflective change from injury. Consider it an acute problem. Whats the difference? What does a "cardiac" patient get that a GI patient does not? If you are worried about a AAA or some sort of GI bleed I would imagine you might be concerned about ASA (and I would too), but it seems you did the right thing by passing that decision on to on-line medical control. NTG as well. Other than that, both GI and cardiac patients get IV/Monitor/O2 and continued reassessment. Don't forget that this patient may have both a GI problem and a cardiac problem. It is not necessarily one or the other. You can't rule out cardiac because he has problems in his belly. Take heart, though. Our job is largely the same. Prepare for something worse to happen, consult on any meds you might want to give (if any), and reassess, reassess, reassess.