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Its not that women can't find a penis in film if they search hard enough, it is that someone else is determining that they cant see one in a movie, while females are shown nude all the time. I liken it to laws that forbid you to buy alcohol on Sundays. Yes I have 6 other days to purchase alcohol, but its the fact that someone else's morals are dictating what I can and can not do !

Good for you. It just take 1 great experience to light the fires. Don't let that flame dim. Keep studying hard and never stop learning.

Hey, everyone. So I just finished day two of a five day stint today, and I had a couple of interesting calls and a good learning experience from one that I'd like to share with you guys. Patient number one was a female in her early twenties complaining of abdominal pain and difficulty breathing. Shortly after arriving on scene, I determined she was in diabetic ketoacidosis (blood sugar of 346, Kussmaul respirations present, abdominal pain and polydipsia) and I got her packaged and ready to go with an IV line running wide open. Unfortunately, I'm not (or wasn't) that familiar with just how quickly an open line should flow in, and while I checked it periodically to make sure that it wasn't flowing in more than I wanted to, it didn't occur to me that in my ten minute transport time I should have gotten the full liter in, and it also didn't occur to me until when we got to the hospital that she had had her arm bent and had kinked the line--which is why only about 150 made it in. My other mistake on that call was to let my uncertainty about our clinical guidelines and protocols get the better of me. I should have given the patient pain relief, but I didn't due to the fact that I was more concerned with what admin would say about mixing protocols. As it turns out, I would have been fine, but the real lesson learned here was that I need to be developing my treatment plans FIRST, and worrying about how it fits into my protocols second. I know what treatments I want to give, but I oftentimes get too wrapped up in worrying about what my protocols let me do that I start thinking only in the form of protocols as opposed to sound treatment. I spoke with Dwayne about this call afterwards, and he really helped to set my head on straight. He told me that I need to be putting the patient--not protocol--first, and he's absolutely right. Treatment plan first, how I'm going to make it work within my protocols second. It's about performing sound clinical judgment, and either finding a way to make your protocols agree with what you know the correct treatment is or getting on the radio and getting the doctor involved so you CAN perform the right treatment. And I know this sounds like common knowledge, but it really is a hard balance to get right, especially for a new paramedic. And even though I later found out that I COULD have treated the patient's pain no problem, it's the simple fact that when I'm assessing my patients, I'm not thinking of how I need to treat them, I'm thinking of what protocol I'm going to work under. So Dwayne's message to me was a good wake up call, and one I'm not going to forget. I'm not out to blatantly violate protocol, but my primary focus needs to be on how I can make this patient better or at least prevent them from getting worse and on how to at least treat them appropriately. And thankfully I got the chance to redeem myself in a way on my last call today, where I forced myself to take a step back and think about what TREATMENT I wanted to give, and then later found the protocol that made that possible. I'm not too proud to admit I messed up today. I had a chance to positively impact a patient and I let it slip by me due to my incompetence (not double, triple, quadruple and quintuple checking my IV line) and due to my preoccupation with protocol over correct treatment. And I'm sure I'm not the only one who's ever made this mistake, and if you work under pretty rigid protocols like I do, you've probably found that it can be hard to do what's right and still be within your protocol. Dwayne, you're the bravest paramedic I know, I've gotta say it, man. You are the epitome of what our mentality towards patients should be. You lost your last job doing what's right, and though it can be hard for us to stand on principle over practicality, you've proven that if any one of us want to be half the medic you are, we have ABSOLUTELY got to put the patient first. I wasn't doing that before, I knew the lines, could recite the mantra back and forth, but it takes more than just being able to read the script to really be that kind of paramedic. I know I get a lot of praise here for being "such a promising newbie", but the truth is, I'm not half the paramedic you guys are. If you guys could see me in action, you'd see just how green I am and how much, for all my words and strong beliefs about what EMS is, I haven't lived up to the message I've tried to deliver. But I'm going to do better. Because I want to be THAT paramedic who never compromises, who never puts anything but the patient first. I messed up today, and I messed up before today. And to be honest, I'll probably mess up again. But I'm going to try not to, I'm going to try and follow through with that I say, to act in accordance to my very strong beliefs about medicine and EMS. And maybe, just maybe, some day I'll really be worthy of all the kind things you guys say about me. But that day isn't today, and it isn't tomorrow. But every patient I see, I am going to remember what you said, Dwayne. I'm going to keep your words in the back of my mind and I'm going to try my damnedest to do what I claim to believe in. So thank you, Dwayne. You forced me to take all my philosophical bullshit and really prove that I mean what I say. And every day, I'm going to consider it a challenge to live up to the things I say and the beliefs I hold about medicine. And this is my challenge to the rest of you guys. If you've been letting protocol dictate your treatment, if you've been thinking protocol first and correct treatment second, if you've been saying the words but not living up to them, I want you to change that. I'm not asking you to violate your protocols, I'm asking you to think about what is the BEST treatment for your patient, and either finding the protocol that lets you deliver that care, or getting on the horn and asking your physician to give you orders that provide that treatment. Practice what you preach if you're not doing it already, and if you already are, make sure your partner is as well. Because that partner could be just like me, waiting to here the same words Dwayne told me, to break them out of their "what protocol do I use?" shell and back into thinking like a paramedic.

WOW missed a good thread LOL Dwayne your an ass clown Hell your the ass clown I WANT on my rig when TSHTF. OK let the Basic have a stab at the ridiculousness (is it a word?). If I understand correctly, Dwayne you had a diabetic PT that was unconscious and possibly CVA due to facial droop which was a new symptom as per witnesses. You ran through your brain and found your diabetic algorithm and realized D50 would be best BUT also realizing the time window for a CVA and doing ninja brain math realized a very short window thus moving to your CVA algo. Realizing the hypoglycemia could be masking the CVA OR cause CVA like symptoms you decided to go D50 which normally would be given IV. Upon trying IV you couldn't get a stick due to dehydration collapsing the veins (or prior venous issues). Upon trying to move the patient's extremities you felt resistance and possible crepitus thus not wanting to further injure the patient you decided on a IO which upon me researching means you drilled the bone to inject directly to the marrow (hopefully I understood that right)My link . Knowing this would cause extreme pain if and when the patient regained consciousness decided some lidocane, a pain killer, would be appropriate. Now I had to look this up so bear with me.... My link Upon realizing this is the only contraindication and not knowing if she was, guessing here witnesses said no, you felt OK to use this mode of pain relief under the assumption she would regain consciousness due to the overlying symptom being low blood sugar and D50 would correct this issue. Also noting what possible side effects could be caused and anticipating them you felt you were within specified area protocols, likely standing orders, so no consult was needed. Now thinking ahead the benefit to the patient at this point would be coming out of a depressed state of consciousness and also possible resolve of the CVA S&S which would not necessitate the call to have the team readied. If the CVA S&S did not resolve all you have done is give the clinical team access to add whatever meds they need once in the ED without any wasted time. Thus again keeping your ninja skills sharp and wielding the time window for proper treatment of the CVA. After all this at some point your employer for whatever reason decided to terminate you and used this call along with two others. Even though at this point I am assuming (see now I am making an ass out of you AND me) the previous call was all within protocols and standing orders. So basically you stood your ground with an inept manager and walked instead of betraying your belief in patient care. Ok so did I miss anything? If no then why all the hostility? You followed protocol, stood within the bounds of excellent patient care, used sound clinical judgment and moved forward in your algorithms to the benefit of the patient. Nowhere do I see a "cowboy" mentality, nowhere do I see anything outside good clinical judgments, nowhere do I see anything wrong except a bad management decision. Now if a Basic can follow this, ok had to look up a few things but linked my sources (see not that hard), then how does a seasoned medic with advanced (well according to them, no link to source no dice) protocols not follow the mention used, the pathways used, or drugs used? 12 year old? Naaaa they would follow too. Troll? Ding Ding Ding we have a winner!!!! Here is your prize To everyone else, too bad this thread got derailed, it seemed like a great one, even for the Basics and Intermediates out there. We all need to be thinking this way. We have guidelines not handcuffs. BTW johnboy with just these few posts in this thread to go by I would rather have my probie and a firemonkey in the back with me helping then you Mr. Paragod. Please stay off my rig. Also if your wondering who gave you the minus in the Beiber jab it was me. That kid has a great future as a medic and has the balls to admit his flaws here and moves forward as a better provider for it and I as one of the members here am glad he is part of our profession. edit to add link for lidocane no other changes made

Seeing how they were involved in a rollover MVC : did you or your partners not do a trauma assessment? This is something that might have been done as part of the total patient exam in documenting injuries OR the lack of them. ALL pt's worthy of transporting from MVC's should at a minimum get a once over with you palpating all parts of the body to see if you elicit a pain response or notice deformities, contusions or wounds. People involved in MVC's tend to go into an adrenaline based shock and don't immediately notice many injuries, until said adrenaline wears off. Then all of a sudden when the nurse asks you why you didn't notice something such as this case you would of had a response.

So I got my wish! I went with a different ambulance company this time and we were pretty busy. First call: Foot Problem, transport for eval. Second Call: AMS, hypothermia Third Call: Car VS Telephone pole Fourth Call: OD/ Suicide Attempt Over all a very cool night, got to watch an IV put in, got to watch the heart monitors and even got to check the glucose. Made sure I asked all the questions I didn't ask the first night. Followed the EMT and Paramedic around all night either watching or asking when applicable. Got to go into the hospital and asked a lot of questions there, found where the equip was, etc. Preceptor asked me all kinds of questions at the end of the night like what we were looking for with the Car accident. I told her, but she wanted the "big girl words" and I kept mixing up Embolism and Pneumothroax, even though I know what they are. She asked me right as they were dropping me off at 1 am... Little unfair since I had been up since 6 am. But at least I know I have to really pay attention to what wording I use. The people I rode with were awesome, asked me all kinds of questions about Pt's (What are we looking for? How does PT skin look? etc) and were very receptive to my questions as well. One thing I have to work on- Taking BP's. One of the people with one of the Volly's offered me a job on the spot. Told her I was still in training, she said to call her when I get certified.... Yeah. Good night and I'm really hoping I get to go again although I've reached my required limit for the class. Interesting side note- My step brother went and friends mother in law both went into the hosp on Sunday night, both had stated they wished I'd have been there to help transport! Kind of warmmed my heart. -MetalMedic Edited to remove even the vague details, don't want to lose my job before I can even get one!

John, tell me about your paramedic school. What were you taught from day one of paramedic school? Were you taught that the goal of paramedics was to follow their protocols faithfully, unquestioningly, and without ever thinking outside of the box? Was that the moral at the end of the story? Or were you told that paramedics exist to provide competent, safe, and appropriate medical care to patients? I challenge you to find in any paramedic textbook any quote that says that our mission is to follow our protocols. You won't. That's because that's not the mission of EMS. The mission of EMS is to provide emergency medical care to patients and to help them in their time of desperation. You may not agree with Dwayne, and that's okay. But why did you get into this profession? Were you bursting at the seams when you got your acceptance letter, so full of exuberance and jubilation, at the idea of being able to follow your protocols to the letter? Or were you excited to be able to provide medical care to people when they were at their worst; ecstatic to be able to HELP people? We didn't get into this job to follow protocols, we got into it to help people. That is our primary goal, that is our mission. Protocols exist to facilitate that mission, but at the end of the day, you have somebody's life in your hands and you better learn to respect the fact that it is up to YOU to protect that at any cost. Are you going to have the same courage Dwayne has shown when that day comes? EDIT: (Addition) I'll say this. Someday I am going to be dying. I am going to be sick or injured and I am going to know all too well the kind of men and women who will be taking care of me. And there, in the back of my mind, I am going to be crying out desperately for someone to save me. I am going to be begging for someone to do whatever it takes to keep me alive--not to do whatever it takes to follow their protocols. And I hope that the person who cares for me in my time of need is as selfless as Dwayne and as willing to give up everything for my life, because while it's easy for us to take a step back and not really see the value, the preciousness, and the gravity of our patient's lives through their eyes, we need only become as helpless as they to realize just how desperately we all want to live and be saved by that one person who is willing to do whatever it takes for us. Dwayne has proven himself as that man. I haven't, not yet. And I'm willing to bet many of us here haven't yet proven that yet, yeah, even you. So Dwayne, by all means, drill into my bones. Act outside of your protocols if you feel you must. Do whatever it takes. Because when my time comes I am going to ask you to do one thing and one thing only, the same thing every one of our patients ask us, the same thing we will all eventually ask of someone else in the hopes that they will have your same courage and conviction: Save me.

I think I am going to ask admin to check your IP address.... your actions are very similar to another member here who tends to throw out supposed facts and then cannot support them with actual references. Your continued attacks on Dwayne are childish and unprofessional. Did Dwayne act outside of protocol? Probably.... did he have justification for it? Absolutely. Did he do more harm to the patient? Absolutely not. Did he get fired? Yup. Was the firing justified? Not in my opinion, as he had valid reasons for his actions. He didn't use the IO to be a cowboy... he did it because it was the right thing to do for that patient. If I or a member of my family were sick or injured, I would want a practitioner like Dwayne to respond, because he is NOT a cookbook medic who can't think outside the box, and who puts the care of his patient first. Dwayne has been very open about the fact that his care was aggressive. I would like you to explain how his actions were "wrong." Did he do more harm to the patient? Your comments of "you people" and "people like you" are emotionally based, not factually based, and show that you cannot support your claims with more than emotion. If you continue to post on this site, you will continue to be asked to back your claims with something factual. Twice I have asked you to provide references, and twice you have ignored my request and responded with replies that are completely opinion, not fact. I cannot treat your posts with the respect you think they should earn, when you cannot provide information to back up your claims. Based on your posts thus far, until I see an intelligent post from you, backed with actual evidence, I will assume you are a troll here for the sole purpose of annoying others. I am open-minded enough to change my opinion if I am shown evidence to prove me wrong.

Back to the matter? How so? Being new to the forum I will happily explain where the true matter herein lays. Are we to toss our experiance and best clinical judgement aside to follow a written piece of paper that doesn't follow that minutes problem? We are medical professionals who are globally spread and sit on this forum not to quote what our Medical Program director has written for us, But rather to share our experiances and to learn from each others successes and mistakes. I have heard it said that "A smart man uses all of his brain, but a genius uses all brains at his disposal." We talk here to cause ourselves to be better practitioners and back our methodologies with hard science and medical research. I understand not to treat based on what I have learned on this forum but rather can use this as a stepping stone to getting protocols changed, to ultimatly provide best care to our patients. I can't remeber whos tag line used to state a waiver of "follow your local protocols". I believe that there is a best of both worlds here. I believe that to be by the book, Online Medical control could have been contacted. But I also can't argue with positive outcomes. Fireman1037

Hi all got bored and decided to join another EMS board and see what this one is like. Been in EMS since 2003 and got my paramedic in 2008. Now working in Colorado state doing 911 and IFTs.

You will be surprised that by the end of your course, you will know the 95 meds. It does get easier when you can put them into categories, and when you start to see that certain drugs have the same characteristics. I made chart after chart, and then tested myself by filling in blank charts: Drug Name, Generic: Drug Name, Trade: Supplied: (eg, 1mg/10,L) Classificatyion(s): Indications: Contraindications: Dosage, Adult: Dosage, Pediatric: Yeah I have killed a lot of trees in my studies, using pages and pages of notes and indexs cards.... but it is worth it. You can do it!

I agree with Ashley. When I was in Paramedic school, I wrote out all the drug cards that we needed and even some that we didn't but I knew that it was in my protocols at work. Yes, I had the ones already printed out in the back of the workbook just like you do. The thing is by you writting them down and spending time reading all the info on each drug it actually helps you remember that drug. The color code thing works too, mainly it keeps you a bit sane after all the hours of sitting there and studing the same cards over and over and over. A change in the color helps you focus. It will all come in time, when you start applying the drugs to actually treating pt.s it will make it easier. For example you give a person having an asthma attack Albuterol because its a bronchodialator and its going to decresass the bronchoconstiction going on. Its things like that, which will help you learn the drugs too. Study hard and good luck.

Ok, I guess it's 'confession time' here.... As an EMT, I looked at a lot of the medics I came in contact with as 'pompous asses' because of their attitudes toward the lower license levels. This thread has forced me to re-evaluate my position. As I climb through the license level ranks, I find more and more that there’s so much I DON’T know. I’m not the first EMT to come to this stark realization, and I know I won’t be the last to ‘figure it out’. Working my way through EMT, then EMT-I and eventually onto EMT-P, I find that when I was a ‘mere EMT’ I thought I knew it all. This feeling was great to hold onto, and gave me confidence to do my job. Then I went on to the EMT-I portion, and realized that I didn’t ‘know it all’ like I thought I did. But I learned more, and still felt good about it all. I was still confident, but looked at things differently. When I started my medic class, I quickly learned that what I really knew nothing more than oxygen, stop bleeding; and keep broken body parts from moving. Those that know my story know that I had to drop my medic class for reasons beyond my control. I haven’t given up, and will be working toward getting into the next class. As I wait for the next class to start, I realize how painfully inadequate my education has been, and how much I still have to learn just to be able to call myself ‘competent’. Terms like ‘good, great and exceptional’ will just have to wait. I do not deserve them … yet. As with every ‘confession’ comes the opportunity to eat a little crow. I think I’ll have mine with a generous dose of A-1, to make it more palatable. To all the medics that I call ‘friend’: I offer each and every one of you a sincere apology. While I thought that many of you were ‘harsh’ in how you dealt with the lower license levels, I’ve come to realize that it wasn’t out of ‘meanness’. You were challenging me to not only prove you wrong, but also push me into learning more. For that, I owe each of you a great deal of thanks and appreciation. This confession serves as a warning to all of those medics (and the Doc’s too!): Since you all have pushed me into going further than I thought I could, each and every one of you will be ‘hit up’ as an information source with even more questions than I’ve already hit you with! To everyone else: This site is a great place to ask questions, debate theories and ultimately LEARN. These ‘grouchy old medics’ may seem harsh and ‘mean’, but they’re only want you to push to be the best that you can be. We’re taking people’s lives into our hands, and the patient’s deserve more! When the ‘old hands’ around here challenge your posts; whether for content or spelling/grammar, they aren’t being ‘meanie-heads’, they’re pushing you to correct the ‘little mistakes’ before they snowball into ‘big ones’. One misspelled word on a PCR can change the entire meaning. It’s been said that those that have successfully completed the medic course (especially with a degree), have ‘forgotten where they came from’. Some have gotten ‘arrogant’ because they’ve completed the course; but most appear to be coming from the same position that the previously addressed medics are. In the United States, our EMS education is very lacking in content. The cliché “You don’t know what you don’t know’ is so very true. The ONLY way to get a glimpse of this is to pursue your education above and beyond the minimal course called ‘Emergency Medical Technician – Basic’! When I finish my degree, I hope to remain the same person that some of you have come to know and at least ‘like’. I’m going to push you as I always have to get more education. I’ve had to re-evaluate what I thought I knew and now have to look at things much differently than I did from the ‘safety’ of my EMT-B world. I hope that many of you will find yourselves in the same position! ER Doc, Thanks for reviving this thread!

Remember, while your test might still be stuck in the seventies actual praxis is not and has evolved beyond such a primitive approach to medicine, but ssssh do not tell the Houston Fire Department or other such reputable agencies. Not every cardiac patient requires oxygen or cannulation, or amiodarone, cardioverison or adenosine ... treat the patient not the rhythm.

What?! I just said something Dust was thinking before he said it?? No way! :shock: I guess that means I'm learning something afterall. Maybe one day I'll *almost* be as good as you. 8)

Wow, glad to hear everyone liked my post. My clinical instructor who told me that was true to his word, I should add. The day we passed our finals and were certified, rather than have any sort of fancy graduation, did something much more meaningful. He and all of the paramedic instructors who had kicked the crap out of us all year took us to the local bar and bought us all lunch and a few drinks, laughed and joked with us, and treated us as equals. It was one of the most memorable experiences of my life.

My advice? Paramedic school is not EMT part 2. It is totally different. Study everyday. Don't try to get a passing grade, try to know it all, verbatim, backwards and forwards, because there is no such thing as a 75% successful intubation or cardioversion. Every person that was in my paramedic class who now works professionally used to consistently score at least 90% on their written and skills exams. Know your BLS skills, but don't obsess on them. You will have the bitter 'experienced' EMT's try to rattle your nerves by making it look like knowing the textbook ratio of compressions to ventilations in CPR is more important than knowing the principles of circulating oxygenated blood in a person in cardiac arrest. Correct splinting might save a limb, knowledge of cardioversion and cardiac drugs will save a life. Know yourself and be confident in yourself, because everyone will be trying to tear you down, from the EMT's who can't hack medic class and will use you to vent their frustrations, to the nurses who don't think paramedics should go anywhere near 'their' patients, to the doctors who were born with 'argentum coclearium rectus' (silver spoon in the ass), to your preceptors who will only be there to make sure you can do your job, not to be be your friend, you will be on your own, you will be a new person in a relatively new profession. Be sure you want to do this, be sure your desire is pure, the adrenaline rush will wear off, you will get to the point where you want to tear the siren off of the ambulance, shoot it twice, and throw it into the river, you will realize for how many patients how little you really can do, and if you got into this field for any other reason other than the purest of intentions (or, I suppose, because you are sociopath who enjoys hurting others), you will be burnt out before you graduate. In the end, however, if you make it through, if you pass the tests, written, skills, and life, you will be a very special person, you will be unique among men and among the medical profession, no one will appreciate you, no one will respect you, few will even know what you are actually capable of, your victories and defeats will be personal and private, but if you succeed, as my Clinical Instructor once said, you will have earned my respect and you may call yourself my colleague.

8) ok to the response to the person above me about all the education crap he wrote, listen when it comes down to it, put the dang tube in, you are paid to do a job, all the education in the world will not prepare you for the streets, things are a whole lot different, all the book smart people and thier views and opinions are nothing but a bull of crap. The greatest medics and basics come from road experiance, I let all my basics do everything as long as they are doing things right, you only learn by doing

Justin beiber, let me shed some light for ya....the IO should not even have been placed, unless the the useful hormone that we have in a siringe did not work!! Brain child you are buddy!!! Please do, go back to driving the ambulance, and better yet make it a transport company so you are not presented with critical patients Justin Beiber....

Dwayne- face the facts brother- and accept it. You were fired for doing this and for good reason. Someone other then myself also thought what you did was wrong- guess what, because it was dip shit. Who in there right mind would drill a diabetic that was hypoglycemic, prior to trying glucagon?? Oh wait- you , that's right!! Good luck, you are cool on this site , but I am quite sure you are black balled in the real world cowboy!!! Again- I would have fired you also cowboy!!! You are not only an idiot, buy a stubborn one at that...

D- back to the matter- you were apparently fired over this, and now a complete stranger agrees with the outcome. Wake up.... It is this attitude, that gets paramedics in hot water and you are living proof.....

If you people can't find a procedure that has been going on since 2008, then you all need some help.. The problem Here is we have a person here that can't face the fact that he was wrong. Hopefully you are not around myself or my loved ones....maybe someone should buy you a holster so you can wear that EZ io gun all day long...people like you are the reason why procedures like RSI are not available to educated paramedics...