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So there you have it. The rest of the arguing is just noise. JB is willing to work "outside" the box for family only because his ethical/moral stance is that only they deserve the very best. The rest of his patients get the basic cookbook medicine from a cookie-cutter medic. This argument will never go anywhere since this is 2 different styles of treatment trying to prove themselves right. One with law on thier side, one with morals on thier side. Here is some reading for ya JB, from the man who wrote the "cookbook". Cowboys in EMS

Wow. With all due respect, it is rare that I hear something so audacious and offensive to my sensibilities that my jaw drops the way it did when I read this. What else can intermediates do in your area? Can they push narcotics as well? ET intubation? NG tube placement? Manual defibrillation? EKG and 12-lead interpretation? Why are they even hiring paramedics? If they can get away with just letting an EMT-Intermediate with two semesters of coursework take the place of a paramedic, where's the incentive to hire the higher educated provider? This is exactly the kind of backwards thinking that is dragging EMS down. Instead of providing higher education opportunities for paramedics, we're catering to EMTs and just tacking on skill after skill until what you have is a cheap paramedic substitute with not even half of the education but all the power to do harm. It's no wonder people don't take us seriously, we're not even taking ourselves seriously when we allow this kind of shit to pass. Can you imagine what our colleagues in the hospital must be thinking? That we're seriously allowing people with only two semesters of education to give all the same drugs everyone else in the healthcare industry must spend YEARS of education to earn the right to push? It's madness. And no, this isn't personal. I'm not attacking you, sir, but the system you're working in. Unless you're an advocate for this kind of crap, in which case, with all due respect, you're out of your freakin' mind. Paramedics as they currently are probably shouldn't be doing a lot of the things we are, yet we're letting EMTs grow ever closer to paramedic level care?

Gotta give that a point... salient, succinct and undeniably correct

Ass clown

HELLO Kettle this is the POT :-} My guess is that JB spends far tooo much time on his knees under dwayne's ex bosses desk. Or it's as annie said a former troll come back to haunt. JB how about a link to the standard of care you state, or a link to your protocol that gives IN glucagon administration. I've worked in several places that used IN for many drugs, but none used it for Glucagon.

Ahh, johnboy, glad I coaught you, that other thread is getting bogged down and I was hoping you could help me out some more. I'm still struggling with two things 1) How does IN glucagon work better than IM glucagon? The last reference you posted was with regards to centrally acting medications where IN is very handy due to the rapid absorption into CSF and the brain, but glucagon doesn't really fit this model, so I was wondering how it works? 2) How is it that hyopglycemia eliminates even spinal reflexes? Thanks for your help Paramagic.

I agree dwayne isnt a vet, but he does say he knows how to make a canadian beaver feel better ..... And Dwayne Annie was going to get Admin to check some things out as she too has the same creepy crawly feelings

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!

You're ridiculous. If the solution to the patient's problem is to pump them up with sugar, and if pumping them up with sugar will (see, Wonder Drug Advertising) take them from obtunded to alert in a matter of moments, then how do you think they're gonna feel when they wake up with an amp of sugar in their bone? Think it might be a little painful? Think a little prophylactic lidocaine while they're unconscious so when they return to consciousness shortly thereafter might not be not only reasonable, but good patient care? "Nah, Bieber, shut up you silly newbie. That's just crazy talk. Go back to driving the ambulance."

1st semester medic students need to stay away from trying Google-Fu...

Oh sorry, I see there were some posts while I was typing. I'm a bit confused with the last reference you posted from the Annals of Epidemiology. This article is discussing the advantages of IN administration that need to cross into CSF and across the blood/brain barrier to be effective. Midazolam, naloxone and fentanyl are good examples of these drugs. However, I don't see how this applies to glucagon, which of course needs to get to skeletal muscle and the liver to have an effect. Can you explain how this applies as I'm obviously missing something?

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.

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.....

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....

How so Ruff- this stuff takes place everyday....

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...

You idiots on this site have blown me away, this isn't a site for learning. You people are idiots ! Plain and simple. I was on here for a week and am already done. You assholes simply amaze me. You all feed off of each others stupidity. Dwayne , as I said before - you deserved to be fired, why - because you are a strum job... Period...

Anyone else know of situations of Paramedics losing their jobs because of unjustified IO placement?? No names please, just situations. Thanks JB