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On the pharmacology of ketamine: [Just for general information -- I'm aware that anyone with MD after their name is already aware of the following ] * Ketamine itself is a negative inotrope. * However, ketamine stimulates sympathetic discharge, so administering ketamine may increase CO / MAP, provided, the patient has a functional ability to increase their heart rate and constrict their peripheral vasculature. This may not always be the case, in which case ketamine may cause hypotension. * It is not hemodynamically neutral. It just has less potential for hemodynamic compromise than benzodiazepines, and most opiates. * Part of the hemodynamic effect of ketamine is to raise ICP. However it's also been trialed (unsuccessfully) as a neuroprotective. There is ongoing controvery as to its use in closed head injury. * Ketmaine also has an intrinsic bronchodilator effect, making it beneficial in situations where bronchospasm is an issue, e.g. status asthmaticus. Ketamine is beginning to find its way into prehospital care. For example this system -- which I don't work in, before anyone asks --- (http://www.albertahealthservices.ca/hp/if-hp-ems-mcp.pdf) allows ketamine for RSI or as a sole agent in the intubation of patients presenting with hypotension, airway burns, acute asthma or procedural sedation in hypotensive patients <80mmHg (e.g. pre-cardioversion, or for fracture realignment). I think it's often finding use outside of the US in situations where US providers might opt to use etomidate. As a medic, I'd happily come out to give pain control to anyone. I think it's one of the most tangible benefits of having an ALS response. It's something we actually know we're good at. Personally, I'd never have an issue with coming out to pain control someone. Or, in general, to back up BLS. I'd rather a BLS provider calls me, if they have a concern, and have it be a waste of time than have someone be too afraid to call, and have the patient suffer. But this is going to depend on your system, and the availability of ALS resources. I think that if you're close to the hospital, and can move the patient without undue pain, or you think that a critical life threat is present, then you probably shouldn't wait for ALS. In contrast, if you have someone with previously diagnosed renal colic, having symptoms suggestive of their prior renal colic, and they're a vomiting, diaphoretic mess on their bathroom floor, it might be better just to start an IV (if that's in your scope), and wait for someone who can give opiates.

Dwayne - I'm picking up what you are throwing down brother. Concerned or grieving parents will appreciate genuine empathy. I have cried with parents and sat by silently while they did. The key is being real and available. I answerer their questions but try not to talk too much. If you really care they will get it although nothing really helps when a parent losses a infant.

You can't be offended, you're white.

I didn't realize that holding your penis was a strictly black thing. Thanks for the education. I don't see anyone holding a gun to the shooters head making him dress in hood clothes (I'm still not sure what that means), hold his crotch or making him do anything else. It sounds to me like the black guy took it upon himself to meet your stereotype, so the only racist one here is him, oh, and you.

Why not. You seem to believe that everyone that has applied was black or a woman.

That is called student racisum, you were a student once and Im pretty sure you had an opinion, and by the way you act here Im pretty sure you voiced it or you would say to the effect "I cant have an opinion because Im black"

Well since first writing this post I've dealt with my first gun shot. I must say i held my nerve pretty well and I realized this is where I belong.So medic school isnt far off for me.

Did anyone check the website for the fire department? They have a black man as an assistant chief (Nakeya Lovett, who was interviewed for the article). So here we have a southern, rural fire department who puts the black man ahead of the white woman. It's a crazy world we live in.

All great advice! As a parent who has lossed a new born child. I would not wish this upon my worst enemy! What ever you tell the parents make sure it is the truth and remember when you tell them be ready to comfort the parents the best you can. Never tell them that it is going to be okay or you know how they feel. Tell them you are sorry for their loss, hug them if needed, ask if there is family members that you can contact for them. Let them grieve in their own way. They may scream at you,hit you, fall to the grownd, pass out, or not say anything. Just remember it is not your fault and that you and your partner did everything that could be done. Before leaving just make sure there is someone else there for the family as they should not be left alone after such a loss. Just never lie! Brian