HellsBells

I don't have a problem with the sentiment behind "ït is what it is," I simply think its chronically absued to the point of annoyance.

"It is what it is" Totally, Such an annoying turn of phrase.

It is a catchy song... do you have a point here?

Its a "No Brainer"

Its a little blurry, I don't think there are any significant ST changes, the T waves in V2, V3, V4 seem to be slightly peaked, which could lead to the conculsion he may still be somewhat hyperkalemic

http://www.ottawacitizen.com/touch/story.html?id=5853644 Here is a really good opinion piece on the issue. To answer your question tniuqs, the turban right should not supercede saftey concerns. However, normal day to day operations of a cop do not require ballistic helmets.

This is a particularly sensitive issue, and a good wedge issue for the Conservatives. Predicibily, the hyperbole has already went off the charts on this issue; considering very few actually wear the head covering here (I was unable to find any statistical sources, but if appears about 1-5% of muslim women wear a full face covering). The reasons for banning it outright at the swearing in cerimonies are equally dubious, as I assume that its fairly unlikely someone would try to sneak in under false pretenses, or refuse to utter the oath, after having gone through all the other requirements for citizenship. However, banning full face coverings at these cerimonies is the right thing to do. Technically, they are not required in the Koran, and (to my limited understanding) for Muslims, if its not mentioned in the holy book, it is not specifically nessesary. The Koran does mention the need for women to be covered from neck to ankle, but not the face. Therefore this is not a specific religous right, but a cultural one, and not protected under our charter. But, beyond the truly religous aspect, in my view there is a moral aspect to this issue as well. Personally, I recoil when I see a woman walking the street, clad from head to toe in what appears to be a black ghost costume. Whether that reaction is a moral failing of tolerance on my part, I can't say with certainty. However, my feeling on the veiling of women is that it is deeply disrespectful of both men and women of all creeds. The implication of this garment is that it is nessesary because if men are allowed to gaze a women's face, they will be overcome with unsatible lust, and carnal knowledge of that women will then become unevitable. This makes two statements very clear. One: Men have no ability to control or disipline themselves when it comes to matters of sexual congress. Two: All women are sinister tempresses, that must be held at bay by formless coverings, lest they spoil all men around them with their sinister facial features. Of course, a practical display of this mindset was played out in Afganistan recently, when a women was forced to marry her rapist, rather then her be sent to prison for the crime of being raped. However, my feelings on religious accomidation differ on other issues. I see no problem with Sikhs wearing Turbans as RCMP officers, in my opinion, its a hat. Whether that hat is a turban or their regular duty cap, it doesn't effect their ability to do the job, besides, I've witnessed plenty of RCMP officers come into the hospital wearing nothing on their heads at all. Now Tniugs, I have to ask, would a constable not wearing any hat at all sully the reputation of the uniform any more than a Turban would? As for the postings of Craig, I fear he displays a insideous and dangerous attitude that has slowly crept into our society over the the last couple decades. One that equates any type of criticism of religious or cultural minorities with rasicism and ignorance. Once which is being upheld by our infortunate human rights tribunals, that in some cases seem to supercede the criminal and civil courts of our society. Anyway, my point on the whole topic is that it is right, but perhaps for the wrong reason.

CrapMagnet, it sounds like you were irritated. Is that true?

I don't want to get too bogged down with this issue, but I don't understand the comparison. First of all, I am lucky to work in the service I do, because we have a bariatric truck we can call to transport these pts. However, if you're working a small rural service, that has no other options, how can one defend not transporting the pt because it may be unsafe, etc (providing, of course, the pt actually requires ambulance transport)? On the other hand we have a dog, who may be very usful to the pt, is not required to provide medical care. So, if the Paramedic thinks the companion animal will lead to an unsafe working environment, the animal can be left behind and the pt will still receive treatment. In the situation with the bariatric pt, that is not the case. I have a question for those who do work in hospitals: How are these animals cared for in the hospital setting? Are there any specific procedures in place? Do volunteers offer to stay with the dogs while pts are undergoing tests? Furthermore, what about other pts who have allergies to dogs, where do their rights end and the pts with companion animals rights begin?

Was it perhaps left in a certain politician's chest cavity, by accident?

First off, I wasn't referring exclusively to you flamingemt. That comment was a little bit of venting I had to get off my chest. As for a less than professional response, I don't think anyone was promoting treating people disrespectfully. However, this is an EMS forum, and if people want to come here and blow off some steam about what they regarded as a BS call, then thats their right. I fail to understand your argument that paid practitioners have no right to be annoyed by frivilous or unessesary calls. I personally have felt that way on a number of calls, but can still function properly, and feel that I do what is in the best interest of the pt.

I don't consider this a BS call. This woman is stranded and does need help to get home. The wheelchair most likely doesn't fit into a police cruiser. The ambulance is most well equiped to transfer this person home. However, the overall tone of this thread is correct. There are BS calls, and I think EMS folks should have a little responsibilty in who is transported to hospital. The old "you call, we haul" mentality is outdated and there should be alternatives to mindlessly tranporting every pt to a hospital. If one truly wants to "touch" the life of a pt, educate them about alternatives to calling 911; your feet are mildly sunburned? A recomendation for aloe at the local drug store may improve this pts quality of life much more than an expensive hospital trip and a long hospital wait.

Where did you get this legal opinion from mobey? My understanding, per ACP is that if any ALS drugs are given, ALS must monitor them for the duration of transport. Furthermore, what meds specifically are you referring to? Now I know that in actual practice, we do in fact hand off pts who have had analgesics, antiemetics, etc. to BLS crews. Particularly in situations where hospitals will send pts out for BLS transfers, who have recently had morphine or other pain control. However, I think if we are actually following the law to the letter, it is technically not sanctioned.

Well, here is another thought... I still stand by my plan to take the head injured pt ALS, but yes the neurologically impared pt does deserve a ALS care, however this is obviously not a perfect world and somebody has to go in the BLS unit. I agree with Mobey that intubations on trauma pts are controversial, but in many instances that is because they delay your transport time. If youre already looking at a half hour transport, push any RSI drugs you may need while moving, pull over to place the tube, shouldn't delay you that much. The thing that I find kind of amusing out of this whole discussion is that in the actual situation, Mobey's service had to transport both pts in BLS units anyway. That said, do you know what the pts outcomes were, post fixed wing transport?

From an Alberta point of view? I'd say pt #1 needs ALS, The second pt would initially require some BLS type NaCl, at least to get the systolic above 90mmHg, the aggressiveness of which should be titrated as to whether you think its high space shock, or a bleed (assuming thats possible). If the BP doesn't respond to fluid, there is of course some ALS options here, but to me the altered GCS guy seems like the priority here.

Ill try to respond to this in the spirit it was posted, as if I had to make the decision quickly. Pt 1. would come with the ALS unit, intubated and treated accordingly, a firefighter driving me and my partner Pt 2. would go with the BLS crew, fluid bolus's as reqiured, again with a Fire Dept. driver. Since the trip to definative care is a long one, its hopeful ALS mutual aid could hook up with the BLS crew. There is no way I'd take both pts with the ALS ambulance, there would not be enough room to provide needed care for both pts and they would suffer as a result.

It seems to me this is more of a concern when using paralytics to intubate a status seizure pt.

As I Canadian I always follow the American Election process with a great deal of interest. I find it fascinating how the US is in full on election mode a year before the date. Our elections are like 3-4 months long. That said, the election is still a year away and Ronmey's fortunes could rise or fall significantly in that time, we could even see some new republican sweethearts who arn't even on the radar yet.

This is a good discussion. First and foremost, there should be no pay per call in EMS; not ever, it is utter bullshit. As was mentioned before in this discussion just ask how well that is working out for B.C. paramedics. To add some context to my opinion, I will admit to working in a busy urban system in Alberta with a population of over a million (whoop-de-fucking-do), but with less than thirty murders this year. I must disagree with Stiffaliss comment that wage have stagnated and gone down for some paramedics, with the new receiving agreement, there have been modest wage increases across the board, personally, as a one year paramedic, my wage jumped about $3/per hour. The EMT's are seeing slightly lower wages than before, but those who were making more before the transfer were red circled, meaning their pay stays frozen until the wage scale catches up with them. So, although new hire EMT's may make less than before, no one actually has had wages clawed back from them. Personally, I think it rocks that rural services now get the same wages as their urban counterparts. Since the system is not set up to pay by the call (nor should it be), the argument that urbans work harder, hence should get paid more is moot. My argument for parity is this: Urbans Paramedics work busier shifts, and have to be at the hall for their entire 10-14hr shift, but get to go home at the end of the day, turn their radio off, have a beer, drive out of town, etc. Rural paramedics on the other hand have less call volume, but typically are on call of 48-96 hrs straight, and have radios turned on, can't drink, can't leave town, etc. So both parties make a significant commitment to their job, and should be paid accordingly. Additionally, before anyone jumps on my back, saying "Oh you've just worked urban, you don't know what rural is like." I did work for about two years in a town with 3500 citizens (hopefully this is small enough to be considered TRUE rural). As Tnuigs pointed out, this divide and conquer technique is very real within the AHS management, and we really do need to present a unified front, because I think we are going to see some low ball tactics and bad faith negotiation practices from AHS, particularly as the next round of contract negs get underway.

Since there is some dispute over who authorized the killing of Kadafi. Lets instead compare it to the killing of Bin Laden, who was definatively killed by US forces. The US strike on Bin Laden was a surgical strike, they had one specific target, made sure he was isolated, took him out at a specific place and time to prevent collateral damage. The Iran plan involved hiring Mexican drug dealing thugs, targeting a low level Saudi diplomat at a public restaurant with no concern over civilian deaths, all for fairly dubious results. So for one, the US is at least superior and distinct in its tactics. As for the moral debate, it gets a little more sticky. It can obviously be considered amoral to conduct clandestine operations on foriegn soil that would be considered criminal by domestic law. Additionally, its always risky to take out a foriegn dictator and create a power vaccum that may be filled by someone or something worse. On the other hand, is it wrong to finish a mad dog ruler and prevent years, decades of suffering at their hands? At the risk of using a cliched example, if you could have taken out Hitler before his rise to power, would you? Could that be considered the moral, just decision?

..But House is unkempt, unshaven and rude, and he is the best doctor ever.

If you want to make good pay as a paramedic, come work in Canada. Medics in the province of Alberta start at approx. $30/hr. Of course, this may be more of a move than youre willing to make. But, if you're interested check out this website... collegeofparamedics.org

Thats interesting. Ive been thinking for awhile now that we should take the "emergency" out of EMS, as true emergencies comprise a much smaller amount of our job than is perceived in the public.

No most crews dont do this. You're right, it is gross. Additionaly, I don't know why anyone would flip the sheet, as it takes about the same amount of effort to throw on a clean one. As for reporting them, thats a judgement call you'll have to make. Just remember, EMS is a smaller community than you think, and you have to choose your battles wisely.

I think that the matter of whether or not to sustain paralysis with pts on vecuronium would be somewhat of a moot point, as it should last for the duration of most trips to the hospital.