CBEMT

In the case of the Columbine shooting, it seems that ALL of the weapons involved were purchased legally, but with the sole intent of being provided (illegally) to the perpetrators. I believe the purchaser went to prison for that. In the West Paducah, Kentucky school shooting (prior to Columbine), ALL of the guns used were stolen- including shotguns that were taken from a locked case. Your open-mindedness is inspiring. :roll: My actions? Are you stalking me now? I hope I never shoot anybody. The one person I know who has done so outside of military service was a police officer, wound up quitting the force after that. I would imagine, then, that is is a fairly stressful event- even if you save lives in doing so, as he did. I honestly hope I never have to go through it. But I'd much rather be prepared for the evenuality with more than just good feelings. It's the same reason we bring jump bags, monitors, etc into scenes when we often don't use them- we'd rather have it and not need it than need it and not have it. Oh. I'm not a gun owner, for the record.

OVB I feel your pain. The first SOB patient I ever had as an ALS provider was much like this, with a similar result. The only differences were his pressure was much lower but he had the classic CHF rales that you could hear down the hall. I had seen many CHF patients as a Basic, and this one was screaming CHF at me. No history that would've normally pointed me towards failure, but I went there anyway. To my credit though, so did the ER MD. I had given and 40mg lasix enroute and the doc ordered another 80 before he was even off our stretcher, followed later by CPAP, which the patient was less than compliant with. I followed up several days later (with the ER MD), and found out that the DX was in fact pneumonia. ERDoc- in my case, with an assessment seems most likely pneumonia with a low pressure (90's) would a fluid bolus be something to consider, or do we want to avoid that and just try to maintain him as is? I ask because many of the pneumonia patients I tend to see are on their way downhill towards fullblown sepsis, and once I'm satisfied that it's not CHF I'd like to be able to do something for them, but I've been hesitant with fluids do to everything they've already got going on. Plus, on occasion, there is still the nagging doubt of whether it IS CHF or not. I have gotten 200x better at differentiating though.

Backasswards Northeastern state which shall remain nameless. EMT-A(mbulance)- No longer issued. The original basic level before the NREMT, phased out in 1995. Anyone who still has an A license keeps the designation but refreshes with a DOT standard EMT-B refresher course. EMT-B(asic)- NREMT certification for licensure, DOT standard refresher to maintain. NREMT maintenance not required. EMT-I(intermediate)- No longer issued. Phased out in the early 80's I think. Skill set, as I've been told, was IV access and Epi 1:10,000. Like the EMT-A, anyone with an I license maintains the designation but refreshes with the DOT standard EMT-B course. Very rare to find someone with an I license that didn't either drop down to EMT-A or step up to EMT-C. I only know one myself. EMT-D(efibrillation)- optional skill level for As or Bs. Consists solely of VF/VT rhythm recognition and manual defibrillation of pulseless VF/VT, as opposed to auto or semi-auto AED deployment. Uncommon but they are out there. EMT-C(ardiac)- created under pressure from cities and towns who wanted to be able to claim ALS services to their community but didn't want to pay for paramedic school or have to wait for the personnel to finish. Pretty much the standard level of care, results in very, very few BLS emergency responses due to how widespread they are. IV (no EJ), manual defib (no pacing), cardioversion, oral ETI, 30 meds including narcs. May initiate Dopamine and Lidocaine drips with MC, may transport if already established. BLS refresher plus 24 additional state-designed hours. May initiate Dopamine and Lidocaine drips with MC, may transport if already established. EMT-P(aramedic)- NREMT-P for initial licensure, must maintain it as well. Standard Paramedic skills up to and including pacing, NG/OG, nasal ETI, central lines, needle/surgical cric, etc. Several meds and infusions on standing order that EMT-Cs must make MC contact for (Dope, Lido, Amiodarone, etc). May transport Heparin/NTG/etc drips without a nurse after an additional IV pump/anticoag training class after licensure (pretty much required by your employer if you work for a commercial service. Without a pump card you're basically no better than a Cardiac to management, depending where you work). Screwed up for the moment, but I think there's a light at the end of the tunnel. I wouldn't be surprised if EMT-D is the next to go, and the remaining A's and I's are coming up to retirement age. I figure EMT-C has another 10-15 years of life left before the state grows a pair, cuts the cord, and grandfathers whoever's left. That'll be a hell of a battle though- you'll see the fire unions combine forces with their city and town governments to fight that one aaaaaall the way. I am, however, starting to notice a trend of people getting their C licenses, practicing for a couple of years, and then going medic, usually while working for a commercial service. Typical career paths here are Basic--->Cardiac--->Fire Department, Basic-->Cardiac-->RN/PA, or Basic/Cardiac-->Paramedic-->leave the state/work out of state.

VA's probably just north enough that $12/hour is not generally a great idea. Bus it is southerly enough that with the cost of living, a single kid with no dependants might be able to pull it off. Either way, it's a damn sight more than medics make in some areas, even today.

Neither do we. But in typical European fashion, you assume that this is what gun owners do. So have Americans, because that's what the government wants- citizens to be dependant on them. The dirty little secret is, they can't protect you. Personal Responsibility. "Know it. Learn it. Live it."

Me to- a sawed-off is illegal. Duh. No, that's NOT what you said. You said that if I scare a criminal with a weapon, I'm committing a crime, which is so laughable that I almost didn't respond to you because you clearly aren't going to be able to grasp the concepts we're talking about. Which is NOT WHAT YOU SAID. Stop being such a typical liberal and changing the goalposts everytime you get proven wrong. I'll also ask you to stop thinking so little of my intelligence that I can't tell the difference between two makeout artists and a woman being raped. Typical elitist... Who said anything about cleaning up the streets? God, you really DO think gun owners are out every day looking to shoot somebody don't you? Could you BE anymore self-righteous? More assumptions and elitism.... They build roads just fine. It's my life I don't trust them with. Yeah, you're just smarter than everyone, aren't you.

In many cases no, they are not. Ever see the YouTube video of the police officer accidently shooting himself in the leg in front of a room full of schoolchildren? If I didn't have a gun and lived in that town, I would've bought one before the end of the day. There's a thousand other examples, including the TV crew that followed two New Orleans PD officers looting a Wal-Mart during Katrina. Even if your police ARE trustworthy, the very principle they operate under on a daily basis is that they RESPOND to crimes. Sorry, I'd rather defend myself than wait for the cops to show up, especially in the cities. I don't have time to wait for someone to call 911, the state E-911 operator to determine the location and type of emergency, pass the caller onto the PD calltaker, who has to hear the whole story again, doublecheck the location, pass the info on to a dispatcher, who has to find the closest unit, who then has to come from who knows where. Meanwhile, I was dead 5 minutes ago. No thanks. Europeans also tend to have the Eurpean mindset- The Government Will Provide. It isn't like that here, yet. Lord knows the Democrats are trying, though...

"Pt t/p from ABC Hospital ---> XYZ nh for rehab p tx of fx R hip c repair. T/p via stretcher s incidents or [change], care left c medical staff. " Which is actually about twice as much as my company wants. Emergency runs, they get something between what you wrote and what scratrat wrote. Ummmm.....

Hmm... without a knowledge of what fungu fish was at the time the patient was presented to them, I'd say most providers around here would probably throw the Anaphlyaxis protocol at him (Epi, more epi, Benadryl, and Solu-Cortef), while preparing to manage the airway.

One interesting point someone raised to me in another forum is that the KED, as designed, was intended for vertical extraction of racecar drivers, F1 I believe. Could explain some of the trouble people have applying the device and then pivoting the patient out the door...

Peter Canning seems to have the right idea, hopefully fiznat will learn from it. Change days, time of day, change genders even, and if necessary file it away and post it a few weeks/months later. Most EMS bloggers tend to post about interesting calls right away, which can lead to trouble.

You've got a good point, for once. If more crime victims start shooting to kill instead of just producing the weapn to scare the crook off, we might actually start getting somewhere. Oh MAN this is the funniest thing I've read all week. "Officer, that lady put me in fear of my life with her gun! I want her arrested!" "Welp, if you hadn't been trying to rape her at the time, d'ya think she would've pulled the gun on you?" Not even cops are dumb enough to arrest someone who uses a gun to scare off a criminal. Not even Massachusetts cops.

Umm... I don't get it.

I've never actively protested against anything in my life, but that would be enough to get me on a street corner with a sign.

Competing company bought a small flotilla's worth, apparently the crews hate em. I'll try to find out why.

Anything that's missing, I write in big bold letters at the top of our checksheet which is handed into the supervisor before I take my first run. What happens after that depends on which supervisor it is (some don't even read the checksheets), and which crew are the miscreants (ie favoritism). I've been written up for forgetting to gas up my truck at the end of a shift a few years back, but when I report a used IV needle left on the bench seat, nothing happens. Running over a brand-new stepstool with a wheelchair vain, however, will buy you an immediate suspension, even with no disciplinary history. My other policy is to make sure that I tell as many people as possible who the scofflaws are. As for hitting the streets with stuff missing, there is no recorse for me to get out of a run even when I'm not done with my check yet. In the old days, if something was missing I was told to just get it from a hospital later. "Ok, so what happens when I need it before I get to a hospital?" *blank stare* Another trend of the Bad Old Days was: "I need gloves." "Take them from a hospital like everybody else." "So, on these two dialysis runs I just got, I'm supposed to do.... what." "Use the nursing home's gloves." Nowadays, as long as you get to the main station before the one guy with keys to the supply room leaves for the day, you can get whatever you need. If you have the kind of day where you get a run handed to you along with your keys and don't see the station until the end of shift, you either steal or pray that you won't need whatever you have. One thing I've proven is that you can write up the same dead portable suction on the same truck for 3 months and nothing will happen. The state inspector never tries to turn it on, so as long as it sits there taking up space it's all good.

As long as you're doing your job, that would never happen here.

"I don't care who ya are, that's funny right there.

I've got facts, what do you have? 44,000 to 98,000 Americans die each year not from the medical conditions they checked in with, but from preventable medical errors. Doctors are a preventable medical problem that guns could never dream of being! http://www.fda.gov/fdac/features/2000/500_err.html But we should stick to the topic. I just find that one fun. Analyzing county level data for the entire United States from 1977 to 2000, we find annual reductions in murder rates between 1.5 and 2.3 percent for each additional year that a right-to-carry law is in effect. For the first five years that such a law is in effect, the total benefit from reduced crimes usually ranges between about $2 billion and $3 billion per year. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=372361 Guns used 2.5 million times a year in self-defense. Law-abiding citizens use guns to defend themselves against criminals as many as 2.5 million times every year -- or about 6,850 times a day.1 This means that each year, firearms are used more than 80 times more often to protect the lives of honest citizens than to take lives.2 1 Gary Kleck and Marc Gertz, "Armed Resistance to Crime: The Prevalence and Nature of Self-Defense With a Gun," 86 The Journal of Criminal Law and Criminology, Northwestern University School of Law, 1 (Fall 1995):164. 2 According to the National Safety Council, the total number of gun deaths (by accidents, suicides and homicides) account for less than 30,000 deaths per year. See Injury Facts, published yearly by the National Safety Council, Itasca, Illinois. During the first fifteen years that the Florida law was in effect, alligator attacks outpaced the number of crimes committed by carry holders by a 229 to 155 margin. And even the 155 "crimes" committed by concealed carry permit holders are somewhat misleading as most of these infractions resulted from Floridians who accidentally carried their firearms into restricted areas, such as an airport. John R. Lott, Jr., "Right to carry would disprove horror stories," Kansas City Star, (July 12, 2003). Armed citizens kill more crooks than do the police. Citizens shoot and kill at least twice as many criminals as police do every year (1,527 to 606). And readers of Newsweek learned that "only 2 percent of civilian shootings involved an innocent person mistakenly identified as a criminal. The 'error rate' for the police, however, was 11 percent, more than five times as high." Kleck, Point Blank: Guns and Violence in America, (1991):111-116, 148. George F. Will, "Are We 'a Nation of Cowards'?," Newsweek (15 November 1993):93. "What we can say with some confidence is that allowing more people to carry guns does not cause an increase in crime. In Florida, where 315,000 permits have been issued, there are only five known instances of violent gun crime by a person with a permit. This makes a permit-holding Floridian the cream of the crop of law-abiding citizens, 840 times less likely to commit a violent firearm crime than a randomly selected Floridian without a permit." http://www.davekopel.com/2A/OpEds/More_Per..._Less_Crime.htm Citizen Self-Defense Blog http://www.claytoncramer.com/gundefenseblog/blogger.html Anecdotal evidence technically, but I thought you'd like to see some examples outside of statistical studies. Even so, such media reports are extremely rare: Outgunned: How the Network News Media Are Spinning the Gun Control Debate I've got plenty more, but you get the idea. Not that I expect to sway you one bit- those who yell the loudest about being open-minded usually aren't.

When you constantly deal with people who use use use and don't replace, you do what you have to do. The hospital will get them back in short order, don't worry about that. It all evens out in the end. It's a SHEET for god's sake. When I walk out with a thorocotomy tray, a monitor, and the linen cart the sheet came from, you can accuse me of a crime. Until then, keep your goody two shoes on your own feet. Only time I ever saw knew somebody to really overdo it is when I was checking my truck one morning and a coworker approaches me. "Hey listen, if you happen to use your pulse-ox today going to XYZ Hospital... umm, I would suggest you leave the pulse-ox in the truck when you get there." *headdesk*

Ah, a real dye-in-the-wool gun-grabber shows his true, however uneducated, stripes. Citizens with guns prevent or stop crimes every day, all over this country. Your personal issues with guns don't make this any less true.

No kidding. :twisted:

Sorry Doc, I guess I should've provided context for my statement. Basically I (like the general public, even if I'm more in-tune with the goings on than they tend to be), have to go one what I see. When I see patients in "Critical Care" rooms at the ER for upwards of 6/8/more hours when I know there's beds upstairs, it does make you wonder. I know that ERs often board patients during cruch times, but when there's beds waiting and it's 8 hours later, it can't possibly be an emergency anymore. The scans HAVE to be done by then, and not even the lab on "ER" takes that long to return results. There has to be a point where you can say "Ok, they're stable, we know there's nothing we didn't check for, the unit can do the rest." Isn't there? I mean, if I'm wrong tell me. I've taken patients home directly from the CC room. If it's been decided that they're going home, get them the hell out of the trauma room! They're literally taking up space at that point.

He either doesn't get much business, or doesn't charge much. Both of which could be for a number of reasons. Ah yes. The very thing that causes sky-high healthcare costs, being encouraged by a hospital. THAT, I tend to believe without question.

So wait- I'm supposed to keep track of which one-time use supplies came from which hospital? I only do that with IV drip sets, for reasons stated previously. Otherwise, it can't possibly matter that the sheet and blanket I got from hospital A get used on a patient going to hospital B. Same reason I got a Mass General sheet at a hospital 60 miles away. It happens.