Just Plain Ruff

My first partner in EMS, Randy Bever RN was killed in a air ambulance crash last thursday, near Mosby Missouri. He was killed as well as the flight paramedic, the pilot and the unidentified patient. The news reports that the pilot radioed that he was going for fuel at a small airport and that was the last report from the helicopter. The next information they were getting was 911 calls regarding a helicopter crash near the airport. All were killed on impact. All in our extended EMS family are saddened by this loss of life. FAA investigators are working the crash. funeral for Randy will be this thursday at 11am I believe or it might be noon and funeral for the flight medic is at 10 am the same date. Ruff

who knows Mike, they occasionally have to do something that actually succeeds. Not often but occasionally.

Yeah, I was appalled at what happened at Waco. The assault by the FBI and others was a terrible one. I don't remember much more of the particulars as I wasn't paying much attention to the standoff. It was like the news today, same old same ole from the same old group of biased individuals. They only put out what they or the government wanted the public to hear. Why were there not any more interviews of those who got out prior to the fire? Because those in power didn't want us to know what really might have been going on there. When I saw the fire that morning, I knew that everyone in that compound was now dead and it was our government at thehands of the slaughter and I was disgusted with what I was seeing. hope that some got out quickly came to knowing they didn't. It was I think the most feasible and easiest way that our government had to get rid of the witnesses and those who could actually tell the truth. I think that this was the first time I had cried in a very long time. And we wonder why the government is not to be trusted.

I think a CSI episode had a club that had alcohol being misted from the ceiling. I also know of one medic who ran a patient from a house that had misting alcohol in one of the rooms. they had been warned about the alcohol being misted prior to entering the room so they had donned the air tanks. Patient was unresponsive due to the alcohol and drugs they had taken. Turned out there was also a meth lab in the basement. He wasn't told about it though. That was raided about 2 weeks later.

Actually those BS patients usually have medicaid or no insurance so they are NOT paying our bills. The people who actually pay your bills are the ones who can pay for your services, hence the ones who have insurance. My insurance is pretty damn good and we called 911 for my wifes first pregnancy and we were billed 930.00 of which insurance paid only 360 of it because we had not met our deductible yet. So I suspect that us paying almost 600.00 of that bill, which we did promptly paid for one medic and one EMT's salary for the day and the gas for the fire truck and ambulance. What a banner day for the service who transported us. We ended up using this particular cities ambulance service twice during the pregnancy and our the second trip was completely free to us because we had met our out of pocket maximum deductible. so honestly, most of the BS calls that you get are from uninsured/medicaid patients and do you honestly think that most of those people are going to pay the bill they get? I think now. I think the ambulance service I worked at last had a collection rate of about 38% or so based on the large numbers of uninsured/medicaid/medicare patients in our district.

Nope it isn't right. If a church or any other organization wants to build, they should be able to build, barring legal and regulatory restrictions.

I'm sure the sentiments are much appreciated.

Dang, those on this thread all need to get together and teach an airway class. Ch, where do I sign up to learn about newtonian gradiants and all that. I can't imagine how much I'd learn from you.

I don't know why she said it was this, but this comes from a highly respected endocrinologist who said that Diabetics seem to have a tendency for this syndrome. She asked me a lot of more indepth questions which I won't get into here, but her questioning was pretty thorough but just in case, next friday I get my cardiac stress test, maybe an echo and lots and lots of labs. Thank goodness for my family reaching our maximum out of pocket deductible already this year. Everything medical except for co-pays are paid for in full with nothing out of my pocket. That means that my wifes delivery will be FREEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!

So what do you think would be the ramifications of just resorting back to BLS/defib/pace with airway support and transporting? If medications haven't shown to improve outcomes then why do something that hasn't been proven to truly benefit patients. I have always wondered why in EMS we continue to do things the "old" way and not embraced evidence based items? Is it that it's always been done this way so we can't stop it because it would prove us wrong? or what?

Well I'd suspect that the leaders of the Church wouldn't act like buttheads and take the offer under serious consideration. But if they chose to turn it down I would respect their decision as they have the big picture in hand when I don't have that ability. If they started to ask for more money and that kind of crap I'd sure want answers from the church leadership. I am more than sure that many of our members would say "take the money and if you don't then we are leaving" but that's what would happen to many groups of non-religious basis as well, surely you can't dispute that can you? but seriously, what is a church or any organization of the size that we are talking about going to do with a building that is 10 times as big (or 5 times as big) if they don't have the members to fill it? I can say that my congregation would want the extras but like I have said, so would any organization. There will always be those who will demand more and more but I have to rely on our church leadership to temper the demands of the congregation with what is realistic. If they can't do that then I don't want to be a part of that church or organization. In all seriousness, my church has that many members but we have an entire wing of the old church that is sitting unused. I don't know what we'd do with that extra space. Our church is actually about 30000 square feet already so the comparison offer would have to be around 400K square foot to make your analogy be comparable.

"Do you think it would be a good idea to give a drug to someone that prevents platelet aggregation who has a dissection? I'll let you think it through." oooooooh!!!!!!!!!!!! I know this one but I won't spoil Crotchities thunder.

Before you start blaming the schools for being poor schools take a look at this report from the Cato Institute regarding the KC MO school district. During the 1990's a federal judge ruled that KC schools were horribly segregated and ordered them desegregated. Their budget for the school district rose from 120million a year to nearly 400 mil a year. It's a long read but it goes to show that if you provide exceptional facilities, try to bring in teachers with a higher salary and provide the best curriculum, the end result is a dismal failure. It's a very interesting read. Credit goes to the Cato Institute for this article http://www.cato.org/pubs/pas/pa-298.html

Dang Systemet, another great response. WE need to have a beer summit.

Systemet, excellent responses. I've learned a bit today.

Yep. Remember most instructors are teaching their friends and co-workers. I know this because I used to teach these classes. You name it I taught it, ACLS, PALS, NRP, ABLS, ITLS and others . I felt incredible pressure from the course organizers as well as the company that I worked for to pass these people. Some couldn't find their way out of a brown paper bag. You don't want to embarass your friends or co-workers by failing them but then again you don't really want to pass them when they fail. I know many instructors who have lost friends based on failing them in ACLS or PALS. Employers just want their employees to have that card, they really don't care how they get it. So peer pressure to pass your co-workers is very prevalent in these types of classes. I like the classes where they have a majority of people that I don't work with. I don't have the pressure from management to pass my co-workers. But I've never been one to pass someone I didn't feel like they should pass. It was well expected that no-one failed ACLS or PALS. Many of the courses I worked in, if I failed someone on a particular station, the faciliators would sit down with the student and do remediation. They would run them through a set of questions and then if they felt that the person needed to retake the station, they would do so but of course not with me but with a 2nd instructor to promote fairness(I am ok with that). 99.99999 percent of the time, that person would do fine, but the odd times that they would do not and I was retesting them, they would fail. The facilitator would remediate one more time and then the would miraculously Pass. Amazing. Again, NO one failed these classes. Failure to hold the students to a standard? I'm not sure. But a failure to patients, I do think so.

But that's what set's our good friend Crotchity apart from us. He has x-ray vision, clairvoyance and is the right hand of God. He has the power to heal by touch but also the power to smite thee in your boots if you disagree with what he knows. Thou has a feeble understanding of what's not in the books yet thou understanding of book learning is well renowned. Get back to thee tiny hovel and begin to pray at the altar of Crotchity "all knowing of things not in the book". We should not be worthy to even read the book LoneStar suggested that he write. The book may just strike us dead where we sit.

That's true AK, Our church says it has about 5000+ members. But on a normal sunday we might get around 900 on a really good sunday. Where are those other 4100 people? they are people who have joined but don't attend regularly, those who are shut ins and various other reasons. But they still are members none the less so they get counted. You can doubt the 70 family claim but since you nor I nor anyone else here knows for sure, that's all it is, a doubt.

ok, yep I did jump on it. Fair enough. Time to go do some reading. It's good you aren't partial to one particular side, good of you to remain objective. Off to search google now.

i had a patient presenting like a CVA one night. Left side paralysis, facial drooping, inability to speak. Did a blood sugar, it was 325. Called the helicopter for transport to the stroke center. Repeated the blood sugar and it was 300. Patient put in chopper, still critical, flight ensues. Patient getting worse, nearly causing intubation. Flight crew did repeat blood sugar about 5 minutes out from hospital and it was 40. they gave sugar and he perked right up. Wasted flight, maybe. But what the patients family didn't tell us is that his blood sugar was LOW on their meter and they pumped him full of a entire jar of grape jelly they told the flight crew. We were on the end of the grape jelly working, and by the time the last sugar had been checked the jelly had worn off. Based on my report I flew the guy, but I guess had I have waited 10 more minutes I would have seen the precipitous drop in his sugar as the jelly wore off. What the doctor in the ER said was that the patient's blood sugar had been propped up by the jelly that it was only a matter of time that it would have crashed again. He said the right decision based on presentation was to the stroke center. Hell the patient family didn't even bother to tell us they had given him jelly nor did they think it was important to relay that he was a diabetic. That's what pissed me off most. their leaving that information out cost the guy a 20K helicopter ride or some gawd awful amount.

I'm all for a nationally recognized test for hiring people. that way it's generic the whole country wide. The black's would have no reason to bitch and moan or claim racism because it's nationally and I'll bet all the court challenges would be settled prior to the test going nationally. The whites would have no reason to bitch and moan because the blacks were treated differently. No-one gets treated differently. hell, why not just make a statewide job applicant pool. Each applicant is trying to get the same type of job. have a nationally recognized test for applicants to take, then put those who passed the test into a pool and when a position opens up or open positions are available then they call those applicants who are on the list. the applicant can either say "yes I'll take the job or No I won't" they can even put down geographic preferences and if there are open positions at a department in lets say west missouri, the applicants on the list are called. those with geographic preferences that match the locale where the job is at are given calls first. That might not be fair on the location requirements. Maybe just call the person and say There's an opening in the KC MO fire department, are you interested. If they say yes, then they go on to the interview process and if they say no, then they are put at the bottom of the list. The test is given 1 time a year or once every 6 months in each state. Take the test or not, your call. But the only way to get hired on any fire department is to take the test. If you don't take the test, then you don't get on the list. the applicant pool is updated after each test. You may not get called at all or you might get called. You would be rated on how well you did on the test. sorry, the racism is out of the equation because the test had been vetted as non-racist in the courts or by specific experts in the field of testing, the test is determined to be the same in LA as it is in Minnesota and the same in Bangor Maine. Do you think that might solve the problem?

I only commented on what I heard today. If I had all the information that you have then i'd have posted that. Can I ask where you got your info from? I want to go back and read about this. i do agree that public money should not be spent on stuff like this. I did not know that it only served 70 families. See with the right info it's a different story. But what I do have a question is to why do you say that they are going to try to seize the money? I don't understand that comment. Care to clarify?

Might want to preface that funny photo's link with NOT appropriate for work.

The best instructor who I know of that epitomizes the crazy scenarios is Bob Page from Springfield Mo. Most will know him from his 12 lead courses. I had a guy with some obscure electrolyte imbalance that only a infusion of calcium and glucose would fix. Needless to say, the guy died because well, patient's just sometimes die.

What would you do Crotch? I for one would treat the patient with the ASA and the nitro. See how the nitro does. If the nitro didn't work, I'd work him up for Ebola or maybe Benign Essential tremors. I don't care really what the monitor or 12 lead says. I read somewhere that between 20 and 30% of all heart attacks don't actually show up with the classic elevation and depression on the 12 lead. my figures might be a bit off though.