Just Plain Ruff

I agree Herbie. I won't bash him either and I hope that's not how my original post came off. But I also agree that IO's are for the patient that is eitehr crashing or going there. A unresponsive person would not warrant a IO without some additional criteria being met at least to me that is. The generic response would be 3 iv attempts and then IO is a rule to stick to most of the time. If I have a critical patient and I cannot get an IV in the AC or the EJ the first time then IO is the way to go. I prefer the EZ IO drill. You can drop an IO with that device in less than 10 seconds from start of the drill to hooking up the line. one thing to remember with those is to make sure you choose the correct needle size. Nothing worse than choosing a long needle and drilling all the way into the other side of the bone. Fluid definately does not flow then and it does cause tremendous pain in trying to flush the fluid into the bone and not the marrow space. I speak from experience here on this. Trust me. As long as you get the right size needle then you are golden most of the time. Taking out the IO needle I found causes more pain than putting it in if you use the drill or it may just be that when I've taken the IO out the patient was conscious and when I put it in the patient was unconscious.

remember, I said that most of the class were people who were not interested in a EMS career. They had no incentive to really do anything but come to class and flirt/hookup, plus they were sometimes the ones who wanted to play victim when patient assessment came around. The ones who really were flagrant about getting together after class were the married housewives. When class started we had 48 people in it. At the end of class we had 19 people sit for the state test. All the rest had either dropped out or just decided not to take the state test for the above reasons. It was one of the most fun classes I have taken. I was going to UMKC in KC Mo for my bachelors degree and took the EMT class on the side. I knew what I wanted to do but my parents who were paying for my schooling made me promise I'd get my bachelors before I started working on the ambulance. Smart parents.

Welcome to the lot of you. Good luck in school I can attest to Dwayne's progress. When he came here about 2 years or so ago, maybe longer, the days just meld together for me, he definately was one of those people who you roll your eyes and say "Oh my, not another know it all newbie" Well all kidding aside, Dwayne has become one of the most accomplished medics on this forum that we have. I think sometimes he has taken Dust's place and I have surely been humbled and maddened by his logic and thought processes. I do believe in this site. I believe that someone who wants to learn more than just what is taught in their medic or EMT class can come here, ask a question and get a dozen different answers, most of them right, to their question. It is then the questioner's responsibility to go out and take what he read on this site and compare it to what he is learning and either ignore it out of hand (sometimes a good thing) or take that information and incorporate it into their knowledge base and then share that information with someone else who was in their shoes. It is up to the new user of this forum to be honest and open in their questions. If you make a mistake and you think others can learn from it, then why not post it and get a discussion going. If you learned something in class that you think this forum will benefit from, then by all means post it, you may get more information than you bargained for. We have all kinds here, fire, EMS, hospital, icu, doctors, whackers, vollies, first responders, lurkers and trolls and all have their place. Come here and learn learn learn. Don't be a bump on the log and not post. There are enough of those people in the user rolls already that have joined and then never post. This site will PISS YOU OFF big time at times, but at other times you will say "WOW I DIDN"T KNOW THAT" and that is what keeps me coming back for more. Take Care Ruff

my EMT class was just like that. You wouldn't believe. Almost half the class hooked up with someone before the class was over. Hell, even the instructor hooked up with one of the students, but they may have been dating prior to class starting, I don't know. I even hooked up with a couple of the girls there. Many of these students were not planning on going on to EMS careers, they were housewives and single women looking for a fun class and even more fun outside of class. it was definately a fun and exciting class to have been in. My medic class was much more subdued with only one or two couples resulting out of 65 people. Even one of those couples ended up getting married.

I think this is open to debate IV versus IO but in my opinion, one of the only reasons why I'll drop an IO is if I cannot get a peripheral be it AC, hand, EJ or what not. IO's are perfectly acceptable but they are pretty brutal and most ER's are not used to seeing IO's in adults so they are not widely used where I work. I have put in maybe 3 or 4 since the beginning of the year. If the medic didn't search for a peripheral site (and I'm not saying that he did or did not) then I think the IO was overboard. But if he did search and didn't find a peripheral, and we all know that Heroin addicts usually have Zero veins, then the IO was appropriate. Now the dark side of me wants to think that the medic did this just because he could and because he might have wanted to teach that girl a lesson. If that's the case then shame on him but I do know several medics who would do just that so this thought process of mine is not based on mere conjecture. I think we definately need more information before we go and truly pass judgement on this medic.

I find that Screaming loudly at the top of my lungs prior to entering a scene rendered safe by PD is a way to let them know I'm coming and I'm no one to be messed with. Sort of like the battle cry of the ambulance service. but seriously I don't think I have many annoying habits (my wife can probably find a couple) but one of the most obvious is I chew my fingernails. NASTY Habit but hey, it's a nervous habit. I only chew them after I've washed my hands.

Herbie, this is where I think you might be wrong. Big pharm and big insurance are just the groups that I think will be targeted in the next phase. Big pharm is hated so what better than to take them over and put them under the government. Besides, government always makes things better not worse right? Insurance carriers - hated too because Obama made that abundantly clear. Who better to save us from big insurance than the government and once they get rid of big insurance the government becomes the defacto saviour of the country because they are now in the insurance business and surely that's better than the free market system and capitalism right? Once the takeover of insurance is complete (think the borg) we will be dependent upon the government for insurance just like I am now dependent on the government to get a student loan. Can't get a private student loan anymore - that's not possible unless you want to pay 8-13% interest or more through a private lender.

Herbie, I'll tell you who will foot the bill for the new drugs and new treatment procedures that are so desperately needed. it will be the american people who will foot the bill. The government will restrict the R&D ROI (research and development Return on investment) by decreasing the amount paid for each procedure to the point where the returns do not justify the means no matter how many people it will affect. The the government can come in and say Roche or Bayer or Teva are too big to fail so they will pump in billions into their operations, require repayment or just absorption into the government and it will no longer be Roche but Government Roche pharmaceuticals. So now the tax payer will be saddeled with even more debt. Why is it that I can't get help with my mortgage but the mortgage company can get help with it's problems. They get bailed out yet I fall deeper in debt and farther behind. No wonder why it's such a vicious political campaign season this year.

Right on Dwayne, yes we don't see the original cost to the manufacturer of getting it right. Consider that to bring a new drug to market it may cost of upwards of 250-500 million dollars. They got to recoup their costs somehow and that cost goes to the consumer. I agree that healthcare is broke and going to get much worse over the next years unless something is done differently and I don't mean this healthcare bill. Here is some info I got from the provider of my HSA or flex spend account. Every over the counter medication such as cold remedies, tylenol, aspirin, and many other items that you used to be able to put on your HSA card or get reimbursed for will not be paid for without a prescription. So what the feds have done now is to force you to go to your doctor to get a prescription for an over the counter drug. So now you need to call or visit your doctor to get that bottle of tylenol to be covered under the HSA plans. In addition, they have now put an extra workload on the already overworked doctors and if your doctor is like mine he has precious few open appointment slots, I am going to have to wait to get that tylenol covered. What freaking idiot thought this one through. There are bound to be more of these types of Gotcha's in the coming months. My advice to anyone who has a HSA or flex account is to make an appointment with your doctor and have a list of medications (over the counter) that you think you might need. Then have your doctor write a script out for each of those medications. Keep those scripts in a safe place in your house and then when you go to buy one of the medications on your list, you will have the script for it. Make sure you get pleny of refills on the script or you will have to go back to your doctor to get another one thus clogging up his office for this Silly and stupid new requirement. How is universal health care going to reduce our costs when we have to jump through hoops like this?

According to the local news station in Atlanta the independent investigatin has recommended termination of the fire fighter and others involved that night. Here is the story. http://www.cbsatlanta.com/news/25531607/detail.html What I read in the story that surprised me the most was this quote - The report contains information, not just about the incident of July 17, but also about the culture and things in the fire department that may have created a situation where taking this video and releasing it seemed acceptable to the people involved,” said Martin. The firefighters name who took the cell phone video is Terrence Reid. Based on the quote above, it makes me wonder just how many other videos are out there from this group of firefighters? How many loved ones are forever immortalized on video when those taking the video shouldn't be? Mr Reid if you are on this site, SHAME on YOU! You are exactly what the public dislikes about public safety personnel. You need to apologize to the family and then find a job at mcdonalds or hardees. EMS/fire service doesn't need you anymore. You are the weakest link - goodbye and good riddance So how many people think the union will stick up for this guy and oppose his firing?

i found that writing them out was the best way to do it. One other thing - put post it notes on the areas in the house that you most frequent. Bathroom, kitchen, stove, sink, doors etc etc on each post it note put a drug name When you get to that area in the house and see the drug listed - recite your drug card. Put a hash mark down and when you hit 5 hashmarks then exchange that postit note for a new drug post it note. Rinse repeat

I have to weigh in here. I'm happily married for 16 years. I've been in EMS longer but. I have had opportunities off and on and always chose the high road. I think that someone above said it truly - for every cheating EMS'r, there is at least 1 if not two non-cheating people. I don't believe it's all that prevalent. Sure there are those in particular agencies that are married and who screw anything that walks but since most EMS Agencies are staffed by less than 20-30 people, I'd say that the cheaters are in the minority. But I could be wrong. So let's take my line of work as I do it now. I travel for work. I have many many travelling companions and colleagues. Most are married. Some are not. I know that all I have to do is go to the hotel bar and I will find another traveller there either having dinner or drinking. You can always tell the travelling consultants and sales people. they are the ones eating in the hotel restaurant or the bar alone. I have struck up conversations with some of them and I'm usually right. Have I had opportunity to stray, sure have. More than once but I don't but I know many many who have. Both of our lines of work, travelling consultant and EMS have one thing in common when it comes to opportunity to cheat. OPPORTUNITY Away from home, privacy (hotel room or crew quarters), the risk of getting caught by the spouse is negligible because most spouses don't travel or work with their mates. Other items in common are loneliness and just the thrill of the chase. Seriously, if you cannot keep it in your pants for 24 hours or until you get back to your spouse then should you really be married? I also meant to add, I don't think that our rate of infidelity is more than the general public. In EMS, we are all a very close knit group so when two people cheat then that gets around to everyone. In a service of 20-30 people, just a couple of people cheating would make it look like a big problem when it really isn't any bigger of a problem than the general public. Take the television shows that show EMS, Firefighters, Cops, nurses, and doctors as sex starved maniacs and you can see where the public get's their opinions. But I would venture to go out on a limb here and put this question to you all In your neighborhood - is there more infidelity occurring in the 10 block radius of where you live or more infidelity going on in your local ambulance service? thoughts?

This is sad.

That's true but I made a little investigation and I called said lab company. I asked them what the cash cost of the 1974.00 test would be to me if I paid cash on the day of the test. They told me 1200.00 and some change. So the cash discount for that particular test was not bad. It makes me wonder what we are to expect from this health insurance overhaul/takeover. The "cost" of the tests I'll bet won't change but I'll bet that there won't be much in negotiated costs changing. But I'll bet that those without insurance who choose to pay cash will be hit with the entire amount due not the cash price above of 1200.00 But seriously, the question I have is this. Does it really cost 1974.00 to do a lab test? Or does it truly cost 27000 to get genetic testing done? I'm sort of thinking that it doesn't cost that much. If the provider writes off a significant amount then you can bet it doesn't even cost what the remainder due is. Just my thoughts.

ok, I had some pretty significant lab tests done over the past couple of months. Just got the insurance notification of payment. Total cost of tests billed to the insurance company - about 4200.00 The lab company wrote off 3600.00 of the tests due to a provider contractual agreement My insurance then kicked in and paid 530.00 of the remaining bill leaving me with a total bill to the lab company of 70.00 and some change. The question I have is this, if the lab company writes off 3600.00 of the bill just how much does the test really cost? One test in particular was 1974.00 and they wrote off the entire 1974 dollars. Did the test really truly cost 1974 or is this just the markup on the test. What makes me so pissed off at things like this is that if I didn't have insurance, I would be responsible for the entire 4200.00 bill. I'm just venting on this as I was without insurance about 1 year ago and the bills from that period of time were high. I'm still paying for the tests run back then. No wonder why the US has the highest cost of health insurance around. Venting over. but seriously 1974.00 for a single lab test. And when our baby was stillborn we had a genetic test done on the baby and my wife and that bill came to around $27000.00 for a battery of about 35 tests. Insurance covered all of that by contractual write off's and provider discounts and our co-pay and our reaching our out of pocket maximum. I know you buy insurance to mitigate your risk but aren't you just spreading that risk and cost around to those less fortunate than you?

Let's remember, safety first. Protect yourself. The eyes are great vecters for the passage of communicable diseases if you are exposed. Just go and take a look at your sclera in the mirror. See all those little blood vessels in there. It's easy for an organism to get through the thin lining of those vessels. Why do you think we ask a person with a scratch on their eye or a foreign body in the eye if they are current on their tetanus status? Certainly not for our health. I always wear a pair of goggles and if there is one available I put a full clear face shield on. Consider what Dwayne said as the Truth. Do an experiment On your next intubation - put on a pair of goggles. On your next intubation after that, put on a full face shield. Compare the two. you will see a big difference. And for the comment of a person coding not having a gag reflex - I disagree. A full arrest might not have one but someone who it coding will still have a gag reflex and often will gag and fine small droplets will fly out of their mouths. It's not the full arrests you need the face shield on(of course every patient you intubate you should wear protection) but it's the ones not to that point that you need the facial protection on. The drug overdoses, the trauma codes with all the blood and brain matter that comes with the territory and a myriad of other scenarios that we can all think of. When in doubt - cover yourself.

Richard, this was at a mosh pit. I think that completely answers the question of why they didn't transport the person involved. If a patient doesn't respond to the first ammonia inhalant, I'm not about to say "Dum de dum dum, maybe if one isn't good enough, the two'll do the trick" If you don't respond to the first inhalant then you are too out of it to not go to the ER so your butt is on my gurney and on the way to the hospital.

What is your budget? You can stay in my hotel room if that will help you. I'm flying in Wednesday night and leaving friday morning. I'm finding flights for around 250-280 roundtrip.

Yes, I have trouble with the editor and formatting also. I usually just do it in word and then paste it.

I wasn't meaning to be funny but honest. I don't remember this person so how can I be upset that they are gone again? Honestly, I don't remember many on this forum who have left. Some I truly miss. But there a shitload of members on this site. I don't remember 99% of them because some sign up and then never post. But I wasn't trying to be mean with my comment, but honest. Plus, aren't you the one who keeps saying that this forum has gone back to the "touchy feely" thing?

Honestly Dwanye, there's nothing in the back of an ambulance that is said that is covered by HIPAA except what you said. I wholeheartedly agree on that. I also agree that there are things that are said in the back of an ambulance that i can comfortably relay to my wife and co-workers. For example - patient is a ww1 vet or a veteran and he tells me of all his escapades while over in Europe fighting, I'm going to tell others about those stories. It's a fine line in what to tell again and what not. I would think that this rule would be appropriate to follow: If it pertains to his treatment then don't repeat unless repeating to someone involved in his current care. If it has nothing to do with the treatement and his illness then it can be shared. I for one don't share much about who I treat and transport but there are some things that I will share. If we take the hard line and say we share nothing that goes on inside the ambulance and sharing that information is steadfast wrong - then how would you address the issue regarding an unsafe scene be it unsafe stairs or knives or guns lying around the house. Somewhere the playing devils advocate got lost in the threads. I beleive the devils advocate was in response to my first post I would definately report this guy to my crews. I think I clarified my statements in a subsequent post The sneaky spitter is a safety hazard to my co-workers so I'm going to tell them about this guy. This is not protected patient information and it lends itself to keeping me and my co-workers safe. As far as I'm concerned privacy laws don't cover this aspect. If my safety is in danger I'll let my crews know the danger. Be it rickety stairs, sneaky spitters, guns and knives in the house or a mean dog. I don't think, but I could be wrong, that this guy spitting on me is covered under HIPAA or Privacy laws. If someone spit on me and said "I'm sorry I was in a bad place when I did that" and then he spit again, well the police are going to be waiting on this patient when we got to the hospital. I'm going to put a mask on him or on me to keep him from spitting on anyone else. He's proven to me that he cannot be trusted and my safety is more important that him getting a nice comfortable ride.

The only thing you should be talking to anyone regarding a patient is the caregivers taking over patient care from you. If you tell anyone else anything really about that patient then you have violated the patients privacy and may have committed that all too often cited Hipaa violation. The only thing I would tell anyone about my patient is to a law enforcement officer or a child/elder neglect hotline that I thought was a problem. If there is a danger to the public from the patient then you are obligated to report that but like the others said. If the patient says "I play with dolls while I'm naked" or something like that, keep that private and don't spread it around. When in doubt, don't tell.

So, Who from this site is going to this? Can I have a show of hands for The 9th?

You know, Rant aside I cannot believe God is allowing all this bad stuff to happen to Ms. Krasny. He's a terrible God I guess But seriously, God is free to talk with, all you have to do is sit down in a quiet place and talk to him. That's a freebie, get it. Plus, the last couple times I was looking there was nobody in chat. One other thing, At the bottom of the screen is a Who's Online. I can click on whoever is online and begin chatting with them. Simple and the best thing is that this is FREE!!!!!!!!!!!!! Sure chat has a charge but to chat between two people Like I do quite a bit with Spenac is totally and completely free. Don't go but if you do, I'm sure not going to miss you because well to tell you the truth, I didn't realize you were gone.

Dang Dwayne, we are agreeing on a whole lot of things these days. I'd like to bury the hatchet. I to think that the argument that Dina makes is ludicrous and impossible to follow.