Just Plain Ruff

Like I said I didn't completely agree with Dr. Laura's statement. What I was trying to say is that if you have a child or twins that your focus should be on them. Can you make it work with working and raising them - yes, I see it done every day. Is that the optimum choice or alternative? No I don't believe so. I have the luxury of allowing my wife to stay at home based on the salary I make. She has been a stay at home mom for over 5 years and she loves it. I feel that my son and daughter are getting the best of both worlds. A stay at home mommy and a dad who is there enough for them at times when it counts. The mother I believe is the best person to raise the child. What I do not like to see is two parents working and then contracting out the caregiving of the child to either a nanny or a daycare. Considering how much daycare costs in some parts of the country it is often more financially prudent for the dad to work two jobs and allow the wife to stay home. I saw some figures on that just the other day and if I can find them I will post them. Do I think that the original poster is a bad parent for working and raising the children NO I don't. I think it can be done but in my opinion the optimum result would be for the mom to stay home and dad to work. Can that be done with everyone nope. I hope that clarified my thoughts a little more.

Hey Doc, is the Doubletree Inn downtown a nice hotel and in a nice location? I have a chance to get a room there for 64.00 or so per night so I want to jump on it if I can.

Dwayne, I don't have the story but it's in the main section of the usa today. I would do the same thing that you would have done if I got a video like that. This is a story that will have long reaching consequences for cell phone usage while on duty. Personally I think that we should be able to carry them to have contact between us and our loved ones. but get caught with a phone taking a picture and no questions asked - you are fired. This is a terrible violation of patient privacy. I think this guy should be fired and then taken out back and beaten senseless And a note to this yahoo if you are on this site, you are scum and a fucking asshole for doing what you did. I might add one more thing. It is not believed that this video was sent to the family intentionally cause them pain, it is believed that this video was sent to the father as a "hey, just to let you know, this is what's out there" The dad who was interviewed this morning said he was not mad at the person who sent it to him, he was angry at the person taking the video.

An article in the USA today as well as seen on the morning news this morning here is the jist of the story Spalding County, Georgia Fatal crash scene A fire fighter took a cell phone video of a young woman who was involved in a fatal crash - she was supposedly not dead yet according to the story on the news this morning, but she did die very shortly after the video was taken. He then shared the video with other fire fighters and patrons of a local bar. The video was then sent to the father of the girl killed. Just what was that fire fighter thinking. The father of the girl is now considering a lawsuit and this news article has gone national.

I'll be blunt, if someone else is raising your child than that to me is unacceptable and can jeopardize the child in the future. You cannot do it all. You have to have priorities. If you choose to have the child then it's your responsibility to take care of the child and not let another person play mommie. I have many many friends who were raised either in Daycare or babysitters and they tell me that what they realize now that they missed was not having their mom and dad their to raise them. It leaves a hole in their lives. Dr. Laura has it partially right (and I don't agree with Dr. Laura about many things) If you are going to have a child then you need to focus on that child or children 100% and not work) Do not crucify me for agreeing with or bringing dr laura into the discussion. There is no substitute for a parent's role in a childs first couple of years. Why can't you hire some additional people to run your service? Where is your husband, or childs father in all this?

Sad sad sad. Prayers and thoughts to the families of the victims. Please be safe out there. Goes to show it can happen in an instant.

I just registered for December 9. Have my flight already picked out. If anyone needs to carpool I'll have a rental. I fly into Columbus BeORP give me a private message or email me at ruffems@gmail.com I'd like to chat with you.

When I first started out in EMS I had a hard time differntiating from the fakers to the non. I used ammonia on a number of patients but my BS Detector got better and my assessment skills got better to the point where ammonia wasn't needed anymore. I personally know a ER doc who dug several ammonia caps out of the nasal passages of a very drunk unconscious woman. In the end he said she had to have reconstructive surgery on her septum and nasal passages because of the ammonia burns and infections. I think a quick use of ammonia for those who you think are faking is warranted and appropriate at times but if no response then treat appropriately. That's the bottom line here, use your mind, your tools and your gut and treat appropriately and never ever delay treatment.

Don't you have google over there? I think you are going about this the wrong way. Middleware isn't just a single aspect in computers but it is something that is firmly entrenched in a data application/system architecture. An EMS forum is not the place to be asking for this type of help. But I already pointed that out to you on your previous post and although I know you want to learn this stuff, wouldn't going to university or higher education be better than learning it on your own. It's my understanding that in India which I believe you posted you were from, has a much better framework and educational system to help you do this than this website to help you. I hope you heed the advice given and look more towards schooling rather than learning it on your own. IF you don't have the hardware to actually learn the concepts then you are really only doing things half assed anyway.

I for one am offended by both the BK ads. I think I saw a 2nd ad. I'm also offended at all the other commercials that poke fun at every other profession. If our industry can survive Turd Watch, Rescue me, and that oldie but goodie Code Red, then I think we can survive a BK ad that won't be on for much longer. Reflecting all the posts except for the original post, I think we have bigger things to be upset about which I won't go in here since they have all been hashed out ad nauseaum (sic) in past threads.

If you look at things from an altruistic level and do it strictly for the helping aspect which many of us do then you can live on being a paramedic or emt salary. For a goodly number of us we are by necessity having to work two jobs to make ends meet. I know that when I lost my job as a consultant, and I was making really good money, I dropped to 36000 per year. It was not a hard time to make ends meet until the additional medical bills came in and the mortgage went up. We budgeted specifically for the pre-medical bills and when they came due, the budget became un-workable so I was forced to get a 2nd paramedic job and when the mortgage went up and other bills went up such as the deferment of the student loan ending I had no choice but to return to consulting. so yes you can live on a paramedic salary. Is it easy, NOPE is it doable - yep If you are going into EMS with thousands of dollars in bills outstanding I would urge you to rethink that thought and get a job that pays better (if you can) and get the bills paid down. There is nothing like not having creditors calling you at work and home trying to get the dime that you were going to pay for food. It's just not fun. Trust me, I've been there.

Those were my thoughts exactly, I was just asking more questions. listen, we all know how these things end. No ROSC, no family reunion. I think we've gone far enough on this topic. Just tried to get everyone thinking that it's never cut and dried and extraordinary circumstances often come up. What I found surprising in the article posted earlier is that I've always been under the impression that our good samaritan protection ended if the airline comped you free drinks or a free ticket which the article seemed to indicate that stuff like that is not considered compensation. Thanks for playing Ruff

Spenac I'm not busting your chops or anything like that, you know me better than that but playing devils advocate here You have already rendered care. NO ROSC yet the plane is diverting. Medical control is saying to continue the code including giving any additional medications that are in the bag. (some bags are better stocked than others). You say to medical control that there is no ROSC and you are requesting to cease efforts based on your ACLS knowledge. Are you telling me that you will refuse to continue the code because after 10 or so minutes there is no ROSC? How would you defend yourself in court when you had a physician on the other end of the radio telling you to continue? Just asking.

1- Were these "patients / prisoner's " actively having CVA during a flight ? From what he told me they were actively having a CVA in flight. 2- Were the events due to the flight or did they have a history of CVA, TIA or uncontrolled HTN ? He did not tell me their history. 3- Was the aircraft pressurized ? Ok late edit you said @ 40000 .. what type aircraft are they using ... a Lear ? thats kinda high for most aircraft used .. 40000 was just a number. I don't know how high they were but the jets they use are mainly 737's. His transport service which is contracted by the US Bureau of Prisons transports people who have been either deported due to crimes or have been convicted of crimes in the US and an arrangement between the US government and their home of origin to send them back to face many additional charges. The stories he tells. In one country when the men get off the plane they are separated out - 1 group goes to a waiting bus and the next group goes to a waiting military/paramilitary vehicle and those are the ones who know what will happen to them. He said some of those going to the military type vehicle are never heard from again. He left it up to me to make my own assumption as to what happens to them but he said that whatever I was thinking was more than likely correct.

ugly, that's basically what he told me but it just didn't sink in. I'd like to find out where I could get some of that literature as I'm thinking of applying to work at his agency. I'd like to be prepared. He is not completely sure if they are allowing just paramedics rather than paramedic/nurses apply. He is checking into it for me.

About 6 months ago I spent some time at Christiana Care Hospital in Delaware. I spent 9 days working with a Prison transport medic who flew on the planes like in the movie Con-air. He said he has taken care of some really sick prisoners. He said that the worst patients were the patients who were stroking. I don't know the dynamics of altitude on strokes. He said that a hemmorhagic(sic) would get much worse on the descent than at altitude. He tried to explain it to me but it didn't make much sense. Can someone help me out here? Flight medics let me know. PS - if anyone wants to work for Con-air let me know, I can put you in touch with this guy.

Spenac I see where you are going with this. I do believe that age is a key point. contrary to your viewpoint. Children often have a respiratory component which causes them to arrest. If you can correct the respiratory element then the child has a chance. A slim one at 40000 feet but a chance. I can see working this code, going two rounds of drugs and then calling it, and the passengers attack me and open the emergency exit and throw me out. (not really) But remember, the amps of drugs on board are for adults but you should be able to convert those drugs with thehelp of medical control and you might have enough epi to make it through several rounds of ACLS. Plus, you have offered to help as the top medical person on the plane. Medical control has told you not to stop and continue. You refuse to continue based on your reasoning. I would think that the family would have a case against the provider who refuses to continue against a doctors orders because that provider was using "accepted practices". I would think you would have a slippery slope trying to defend your actions especially a infant or child. Adult you would have more of a solid support system but to call a infant or child because 2 rounds of epi didn't work might not be seen in a juries eyes as a valid reason to stop cpr and call it. I know where you are coming from on this and indeed it's not cut and dried. Plus one other thing, diverting to a nearby airport would allow a fully equipped ALS crew with many more medications at their disposal to meet you there. The monitor you are using is an AED so that does not allow for truly valid cessation efforts if the patient has a reversable cause. Hypovolemia. You may need more than the paltry 500ML that the airline has. Pneumothorax moving to tension pneumo (the iv caths are only an inch long in the kit's I've used) so using the caths in the kits may not make it through to the lung cavity. Airway obstruction, there is no way to unobstruct the airway in the airlines kits. Anaphylaxis - epi might work short term but they arrest any way - a fully equipped ambulance will have more items to reverse the anaphylaxis. Diverting and not calling the code may be in the best interest of the airline but also the best interest of the patient. So before we blanket statement that 2 rounds without ROSC and I'm done, period might need to be revisited.

Dwayne, I know a couple of medics that have done just that, intubated a drunk for being a jerk. one even said "I showed him who was boss" I then proceeded to demand the medical necessity of the intubation and when they couldn't produce a medically necessary reason for intubating the patient, I took it to the medical director. That ended their job at our shop. As for anti-emetics, Zofran seems to have proven itself with it's benign properties and it can really be used on anyone but didn'twe think the same with Inapsine or phenergen? I do like zofran but I always am saying in the back of my head, will this drug eventually be proven harmful just like inapsine was. I don't think I would have intubated this guy unless he kept vomiting and he kept passing out at the same time but with a 30 minute transport time who knows. I wasn't there. Kudos on coming here and asking questions but I think a better place for you to go to is your medical director and discuss this with him. He knows your area (hopefully) and your patient population so I suspect that he would have better insight than we do. Take care Ruff

It's really a conspiracy among the pregnant and old folks of this country that they will bring the USA To it's knees. Beware the elderly man with the missing pinky finger.

Doc, I think you are absolutely correct. The airline is going to divert probably no matter what. 79 or 29 years old. The decision to stop the code is not yours. It is the medical controls that the airline uses. If you decide to stop then I can guarantee that the flight attendants will continue based on what I discussed with the flight attendants I talked to today on my flight. One of the attendants I talked to today said she went through this situation about 6 months ago and the person in question was a 84 year old guy who arrested an hour outside of denver and they diverted to colorado springs. I know that we as providers know the end result of all our work in these types of patients but no-one on the plane wants to continue on for 1-2 hours flying with a dead person especially when on most planes these days have places to put a dead person. Calling a 80 year old is not as bad for the airline but calling a 29 year old would I think be out of the question for the airline. So those advocating the calling of someone who doesnt' get ROSC, what about a child or an infant? Would you work them for a couple of rounds and then call them? It's not so cut and dried is it?

ok, everyone here I think knows I fly to get to work. I was spending a hour in the airport today and observed something. Have the terrorists migrated to using frail elderly people and women with children these days? The reason why I ask this is for this reason. I watched for over an hour the enhanced screening area (this means the pat down area) and of the 30 people that I saw get singled out for extra security this is the breakdown of who they checked Wheelchair bound people - 10 Women with walkers or canes - 3 Men with walkers or canes - 5 Pregnant women - 2 people who walked with a pronunced limp or walked extra slow - 7 Men with children - 2 women with strollers - 1 What was conspicuously absent in this hour long time of watching were people who had no outward signs of disability or problems. This included the people who walked with a rapid pace and seemed to have no problems whatsoever. I know this is just a random sampling but just right now at this posting there is another woman with one of those rolling walkers being patted down. And now they have just brought an elderly man in a wheelchair into the area for patdown. I'm not a conspiracy theorist at all but with this sampling shouldn't the people who support the ADA Act be in an uproar? I do understand the completely wheelchair bound people getting further screening since they cannot walk through the security metal detectors.

ok, sorry been out for a while. Migraines and kids don't mix if you know what I mean. The AED never advised a shock. the Iv is started and you only have 500ml so use it judiciously You do cpr and give the 2 rounds of EPI and you do not feel a pulse nor does the AED recommend a shock. You are on the radio with med control out of New York. CPR is still in progress with 2 flight attendants and one other person who offered to help. The pilot asks if you think they should divert. Knowing what you know as a EMS provider and not withstanding the advice from some of the best on this board what do you tell the pilot? Do you tell him to divert and work this guy till you land? Do you call the code in flight and advise the pilot to continue to Houston? There are NO right or wrong answers here. Just trying to make people think. Let's add this one thing into the mix. This is a 27 year old female mother of 3 in arrest with her children watching. Do you do anything different?

Guy has no DNR or any family travelling with him so theres no help there. Non ALS Drugs - I meant to say that there are other drugs in there but they include the likes of dramamine and benadryl The kit you are using does not have the capability of starting two iv's to run fluids. Maybe a lock but are you sure you want to do that? The flight attendants at this airline by policy are the ones who operate the AED - so they put the patches on. You are bagging the patient but there is no nasal airway Patient still not breathing and pulse is now Gone. You start CPR Pilot declares medical emergency and the two airports closest to you that can accomodate a 757 are New Orleans - 45 mins away and houston 1 hour away. Either which way you are going to be in the air for 45 more minutes. You are in contact with the Airlines medical control which so happens to be a Hospital in New York City. You have no cardiac monitor other than the AED. The AED is a basic one, one of those idiot proof AED's. What now.

Ok, the ALS kit the airlines have consist of some good stuff. The airline kit that we will use will have the following 1. AED 2. IV bag of NS(500ML) and 1 iv cath of each size 18, 20, 22, and 24 3. Epi 1:10000 (1mg x 2 amps) 4. Atropine same 2 amps 5. lidocaine same 2 amps 6. many other non-als (code) drugs 7. they have 5 oxygen tanks (the small ones) 8. non rebreather mask, bag valve mask and cannula 9. Other items that I can't remember right off the top of my head. That's your kit. The guy slumps over and you help him to the floor and he has a very very weak pulse at about 30. He is not breathing I am heading off to the Eagles Concert in Orlando. I will re-visit this topic tomorrow

You are flying from Tampa to Houston on a 2 hour flight. The flight attendants broadcast overhead the need for a medical person. You answer the call(and you are the only one to do so) and are whisked nearly to the back of the plane to a small frail elderly man sitting in his chair in obvious distress. He's got that fixin to die look You meet the patient and talk to him. He has that thousand mile stare that we all have seen. He then slumps over in the chair requiring you to hold him up. What do you do?