Just Plain Ruff

you are right Wendy, it will not change your treatment but by noting that there is a blackened area or whatever the color of that area was on his bag might have saved him from sitting in the ER for longer than necessary. It also might have saved him from having to wait for surgery until the doctor can get to him. Nut pain does not elicit a lot of urgency in the ER especially if it's been going on for over a month. But if the bag is looked at and assessed then you can tell the doc or the nurse, "the back of the bag is this color or whatever" then this might decrease his wait for surgical intervention.

Well the first thing I'd do is set up a landing zone for the alien ship. This is a job for the Men in Black. Will Smith and Tommy Lee Jones anyone? But seriously this dude needs some haldol. 5mg IM.

one other thing, when I was helping teach a EMT class about 10 years ago several of the students would not do any touching of the patient whatsoever. MVC patient, head on scenario, unresponsive patient. Not once did they touch the patient. I would not give them any answers and shortly the patient coded. They asked me why I killed them and I said, I didn't, you did. They asked why. I said that you didn't touch them and you missed the 4 GSW to the back. That particular student began to touch the victims in scenarios. Others refused to touch even after all their patients would die and several never made it out of class.

Let me discuss the need for touching, feeling and just basically assessing hands on for your patietn. I worked in a small ER in a town of about 9000 people. We had a old country doc who was a phenomenal doc. He sponsored me to go to ATLS and not just as a observer but one who got to do all that the doc's got to do. Well, he had externs that followed him around from the osteopathic medical school. There were two different patients who would come in. One with a artificial leg and another with an artificial eye. He would have his externs evaluate them and give a report. Many times the externs would come back and give a report that pulses were bilateral in both legs or the eyes were normal. He asked them to go back and check again and several times the externs would come back with the same report. He would then proceed to have a loud discussion with the extern and then show them the errors of their ways. A couple of times those externs would pack their bags and go home in disgrace. He said he didn't want a doctor who first off didn't do a full evaluation and then would lie to him when they repeated the exam. I've had students in the past who were scared to lift the breast up to put the 12 lead electrodes on therefore getting a incorrect 12 lead reading. One was so poorly done that the Ekg originally showed less than 1mm elevation in 2 3 and AVF but when I asked them to lift the breast and do it again it showed 3-5 mm of elevation. I've had students listen for breath sounds thru their shirts. It wasn't surprising that they originally missed the pneumo that had developed but after telling them to cut off the shirt they caught it. I have had partners who wouldn't touch the patient no matter what. We have the technological tools and diagnostic tools that enable us to sit back, drink our coffee and monitor the patient. Not even a ambulance with a million dollars of equipment, fully state of the art equipment and eventually we will have the ability to use the doctors wand that we see on star trek, none of that compares to the 5 senses that we have been given by God or whoever you believe in. It's easy to rely on the bells and whistles that our company buys us to put in the ambulance but to not be hands on and use the senses we have then we are nothing more than the Geeksquad. It's disconcerting that the current crop of students are not taught the basics but even more disoncerting that we have medics/emt's out there who let it slide. Like I said in a different thread, the first time that someone misses a GSW to the back of an unconscious patient by not exposing and looking should be the last time they take care of a patient.

the first time that a medic misses a GSW on a guy that they didn't look at the back when the boarded him will be the last time they don't look. Plus it actually should be the last time they take care of a patient but that's for another thread. If you don't look, listen, feel and touch then you aren't doing your job.

Actually I think that palpating it would have provided quite a bit of interesting info. 1. level of pain on manipulation 2. If you examine the right versus the left then you would have a good idea of size comparison (and not to your own coconuts) 3. I believe if you lift a testicle and it causes pain it's a good sign of epididimytis I think(at least that's what I remember on reading about it) EMS is hands on guys, how can we provide a adequate exam or evaluation if we just look at it. I know this is late but the guy probably waited in the ER for hours prior to our own ERDOC to step in a look at it and get the guy to surgery. But had one of us examined and looked at the affected area he might have gotten to surgery quicker. But then again, it's all armchair quarterbacking.

ok, it's like this. CNA's get paid more in hospital settings because they are a member of the nursing profession and as such they get paid more. NOt always but Wendy is finding out that it's that way where she is. Since cna's are in the nursing profession they have a group of nurses and a organization that will fight for them. We as emt's and medics do not have that professional organization behind us and are still considered to be outsiders to many nurses so we will be paid less. Plus, the director of nursing at the hospital helps set the wage scale and go figure, She's a nurse so who is she going to pay more? CNA's or EMT's?

It's an oxymoron sort of like Military intelligence

Spenac, it's about time that you realize that I'm right all the time. Actually just kidding My wife keeps telling me that she's right and I need to get over it. But I digress.

I agree after 10 shifts of working as the medic I relished the shift that I got to just drive and the ability to leave the techin to someone else. Sounds like greyhound. Leave the drivin to us.

Just how much or how little education do you need to save lives? Way to offend about 40 people on your 4th post. Excellent job.

it's good to see that the words used in the above quote matches their user name. How did Smurfwhore get past the filters for new names.

Let me ask one question in regards to field skills. Do you benefit from Field skills as an EMT when you get over 500 hours of field skills in your paramedic program. What kind of field skills are we talking about here? How to immobilize a fracture? How to put oxygen on someone? How to cover a wound? I'd risk it to say that all those skills can be gained while in paramedic school. Just why is it that our profession among the healthcare professions is the only profession that requires someone to get a basic class done before they go on the get the advanced. RN's do not require that you get a lpn or cna training before you get your RN. Physician training does not require that you get nursing or ems training before you get to be in the doctor classes. What about veterinarians? are they required to be vet techs before Veterinarian education? And finally how bout dentists? We don't require them to be dental tech's before they get their dentist training. So why do we require everyone of us to be an emt first and then medic second? Here's a thought or a solution If you want to just be an emt and there are those out there who want just that - then let them take EMT classes and that's it. If you want to be a medic then you should not have to get your emt first. Just go out and sign up for medic classes. I think that this emt then medic mentality and requirements can directly be linked back to the education institutions that train them. there is money to be made in training both levels of provider and as long as you have to be a EMT first and then a medic the schools make money off it. Take CEU's as another example. there are ceu's geared towards emts only and then there are advanced ceu's. There is money to be made in having two different levels of CEU's also. I think that this is the one major problem we have. The education system that we have for EMS is dismal. When you have small ambulance services putting on emt classes, hospitals putting on medic classes, community colleges putting on medic and emt classes and the fly by night 8 week emt class and 15 week paramedic courses with not a lick of conformity in their instruction styles the root cause is lack of consistency. Maybe we need to re-evaluate who actually can teach classes. Someone who has been in the field for 9 days can teach a ceu class if they want. Does that make them a bad instructor, maybe or maybe not but does it make up for lack of experience? NO. You can have a paramedic who has been in the field for 30 years teaching classes but does that make them a good instructor? maybe or maybe not. What about the medics who have been out of the field for 3 years or 10 years and they are still teaching? Do we take their experience at face value or does it provide some skepticism that they may not be teaching the newest techniques and processes that current medics would? Who knows. all I'm saying is this, we get what we pay for. If you want a educational system that will be consistent, constant and up to date then you have to pay for it and as long as we have 10 different tracks for people to become paramedics or emt's then the ball really is not in our court.

JP I stand corrected on the search function. Original poster - I am sorry for bringing the search function up. JP Is right.

ahhhh grasshopper I see a fresh voice here. I like your style. Yes the emt versus basic has been beaten to death but you were not out of line for posting it, it's just that I think that these forums have seen this type of thread over the past 3 months about 30 times.

ok, let's just stop the medics versus basics threads. We read the same thing on these threads over and over again. I would urge admin to lock these additional threads as people who don't use the search function do not see how often we beat this poor horse. It's dead already. Plus, coming here bashing those of us on the forums with your very first post is not something that will endear you to the majority of the group. I do say welcome to the forums but please try to review with a search before you bring up the medics versus basics. ONe other thing of note - breaking up your paragraph into easy blocks to read is better than one long batch of sentences. WE are not all jerks or I'm a medic so I'm better than a basic but if you would have done a search you would have seen the number of posts that are very articulately written that spell out why you need more than the training given to basics currently. I urge these medic versus basics posts to be stopped. They just devolve down to the same posters giving their views over and over again.

well when I posted that 3000th post thing I was at 2999 but I had to answer a couple of posts and the number went up. Oh well< I guess I'll make my 4000th post count

Where do you get that statement of fact from? I'm not accusing or saying this towards you but there might be some on this forum who would say the same for you, that you have somethings to learn on this forum. They could also say that I may have some things to learn but when you come right out and say that you want to be mature and civil yet you fire a shot across the bow of Inf's boat then I do say that you did egg them on.

Incog, you were doing so well in saying that it's nice to discuss in a civilized forum until you egged Inf on. Now Inf will have to defend themselves or bow down to being a bigger person and end the bickering. Who knows which way they will go but you should have stopped while you were ahead. I have found on these forums that if someone makes you mad you can do one of a couple of things. Continue to fight with them - does no-one any good Ignore them even - that's the best plan ignore them until they say something else and then start the fight again - not smart either. You might want to practice what cha preach.

Incog, you were doing so well in saying that it's nice to discuss in a civilized forum until you egged Inf on. Now Inf will have to defend themselves or bow down to being a bigger person and end the bickering. Who knows which way they will go but you should have stopped while you were ahead. I have found on these forums that if someone makes you mad you can do one of a couple of things. Continue to fight with them - does no-one any good Ignore them even - that's the best plan ignore them until they say something else and then start the fight again - not smart either. You might want to practice what cha preach.

my next post will be my 3000'th post. Look for it.

Asys speaks truth I believe Nancy Grace (don't start guys) did a special on under-reported missing person's cases and guess what class and racial status is woefully under-reported in the media? A no-brainer - blacks and men. Believe it or not. If a white woman from a middle or upper class area is missing or presumed kidnapped then all the media is all over it. But if a black woman from the same class area is missing then she will get much less coverage than the white woman. Even the same financial and education and life, the white woman will get more coverage than the black woman. I hate, HATE the news media with a passion, I do not read, watch or listen to the news. The local news I only watch for the weather. When americans can tell me who Paris Hilton is or the names of Brad and Angelina's kids are but cannot even tell me what year 9/11 happened or who the political leaders of this country are, I blame the media and the education system. When Britney Slutspears gets more mention on the news than any other story, When Anna Nicole's death was the only thing that was on at the Jacksonville airport when I'm stuck there on a delayed flight then I blame the media. But Asys speaks truth on the racial issue of this thread.

sorry for posting that long post yesterday. It was not intended to insult anyone's intelligence and if you felt that your intelligence was insulted then I'm sorry but there's nothing I can do about that now.

Dwayne, I hate to blow our own horn but I think we told you so, didn't we. We told you it would get better and keep at it. You have proven the old adage, give it time, it will get better. I am very proud of you that you kept at it, I know you were close to quitting at one time but I'm glad you stuck it out. Keep up the good work. We need you in the field.

http://www.google.com/search?hl=en&q=vq+matching try this, Google is your friend.