firedoc5

I didn't say it was right. It's just what happened. I'd say that up to about ten yrs. ago, there were still some hurt feelings and discussions on it. One thing I will say is that there does needs to be a balance between education and experience. I've known some 33 yr. olds that had more experience than guys 25 yr.s older. And you are so right about the "old guard" doing things the same way. But in many FD's, they hang on to tradition(s) are reluctant to change. I'm all for tradition, but you have to move ahead also. When I got on full time in '89 I was thrust right into that change and the reluctance to change. Maybe that's one reason the Chief and I didn't exactly hit it off, ever.

I think the FBI could have waited until at least the hearse had pulled away and / or most of the mourners had left. They could have even tailed him to the cemetery if need be. But just coming up to a guy and zapping him right in the middle of friends and family, I think is a little premature.

How many of us "Old Guard" been on MVA's or other traumas where the pt. is combative, uncooperative, belligerent, etc. and you almost immediately think ETOH? I learned VERY early in my career, do NOT assume ETOH or other substance abuse over the possibility of closed head injury. Since learning this early in my career I guess I thought that was in EMS - Basic 101 or something. I've had to calm down partners who were getting angry and aggitated at these accidents from the way they were behaving. And they learned that lesson. And with or without a pt., and no matter how close to home you are, you always get permission on the radio to stop there.

I got fired from a factory job for sexual harassment. I touched someone on the shoulder. But the job blew. We made car horns.

I'll just throw in a couple of cents here. If I remember rigt, either hosp. had short ETA's. I'd just continue O2 tx. and take vital often. Make comfy. No nitro or ASA for chest pain in case of TIA/CVA. And no MS in case of OD. There's too many, "what if's" and all to really treat her with EMS. Needs hosp. and all their fun gadgets.

"Help a Nun kick the habit"

Yup, you have to know who to shrug your shoulders at and laugh with them.

"Wish You Were Here" - Pink Floyd

Bad timing on the FBI's part. IMHO

I know that basic military manuals are written on a 4th or 5th grade level. And there were a few that had to be tutored by others. One of the things I am so proud of my son is that he is a big reader. Of course he watches TV and has video games, but despite having all those distractions he still reads a lot.

I'm sorry, but for the last couple of days I've been wanting to say this. I by means tend to be crude, but could removal of the bra take an extra few seconds. The normal way is just to cut in the middle. But for some reason, before ALS get's there, a pair of scissors or even a sharp enough knife may not be obtainable. But you are in luck if it's a front fastener. And as for just pushing it up, it can still get in the way. I'm sorry, but I feel punchy today. I might say or do almost anything, within reason of course.

All in all, man or woman, if they can do the job adequately or better, who cares if they are man or woman?

We only bet on a pt's ETOH level once in the hosp. Quote of VentMedic; The inattentiveness of some not to count was one of the reasons a few of the changes were made. Hyperventilating a patient to a dangerously high pH was as bad as the very low pH. Throughout the years as more research became available or better methods to prove different concepts, medicine has changed its way of thinking may times. The way we ventilate ARDS or a TBI patient has greatly changed throughout the years. Permissive hypercapnia is accepted in some situations as is the use of buffers now. Acceptable PaO2 levels have differed in acceptibility for ARDS, TBI, Sepsis and other disease processes. The limitations and benefits of the pulse oximeter has been defined and further understood as has the ETCO2 monitor. We now have many, many protocols driven by the disease and no longer make blanket statements. The use of oxygen in neonates has evolved into a different way of thinking for resuscitation in that population also. So many changes and some very exciting times to be more involved in medicine. An interesting article about CPR and EMS: http://www.jems.com/Images/CPR-Revived_tcm16-12259.pdf I guess that's what I was needing to know. We did take pH into consideration, but hoped the higher the O2 the less reason to use Bicarb, or at least until they got to ICU/CCU.

That's about how I felt like.

Kidney stones or renal choleic was one thing I was going to mention. There's so many organs and "plumbing" in these areas it's hard for EMS to nail down a definite possible diagnosis. URQ, the first thing you think of is liver or gall bladder, ULQ you can guess AAA, cardiac, hernia. LLQ you can think of AAA, Spleen, well you get the picture. In EMS there's no telling of an absolute problem. The main things you are looking at rebounding, increase in pain upon palpation. N/V upon palpation. Any distention, guarding, discoloration.

Bummer. Maybe she showed more cleavage or something. You never know about some of these people.

I guess some people just don't like injections.

OUCH, in more ways than one. I'd pay money to have seen that.

"One" - Three Dog Night

AT 19, I don't think so. He may know all about the rig, the book learnin', be able to operate it efficiently. But you've got to have the experience. There's too many 'what if's" that's not covered in any book. And he might have the right answers, but being put into a situation that is not a everyday occurence, is he going to freeze? Find out that the book didn't cover it? Not only that, but what about the men below him? If he's got trouble with his crew, is he going to be able to get things worked out? Or is he going to pass it on to a Capt? There was a big hub-bub at my Dept.when a 33yr. old made Capt. There were guys that had been on the Dept. longer than he was alive. He jumped over them somehow. Luckily he could handle it and eventually became Chief in another town.

When it comes to the size of the female usually being smaller than the male, then I've got something to really interject. When I started EMS I was (am) 5' 3" and weighed less than 120 lbs. Yes there were comments made and a lot of jokes (ha ha). But I proved myself. I might have had to work twice as hard to do it...Same with petite woman. In all fairness, let them prove themselves. Many times I was partnered with a gal who was very close to the same size of me, but she could whip your butt if she wanted to. Every now and then we'd get a patient that would tell us that the two of us couldn't lift her. So one or the other one of us picked her up and put her on the cot. Like I said, prove yourself. Of course one of the jokes was that at least when we lifted a cot, it would be level. And of course their was the joke when I worked with several guys well over 6 ft. that we had to watch to not tilt the patient, or asked if I needed a step stool. But women, men, all of different sizes, especially the more "vertically challenged" must prove themselves.

I remember back when you were to do a chest compression, then compress on the upper abd. (aorta), and back and forth. When they went with the 1 and 2 and 3 compressions it seemed more efficient, but tiring. But I'm talking about before EMS arrives. I have nothing against what is taught for CPR, for the general public or rescuers. Sometimes I wondered if when they did make changes just to make changes. But when ALS get's there, and I'm guilty of it. We rarely counted. We were too busy doing other things. If anyone was actually counting was the guy doing compression. Once the pt. was tubed, basically he was ventilated every 3-5 seconds, not going by the compression count. We liked it when PaO2 was 100+ when the labs first came in. Every now and then we'd have temp. doc working and he would be impressed when we brought in full arrest with a PaO2 was 95 or higher and their pH at close to 4. Vent M, I know you know more about it than me, but what is wrong with not actually counting and bringing in a patient with those kinds of labs? I am by no means being sarcastic, it is a serious question.

Been there, done that. On my days off I'd go to my folks where my father was the coordinator of the BLS vollie service. Every now and then I'd go on the calls basically for kicks & giggle. But every now and then they definitely needed ALS treatment. Remember, this is only a BLS unit. no monitor, no drug box, no ET equipment (this was in the early '90's.) The most advanced equipment was IV's and those were only for nurses to use if they were on a long transfer and one of the IV's ran out or went bad. We checked in with the "legal eagle" doc's. and came to this conclusion. Yes, I was a Paramedic, but was outside the ALS EMS system (North Egyptian Advanced Life Support System). Legally I could not do any ALS skills. Now, I could talk someone through it or make suggestions, even give orders. I just could not physically do any ALS skills. Now as far as BLS skills, I could do all that I wanted to. So, I found my usefulness when operating with my dad's BLS service was just to drive. Any suggestions or corrections on doing BLS skills were OK and welcomed, but I could not do any ALS skills myself. I hope this answers some questions. And I really hope things have changed.

I was so relieved when I became an ACLS Instructor. There was always changes and new challenges. With basic CPR, how many years was it the exact same? And when they did have changes it was procedures that were used at one time, then "improved", then change back to the way it use to be. It's been a long time since I taught a basic CPR class, but I hope it covers a lot more than it use to. We had one veteran Instructor that always said that the CPR class should be a two day/night course. But he did try to cram what seemed to be two nights into one.

Man, I had the perfect post going and for some reason my 'puter re-booted on me. Enough to p!ss off the Pope. But to make it short. To me the perfect crew would be a three man (person) crew with at least one woman. On some calls it takes a "woman's touch". There are certain times a woman needs to be present. It can also decrease the possibility of a complaintent in court claiming (falsely) of any kind of indiscretion. Many times, especially if there's been a rape or assault, the patient may be untrusting of a man. I could go on but I think I made my point. Like I said, I was keeping this shorter than my original post. One in awhile we did have a few gals that did have trouble lifting a patient. It wasn't that they weren't strong enough or tall enough. Let's just say "something's got in the way." The only time I wanted to smack a partner was after a call. We were lifting a patient into back of the ambulance. The gal was on one side, a guy was on the other and I was at the feet. Later on the guy came up and asked me if I noticed anything. I was like "Notice what thing". He explained that since he was on the opposite side of the cot, when they bent over he could see right down the gals blouse (shirt). He was making a big deal of it. He even pointed out that her bra was see through. At the time I was a Paramedic, but sort of middle management. If he would have made the same comment about six months later, when I was management I probably would have gave him at least a week's leave of absence or something. I don't know. But for some reason that comment really bothered me. Now the private service I worked for we all worked very closely. The sleeping quarters were more or less co-ed. Us full timers had our own beds. But occasionally you'd start to crawl into bed and you find out someone else was there. For the most part we had a great relationship together, all of us. If it was a gal you'd just go ahead and go to sleep, no problem. But if it was a guy, someone would wind up on the TV room in a lousy Lazy-Boy. That didn't happen too often, but when it did there wasn't any problem. The boss, I mean the "retired" boss did start to say something when we were all comfortable with each other enough we'd even change clothes in the same bunk room. He wanted to put a stop to it. He was afraid that eventually we'd start to shower together. Actually we had a few married couples and couples dating each other, he was a little late for that. I look back now and I know things were inappropriate and should have done differently. But hey, at that age we didn't look at it that way.