under-dreaming

It is available. However, it is strictly a paramedic skill. In Alaska, we have three levels of EMT that are below paramedic (MICP). EMT-2s and 3s are able to intubate. Furthermore, this department has only one paramedic working part time (very part time), which is actually very common in this state, aside from the handful of larger cities. This particular procedure came from one of the other departments in the interior of Alaska. I do find it strange that no textbooks make reference to this procedure

Would you happen to have the ability to send me that section of your protocols? I have pretty much been tasked with making this thing make sense, pending review of course. Thanks for sharing the experience.

I am currently assisting my department and medical director in revising our treatment protocols. The protocol for an obstructed airway states that "If the airway still remains obstructed [after attempting to remove with Magill forceps], drive an ET tube into the right mainstem bronchus, withdraw, and attempt to ventilate." The medical director was unhappy with the wording of this and requested that it be changed to something more like: "withdraw into normal position, and attempt to ventilate." So I have been looking into books and AHA guidelines on this because I am wondering if it would be more appropriate to remove the tube and replace it with a new one just in case the FBAO ended up inside the ET tube. If it remained inside the tube and ventilations were attempted using the same tube, the FBAO will wind up inside the trachea again and continue to act as a FBAO. I have checked four books here at the station (three EMT-I and one paramedic level). None of them reference this maneuver in the first place. None of these books that I have state in the airway obstruction section or the intubation section that one should drive the ET tube into the right mainstem bronchus in the first place. AHA does not get into it either as far as I have found. The only reference to this procedure is in what seems to be a somewhat unofficial blog of a paramedic here: My link. I have heard this procedure referenced verbally a few times in the past, but I have never read anything about it. Do any ALS providers here have experience with this protocol? I would appreciate any and all advice. I really hit a wall on this one.

Wrong only if it is assumed that socioeconomic and political factors were meant to say that they were all poor and uneducated. JPINFV brought up a name that admitted to doing what he did for socioeconomic and political factors: Ted Kacynski (aka "UNIBOMBER"). Kacynski was a mathematical genius and a college professor. He claims that the consumer direction of the West brought him to the edge. I bring this up because there are several political and socioeconomic concerns that a member of a Middle Eastern community would be concerned about. Not just the idea of being poor, but the idea that leaches from the West are taking advantage of your circumstances. Shady political relations and economic concerns between the West and the Middle East have been going on for some time, and it is not all based on religious feuds (though much of it is believed to be). Regarding the psychological development of a human being: in an environment where everyone is claiming that there is a definitive "evil" in this world (America), indoctrination will follow. Indoctrination of any type may lead to radical behavior, as we have seen in American abortion clinic bombings in recent days; or as we have read about in the tales regarding the Crusades and the Spanish Inquisition; even the lynchings of blacks in the post-war south. Even slavery in general! Educated, religious, hard working Americans... who just happened to own slaves and believed that blacks were not worthy of being treated as humans. All this right in our own back yard... now I am ranting... Having a PhD does not necessarily make one more aware and open to the vast perspectives of the human species. It often just makes them more efficient when it comes to achieving their emotionally driven goals. For the record. I don't think America is evil. I also don't think that Islam promotes violence unless one chooses to interpret it that way. Build the mosque. It's not their fault. By refusing to allow an Islamic house of worship to be located at or near ground zero, we will be acknowledging that it was Islam that flew those planes, not a group of men that were in no way officially representing the Islamic people throughout the world, even if they (the hijackers) thought they were.

Article A 15-day ‘observational study' conducted by the Defence Institute of Physiology and Allied Sciences (DIPAS) under the Defence Research and Development Organisation on Prahlad Jani, better known as “Mataji,” concluded on Thursday. DIPAS Director G. Ilavezhagen told journalists here that the study was to understand how a person could survive without food and water and without passing urine or stools for a long time. “A scientific understanding of the mechanism of such survival may help in working out survival strategies under stressful and extreme conditions. This may have applications during natural calamities and disasters,” he said. The Defence Ministry was particularly interested to know if his “survival mechanism” could be explained in scientific terms, and whether it could be replicated for defence personnel doing duty in difficult areas where maintaining regular supply channels at times become difficult. Dr. Ilavezhagen said the DIPAS would draw a conclusion on the survival mechanism only after critically analysing the reports of tests carried out during April 22-May 6. “Some medical parameters may take two weeks to study and a few others may take two months before we can draw any conclusion,” he said. The team would meet periodically to discuss the findings and draw “valid conclusions,” he said. Top scientists from the DIPAS and a team of 35 “super specialist doctors” conducted the study at the Sterling Hospital here. The “study protocol” was cleared by the “ethics committee” of the DIPAS and Sterling Hospital and was “strictly followed” to ensure that the “privacy, safety, security and dignity” of Mr. Jani was “not compromised” at any stage. Because no insurance company would accept to cover the risk for the 82-year-old Jani during the study, the Gujarat government agreed to stand guarantee up to Rs. 15 lakh in case of any exigency. CCTV cameras Mr. Jani, who lived in the temple town of Ambaji in north Gujarat, was brought to the Sterling Hospital and was constantly watched through closed-circuit television cameras. The doctors carried out periodical checks of all his medical parameters. Because he did not take any food or water, the only condition he set for the team was not to carry out any “invasive” tests that would require him to consume water or any other fluid. He took occasional baths and gargled. Mr. Jani's disciples claim that he has not taken any food or water and not passed urine or stools for the last 76 years. According to them he survived on “solar energy.” They claimed that when he was eight years old, Goddess Amba Mata appeared before him in Pune, “touched” his tongue with a finger and since then he had never felt the urge to eat or drink. “I did not give up food or water, nature has taken it away from me. I don't feel the need for it,” Mr. Jani said. He said he had “nothing to prove” but agreed to undergo the study as it could help human beings at large. Dr. Ilavezhagen said during the period he was under observation, he did not consume any food or water, nor passed urine or stools. However, it would be too early to draw any conclusion about his “survival mechanism.” He said people were known to have lived without food or water for a longer period, “but it does surprise us that he can survive without passing urine or stools,” he said. Both Dr. Ilavezhagen and the head of the medical team, Sudhir Shah, said no appreciable change in the medical parameters was observed. “If a person starts fasting, there will be some changes in his metabolism, but in his case we did not find any,” Dr. Ilavezhagen said. “Clinical, biochemical, radiological and other relevant examinations were done on him. All findings were within the safe range,” he said. Dr. Shah said the team “practically studied almost all his systems” and found them functioning almost normally. The brain MRI was normal. Functioning of motor and sensory nerves, lungs, heart, and every other system were found normal “for his age.” “No features suggestive of any psychiatric disorder were observed during the period,” he said. The study was an extension of a similar one conducted on him in the same hospital, also by the DIPAS in 2003, but this time it was carried out with more modern equipment and medical aids, Dr. Ilavezhagen said. __________________________________________________________ I am looking forward to the final research paper on this one.

I didn't consider the refugee aspect. The reason I brought up the "zone" issue is because I thought you were originally referring to guys dressing as fully covered women so that they can pull off some shenanigans in an area that is patrolled for suspicious looking dudes (which would be a war zone). Terrorism obviously can happen at anywhere at any time and it is nothing to be taken lightly. My point was that the covering of ones face with the burqa does not make terrorism any easier or harder in a non-war zone. I was really just trying to figure out what the potential reasons for creating a ban on burqas are, since the article was unclear about that fact. The potential methods of hurting others in the name of a radical cause are virtually limitless. It is my personal opinion that increased homeland security measures - while they may make it harder for terrorists to accomplish their goals by forcing them to adapt their plans/tactics - cause an unnecessary burden on people who are just trying to live their lives. Again, I'm not entirely sure if this is about homeland (Frenchland that is) security. If terrorists start to dress like school children with backpacks on that are filled with explosives, it may come to that. National security organizations and the governments of the world are in the business of treating the symptoms (explosions), not the disease (whatever that may be).

Morphine not only reduces the sensation of pain, it causes an altered mental status. I would assume that it is this altered mental status that blocks out the traumatizing events. But to what degree does it block out the events? Does it just push the memories into the subconscious, waiting to emerge when some sort of object or event triggers them? Would hypnosis uncover the memories and anguish? It is an interesting thing to consider, but I am inclined to think that the memories would be getting stored in a different place. It's like when someone is drugged before they are taken advantage of. They may not remember the event. They may not even be sure that it happened. But eventually the memory emerges (possibly many years down the road) and they are in need of intervention. Traumatic things need to be faced and dealt with in a timely fashion. That is the prevention of PTSD.

Unfortunately the article is unclear as to the actual reason for wanting to ban the burqa. So we can assume it is for any number of reasons; from national security, to oppression of religion, to woman's rights, to prejudice against a race. I don't know exactly what the legal standards are in France, but I usually assume that they are very similar to the USA. If say this is all based on national security concerns with the idea that a man (or woman) could strap on a bomb and cause some ruckus or whatever, then this should be of concern. If one is basing the idea of hiding your face as a reason to presume you have questionable intentions, then you are missing out on the fact that many atrocities can be carried along without the need of hiding one's face. akflightmedic makes a good point regarding that tactic in a war zone. I can't argue with that. But this is France. If someone wanted to do something destructive, they probably won't have to worry about wearing female clothing to disguise. If anything at all, this would cause an elevation in security threats for the country due to the possible perceived racial and religious insensitivity. It could piss some people off enough to go into reckless action. If this is all for the sake of going against the grain of Islamic tradition so that the majority population can gain control over the deemed injustices to women of Islamic culture, then there is also great risk. This risk primarily comes from the source of change. In the early 20th century, many women in the United States got together and worked very hard to change their social status and share equal rights. The outcome was positive. The outcome was the result of their own desires. This situation in France is the desire of a French PM. While I'm personally sure that Islamic women, if given the opportunity, would be better off without the constraints of their traditional standards, many have been raised to believe that what they have going for them is the best that it is going to get for psychological and conditioning reasons that we as outsiders can only speculate on. It's like polygamists. Very few, when given the opportunity, are willing to give up the standards that they have been raised with. While there are many women from polygamist groups that have gotten out and moved on, there are many more who were raised to believe that they are doing God's work. This is similar with women of Islamic traditions. They are doing all of this for God. The PM of France is not comparable to God by their standards. So even if this law was passed, it is very likely that there will be some perhaps unforeseen consequences. If Islamic women who follow the standard of wearing a burqa in public are now not allowed to go outside with their burqa on, what is the most likely thing to happen? They will stop going outside. So if this is about giving some kind of liberation to these women, it is not going to work. So then, is this about being prejudice against a race/religion? If so, that could spell disaster for the citizens of France. While this French PM feels that he is acting on the best interest of the French, it is the French who will suffer if by some terrible chance some extremist feels that he needs to hurt people because of this legislation. Like I said though, this article doesn't even explain why this is being considered.

Excellent point that I think most forget. Who are we to make these potentially life-threatening decisions? I have from time to time felt aggravated when one abuses the system for something that I believed was insignificant. But we have seen it time and time again on this site and others where one EMT or one Paramedic caused someone to die by refusing to take them to the hospital because they thought it was nothing to be concerned about. Speaking of lawsuits and doctors knowing better, what does this mean for the Medical Director that signed off on this? If and when someone becomes seriously ill or dies as a result of this pre-patient contact refusal to treat, does the Medical Director become a target for lawsuit as well?

I hope NYC sees some positive results from this. I didn't realize that NYC EMT-Bs are close to getting protocols for administering Narcan via auto-injector. That should make a world of difference for your system I would imagine. Good luck with that. One probable outcome of this pamphlet could ultimately be not just a decrease in transmission of diseases or mortality from OD, but from the overall increased awareness of the possibilities and implications that arise from heroin use. It's my belief that many people get into these drugs because of education... or the lack thereof. While the addiction itself may be too much to handle for most, those who are still in control may have a new opportunity to get out while they can. If this pamphlet were to reach that person and provide information that was previously not understood, well... you never know, they may just get out of it in time. One can only hope, right? This pamphlet is a step in a new direction. One that may have been called for considering the ineffectiveness of present legislation and dogma.

I agree with both comments.

This seems to be stirring up some controversy in the mainstream. http://www.cnn.com/2010/CRIME/01/04/ny.heroin.pamphlet/index.html New York (CNN) -- A pamphlet designed to help heroin users with advice has come under fire, with some now questioning whether the public health brochure can actually be used as a how-to guide on drug use. While concerns over the 16-page pamphlet have arisen in recent days, the New York City Department of Health and Mental Hygiene created its "Take Charge, Take Care: 10 Tips for Safer Use" brochure in 2007. Its purpose, according to a statement from the department, is "to help people who are injecting drugs reduce the harm associated with this type of drug use until they are able to get into treatment and recover." According to the Health Department, "accidental overdose is the fourth leading cause of early adult death in New York City, claiming more than 600 lives each year." The agency says about 70,000 pamphlets have been produced at a cost to city taxpayers of slightly more than $32,000. "The pamphlet provides potentially life saving advice" reads a health department statement. But critics such as New York City Councilman Peter F. Vallone Jr., chairman of the council's Public Safety Committee, believes the pamphlet is "an indefensible waste of taxpayer money" and is effectively spreading a lie that there is a safe way to inject drugs. "Heroin use is at epidemic levels in New York, and we should be spending money to address that, not teach first-timers how to use," says Vallone. Information in the publication takes the form of "ten critical tips for reducing the harm that illicit drug use, and especially injection drug use can cause." Tip topics include "how to prevent overdose," "prepare drugs carefully," "take care of your veins" and "ask for help to stop using." Within each of the 10 broad tips, the brochure presents several "simple but valuable" related ideas for users about how to lessen potential problems when injecting drugs. One suggestion reads, "Use with someone else. If you're alone and something goes wrong, no one can help." Another says, "Use a new syringe, cooker, cotton, tie, and other supplies every time." Plus, "Warm your body (jump up and down) to show your veins." Along with, "Find the vein before you try to inject." There is also information regarding HIV and hepatitis-C testing, depression and contact information for emergencies and for finding help to quit. New York City Mayor Michael R. Bloomberg addressed the pamphlet controversy on Monday, explaining how "the health department does have an interest in -- if you're going to do certain things -- to get you to do it as healthily as you possibly can." Don Des Jarlais, research director for the Chemical Dependency Institute, said the principle behind the pamphlet has always been to emphasize treatment and to reduce the spread of disease like HIV/AIDS. However, if people still engage in risky behavior, the "Take Charge, Take Care" information is meant to mitigate risks associated with intravenous drug use and present guidance for people to partake in the safest manner possible. But Vallone believes the pamphlet goes "well beyond clean needles" advice, providing anyone who wants to experiment with information about how to prepare drugs and find veins -- information that an already-using addict would find useless. New York state's top Drug Enforcement Administration official, John P. Gilbride, echoes Vallone, saying the pamphlet is essentially a "how-to guide" for drug use. Gilbride expressed his concern that the pamphlet could send a message that leads individuals to believe they can use heroin in some safe manner. "Using heroin can never be safe. It's akin to playing Russian roulette with a loaded gun" Gilbride told CNN. Indeed, "there is no safe way to inject" agreed Des Jarlais, in response to criticism that the pamphlet presents heroin use as harmless. "I think the word 'safely' is wrong," he said, but if people do inject drugs, he hopes large information campaigns can help lessen risks. "Using hard drugs is just not a smart thing to do," Bloomberg said Monday. "But we have an obligation no matter what the people do in this city to make sure they do it as safe as they can." Vallone, meanwhile rhetorically asks, "What's next, a kids' guide for playing safely in traffic?" Vallone said he sent a letter to the city's health commissioner Monday to immediately cease circulation and funding for the pamphlet, and he plans to "hold his feet to the fire during upcoming budget meetings" unless the health department admits its mistake. The pamphlet is just one component of a larger municipal effort, explained Des Jarlais. Along with the informational brochure, there are also face-to-face community outreach initiatives, expansion of drug abuse treatment facilities and 47 state-authorized syringe exchange program throughout New York City's five boroughs. Des Jarlais points to an 80 percent reduction of HIV reported among new drug users in New York City as proof that programs such as needle exchanges are working. The health department reports that overdose deaths have declined by 25 percent from 2006 to 2008, representing at least 200 fewer deaths. "I don't think there is a healthy way [to use heroin[, but there may be less dangerous ways to do certain things," Bloomberg said.

Hilarious! Where was that hospital? I'm glad at least one person on this board has heard of and seen that movie.

I don't recall if we have ever exchanged posts before, but I just want to let you know that I think you have an excellent mindset about this whole thing (based on your reply to cbhare). While he makes a very good point, you are clearly a much bigger person than this type of madness can shake-up. Still, I can imagine you are upset (at least confused). This is probably just a routine thing that your supervisor has to go through because of the anonymous tip. And it will surely end with a lot of wasted time on their part. Good luck.

While this whole idea is ludicrous and hilarious on the part of PETA. I do find the notion of advertising a fast food company on fire safety equipment to be equally or more offensive. Kind of reminds me of that line in the movie "Idiocracy," where the federal government employee ends all of his statements and remarks with "brought to you by Carl's Jr."