HERBIE1

Dwayne is right. Do NOT rely on the bouncing needle- it is NOT accurate. If you want to prove that for yourself, do a little comparison. Auscultate a BP, palpate a BP, and then obtain one by watching the needle bounce on the gauge. Do this for multiple people, and compare the results.

Depends on the circumstances. Is it a healthy kid or is this a baby with problems? Never a "right" way to do it. Feed off the parents and what they may need. Ask them if there is someone they can call for support- family, friends, neighbors, clergy, etc. Have them get any medical information together if pertinent. Have them get a doctor's phone number. In other words, keep them occupied as much as possible until you know the outcome. Telling them is NEVER easy, but be straight forward, do not couch your language because the first step in the grieving process- especially in something like this- is denial. Tell them that despite everything you tried, they baby did not respond to your efforts and has passed away/died/ etc. Answer any questions they have and if you do not know, find out for them. Explain the process of what will happen next- obviously tailored to your locale: That law enforcement will probably need to make a death report, emphasize it's routine for any death and does not imply you believe anyone was negligent or criminal in nature, that because the death was unexpected, the baby will probably need to be taken to the medical examiner/coroner for an autopsy to determine a cause of death, and after that they will release the baby to a funeral home. As was noted, you need to follow someone who has done this before- whether it be in a hospital or EMS situation. VERY hard thing to do, and unless you don't have a soul, it's never easy. Even after 30 years, it's still a difficult task for me. You'll develop your own approach, you will be able to tell what type of language to use, how detailed your description of the medical efforts needs to be, and what the family seems to need at that moment. Obviously if you suspect foul play, you need to change things a bit. Ensure law enforcement is on the scene ASAP to preserve a potential crime scene. Be careful not to mention your suspicions to the parents, or anything that may compromise the case. You certainly can and should ask about any injuries, and thoroughly document the answers you get, with quotations. You still treat the parents with respect and dignity, as well as the baby, but remember you also have another obligation- to allow the police to be able to do their jobs and help figure out what happened. This would be a time when good report writing and documentation are crucial. This case WILL end up in court and you WILL be called to testify.

I have never used a tourniquet to control bleeding. The only times I have had difficulty with massive bleeding have been abdominal and chest trauma, where massive pressure is about all you can do. Even with the most massively injured limbs, I have always been able to control the bleeding with compression dressings, direct pressure, pressure points, etc. As Ruff mentioned, the blood vessels tend to contract and clamp down with a traumatic amputation- unless they are severed on a diagonal/bias, or shredded.

Not sure what type of chair you are referring to, but we have used the same type for the entire nearly 25 years at my current job. The bottom lifting handles are essentially useless in my opinion. Poor design, and I never use them. If I am on the bottom, I always grab the bottom frame of the chair- on either side of the patient's feet. The top handles do not move, so they are not generally a problem, but for better leverage, I grab the frame on the top as well.. Anecdotally, yes, those rubber handles DO tend to work themselves loose over time. which can make using them dangerous, but obviously it depends on how often you use the device.

No quarrels with that, doc. Totally agree. There are HUGE variations in training- especially when the provider may be from a medic mill where they learn the absolute basics with no theory behind what they are taught. Generally within a few minutes of talking to a student or current provider- about EMS, of course- I can generally tell how rigorous their training was. Until our training IS elevated and standardized, I share your concerns.

Absolutely spot on statement and don't ever forget it. I tell my students and new folks on the job- EVERYONE gets a chance with me. I am nice to everyone- be it the guy lying in his own urine, or the big time CEO you speak of. Actually I often prefer dealing with every day folks- they have no agenda, they generally appreciate even the littlest things you do for them, and they do not expect- or even demand- to have their arses kissed or treat you as if you are one of their subordinate employees. That does NOT go over well with me. Am I always nice- yep- right up to the time when it's no longer time to be nice.

I think the "education" most folks need is pretty basic, common sense stuff. Obviously I am not going to compare and contrast the benefits of one type of antihypertensive med vs another, but I can explain the various side effects of a beta blocker, for example. I can however, ask a person who is taking a diuretic if they are taking a K supplement or eating a banana as instructed by their MD, and why it is important. I can ask an asthma patient if they routinely check their peak flows to see what their baseline is, and compare that to when they are having trouble- ie their asthma action plan. Not only do discussions like these help the patient, but it also gives me insight into what to expect in terms of their vitals, associated complaints, and potential complications I may see. Any paramedic worth their salt should at least be able to do these things, right doc? I don't see that as overstepping my authority or acting in an improper manner.

Excellent point about the stairwells, Richard. We did the same thing- especially since most of these buildings had no lighting in the stairs, we used our maglites- just like the police, and the last thing you wanted to do is surprise someone doing something they were not supposed to be doing. The biggest problem- the stench and the filth. A mix of old booze, urine, garbage, and gawd knows what else. You NEVER wanted to touch a wall, or slip where you might fall and touch the unknown substances on the stairs, not to mention you can only hold your breath for so long... LOL

As someone who spent years in the worst places in town(no, not Detroit) and running 25+ calls in 24 hours every day, I can attest to the potential danger. Had a few close calls, but generally we are NOT the targets. That said, we can get caught up in the middle of things that have nothing to do with us. It happens. That's when experience, common sense, and good peripheral vision are vital. In these areas, entire neighborhoods could be considered "unsafe", so the notion of an "unsafe scene" can be misleading. As long as you do not see an immediate threat to yourself or your patient, then there is no reason not to respond. We also developed good working relationships with the local cops. Because they worked in a high crime, violent area, they knew there was a better than average chance they may need our services so it was in their best interests to keep an eye on us. We did not cry wolf, so when we called them, we NEEDED them ASAP, and they knew it. Often times they would see us on a scene, pull over and stick around, just to make sure we were OK. I cannot tell you how much that helped our peace of mind. My point is, in busy urban areas you will learn the job. You will see more in a week than many people get to experience in their entire careers. Is it for the faint of heart? Nope. You need self confidence, maybe a bit of bravado, and your patience will be tested on a regular basis. If you treat folks with respect, you generally will get that respect in return. If you work in an area on a regular basis, the neighborhood will get to know you, know what type of person you are, and know if you treat people right. That said, unfortunately you also cannot control what other crews do, or how they behave, so if you have a rouge crew who are acting like a'holes, you end up dealing with the fallout. Here's a little tip that was shared with me years ago by a local gang banger- generally folks in the ghettos are HAPPY to see us and fire suppression. When we show up, we are trying to help someone. Unfortunately, law enforcement does not see that since more often than not, when the cops show up, someone is likely to lose their freedom, or the cops are looking to take away someone's source of "income". When we would arrive in the housing projects, the gang bangers who were lookouts for the buildings would actually announce our presence- meaning we were NOT the police, and to give us safe passage, hold the elevators, clear the hallways, etc. We would even occasionally have the thugs helping to carry equipment, or help restore calm in a chaotic situation. They knew we were there to do a job, not to mess with them or their "business". Good luck- hope it helps. As someone who spent years in the worst places in town(no, not Detroit) and running 25+ calls in 24 hours every day, I can attest to the potential danger. Had a few close calls, but generally we are NOT the targets. That said, we can get caught up in the middle of things that have nothing to do with us. It happens. That's when experience, common sense, and good peripheral vision are vital. In these areas, entire neighborhoods could be considered "unsafe", so the notion of an "unsafe scene" can be misleading. As long as you do not see an immediate threat to yourself or your patient, then there is no reason not to respond. We also developed good working relationships with the local cops. Because they worked in a high crime, violent area, they knew there was a better than average chance they may need our services so it was in their best interests to keep an eye on us. We did not cry wolf, so when we called them, we NEEDED them ASAP, and they knew it. Often times they would see us on a scene, pull over and stick around, just to make sure we were OK. I cannot tell you how much that helped our peace of mind. My point is, in busy urban areas you will learn the job. You will see more in a week than many people get to experience in their entire careers. Is it for the faint of heart? Nope. You need self confidence, maybe a bit of bravado, and your patience will be tested on a regular basis. If you treat folks with respect, you generally will get that respect in return. If you work in an area on a regular basis, the neighborhood will get to know you, know what type of person you are, and know if you treat people right. That said, unfortunately you also cannot control what other crews do, or how they behave, so if you have a rouge crew who are acting like a'holes, you end up dealing with the fallout. Here's a little tip that was shared with me years ago by a local gang banger- generally folks in the ghettos are HAPPY to see us and fire suppression. When we show up, we are trying to help someone. Unfortunately, law enforcement does not see that since more often than not, when the cops show up, someone is likely to lose their freedom, or the cops are looking to take away someone's source of "income". When we would arrive in the housing projects, the gang bangers who were lookouts for the buildings would actually announce our presence- meaning we were NOT the police, and to give us safe passage, hold the elevators, clear the hallways, etc. We would even occasionally have the thugs helping to carry equipment, or help restore calm in a chaotic situation. They knew we were there to do a job, not to mess with them or their "business". Good luck- hope it helps. As someone who spent years in the worst places in town(no, not Detroit) and running 25+ calls in 24 hours every day, I can attest to the potential danger. Had a few close calls, but generally we are NOT the targets. That said, we can get caught up in the middle of things that have nothing to do with us. It happens. That's when experience, common sense, and good peripheral vision are vital. In these areas, entire neighborhoods could be considered "unsafe", so the notion of an "unsafe scene" can be misleading. As long as you do not see an immediate threat to yourself or your patient, then there is no reason not to respond. We also developed good working relationships with the local cops. Because they worked in a high crime, violent area, they knew there was a better than average chance they may need our services so it was in their best interests to keep an eye on us. We did not cry wolf, so when we called them, we NEEDED them ASAP, and they knew it. Often times they would see us on a scene, pull over and stick around, just to make sure we were OK. I cannot tell you how much that helped our peace of mind. My point is, in busy urban areas you will learn the job. You will see more in a week than many people get to experience in their entire careers. Is it for the faint of heart? Nope. You need self confidence, maybe a bit of bravado, and your patience will be tested on a regular basis. If you treat folks with respect, you generally will get that respect in return. If you work in an area on a regular basis, the neighborhood will get to know you, know what type of person you are, and know if you treat people right. That said, unfortunately you also cannot control what other crews do, or how they behave, so if you have a rouge crew who are acting like a'holes, you end up dealing with the fallout. Here's a little tip that was shared with me years ago by a local gang banger- generally folks in the ghettos are HAPPY to see us and fire suppression. When we show up, we are trying to help someone. Unfortunately, law enforcement does not see that since more often than not, when the cops show up, someone is likely to lose their freedom, or the cops are looking to take away someone's source of "income". When we would arrive in the housing projects, the gang bangers who were lookouts for the buildings would actually announce our presence- meaning we were NOT the police, and to give us safe passage, hold the elevators, clear the hallways, etc. We would even occasionally have the thugs helping to carry equipment, or help restore calm in a chaotic situation. They knew we were there to do a job, not to mess with them or their "business". Good luck- hope it helps. As someone who spent years in the worst places in town(no, not Detroit) and running 25+ calls in 24 hours every day, I can attest to the potential danger. Had a few close calls, but generally we are NOT the targets. That said, we can get caught up in the middle of things that have nothing to do with us. It happens. That's when experience, common sense, and good peripheral vision are vital. In these areas, entire neighborhoods could be considered "unsafe", so the notion of an "unsafe scene" can be misleading. As long as you do not see an immediate threat to yourself or your patient, then there is no reason not to respond. We also developed good working relationships with the local cops. Because they worked in a high crime, violent area, they knew there was a better than average chance they may need our services so it was in their best interests to keep an eye on us. We did not cry wolf, so when we called them, we NEEDED them ASAP, and they knew it. Often times they would see us on a scene, pull over and stick around, just to make sure we were OK. I cannot tell you how much that helped our peace of mind. My point is, in busy urban areas you will learn the job. You will see more in a week than many people get to experience in their entire careers. Is it for the faint of heart? Nope. You need self confidence, maybe a bit of bravado, and your patience will be tested on a regular basis. If you treat folks with respect, you generally will get that respect in return. If you work in an area on a regular basis, the neighborhood will get to know you, know what type of person you are, and know if you treat people right. That said, unfortunately you also cannot control what other crews do, or how they behave, so if you have a rouge crew who are acting like a'holes, you end up dealing with the fallout. Here's a little tip that was shared with me years ago by a local gang banger- generally folks in the ghettos are HAPPY to see us and fire suppression. When we show up, we are trying to help someone. Unfortunately, law enforcement does not see that since more often than not, when the cops show up, someone is likely to lose their freedom, or the cops are looking to take away someone's source of "income". When we would arrive in the housing projects, the gang bangers who were lookouts for the buildings would actually announce our presence- meaning we were NOT the police, and to give us safe passage, hold the elevators, clear the hallways, etc. We would even occasionally have the thugs helping to carry equipment, or help restore calm in a chaotic situation. They knew we were there to do a job, not to mess with them or their "business". Good luck- hope it helps. As someone who spent years in the worst places in town(no, not Detroit) and running 25+ calls in 24 hours every day, I can attest to the potential danger. Had a few close calls, but generally we are NOT the targets. That said, we can get caught up in the middle of things that have nothing to do with us. It happens. That's when experience, common sense, and good peripheral vision are vital. In these areas, entire neighborhoods could be considered "unsafe", so the notion of an "unsafe scene" can be misleading. As long as you do not see an immediate threat to yourself or your patient, then there is no reason not to respond. We also developed good working relationships with the local cops. Because they worked in a high crime, violent area, they knew there was a better than average chance they may need our services so it was in their best interests to keep an eye on us. We did not cry wolf, so when we called them, we NEEDED them ASAP, and they knew it. Often times they would see us on a scene, pull over and stick around, just to make sure we were OK. I cannot tell you how much that helped our peace of mind. My point is, in busy urban areas you will learn the job. You will see more in a week than many people get to experience in their entire careers. Is it for the faint of heart? Nope. You need self confidence, maybe a bit of bravado, and your patience will be tested on a regular basis. If you treat folks with respect, you generally will get that respect in return. If you work in an area on a regular basis, the neighborhood will get to know you, know what type of person you are, and know if you treat people right. That said, unfortunately you also cannot control what other crews do, or how they behave, so if you have a rouge crew who are acting like a'holes, you end up dealing with the fallout. Here's a little tip that was shared with me years ago by a local gang banger- generally folks in the ghettos are HAPPY to see us and fire suppression. When we show up, we are trying to help someone. Unfortunately, law enforcement does not see that since more often than not, when the cops show up, someone is likely to lose their freedom, or the cops are looking to take away someone's source of "income". When we would arrive in the housing projects, the gang bangers who were lookouts for the buildings would actually announce our presence- meaning we were NOT the police, and to give us safe passage, hold the elevators, clear the hallways, etc. We would even occasionally have the thugs helping to carry equipment, or help restore calm in a chaotic situation. They knew we were there to do a job, not to mess with them or their "business". Good luck- hope it helps. As someone who spent years in the worst places in town(no, not Detroit) and running 25+ calls in 24 hours every day, I can attest to the potential danger. Had a few close calls, but generally we are NOT the targets. That said, we can get caught up in the middle of things that have nothing to do with us. It happens. That's when experience, common sense, and good peripheral vision are vital. In these areas, entire neighborhoods could be considered "unsafe", so the notion of an "unsafe scene" can be misleading. As long as you do not see an immediate threat to yourself or your patient, then there is no reason not to respond. We also developed good working relationships with the local cops. Because they worked in a high crime, violent area, they knew there was a better than average chance they may need our services so it was in their best interests to keep an eye on us. We did not cry wolf, so when we called them, we NEEDED them ASAP, and they knew it. Often times they would see us on a scene, pull over and stick around, just to make sure we were OK. I cannot tell you how much that helped our peace of mind. My point is, in busy urban areas you will learn the job. You will see more in a week than many people get to experience in their entire careers. Is it for the faint of heart? Nope. You need self confidence, maybe a bit of bravado, and your patience will be tested on a regular basis. If you treat folks with respect, you generally will get that respect in return. If you work in an area on a regular basis, the neighborhood will get to know you, know what type of person you are, and know if you treat people right. That said, unfortunately you also cannot control what other crews do, or how they behave, so if you have a rouge crew who are acting like a'holes, you end up dealing with the fallout. Here's a little tip that was shared with me years ago by a local gang banger- generally folks in the ghettos are HAPPY to see us and fire suppression. When we show up, we are trying to help someone. Unfortunately, law enforcement does not see that since more often than not, when the cops show up, someone is likely to lose their freedom, or the cops are looking to take away someone's source of "income". When we would arrive in the housing projects, the gang bangers who were lookouts for the buildings would actually announce our presence- meaning we were NOT the police, and to give us safe passage, hold the elevators, clear the hallways, etc. We would even occasionally have the thugs helping to carry equipment, or help restore calm in a chaotic situation. They knew we were there to do a job, not to mess with them or their "business". Good luck- hope it helps. As someone who spent years in the worst places in town(no, not Detroit) and running 25+ calls in 24 hours every day, I can attest to the potential danger. Had a few close calls, but generally we are NOT the targets. That said, we can get caught up in the middle of things that have nothing to do with us. It happens. That's when experience, common sense, and good peripheral vision are vital. In these areas, entire neighborhoods could be considered "unsafe", so the notion of an "unsafe scene" can be misleading. As long as you do not see an immediate threat to yourself or your patient, then there is no reason not to respond. We also developed good working relationships with the local cops. Because they worked in a high crime, violent area, they knew there was a better than average chance they may need our services so it was in their best interests to keep an eye on us. We did not cry wolf, so when we called them, we NEEDED them ASAP, and they knew it. Often times they would see us on a scene, pull over and stick around, just to make sure we were OK. I cannot tell you how much that helped our peace of mind. My point is, in busy urban areas you will learn the job. You will see more in a week than many people get to experience in their entire careers. Is it for the faint of heart? Nope. You need self confidence, maybe a bit of bravado, and your patience will be tested on a regular basis. If you treat folks with respect, you generally will get that respect in return. If you work in an area on a regular basis, the neighborhood will get to know you, know what type of person you are, and know if you treat people right. That said, unfortunately you also cannot control what other crews do, or how they behave, so if you have a rouge crew who are acting like a'holes, you end up dealing with the fallout. Here's a little tip that was shared with me years ago by a local gang banger- generally folks in the ghettos are HAPPY to see us and fire suppression. When we show up, we are trying to help someone. Unfortunately, law enforcement does not see that since more often than not, when the cops show up, someone is likely to lose their freedom, or the cops are looking to take away someone's source of "income". When we would arrive in the housing projects, the gang bangers who were lookouts for the buildings would actually announce our presence- meaning we were NOT the police, and to give us safe passage, hold the elevators, clear the hallways, etc. We would even occasionally have the thugs helping to carry equipment, or help restore calm in a chaotic situation. They knew we were there to do a job, not to mess with them or their "business". Good luck- hope it helps. As someone who spent years in the worst places in town(no, not Detroit) and running 25+ calls in 24 hours every day, I can attest to the potential danger. Had a few close calls, but generally we are NOT the targets. That said, we can get caught up in the middle of things that have nothing to do with us. It happens. That's when experience, common sense, and good peripheral vision are vital. In these areas, entire neighborhoods could be considered "unsafe", so the notion of an "unsafe scene" can be misleading. As long as you do not see an immediate threat to yourself or your patient, then there is no reason not to respond. We also developed good working relationships with the local cops. Because they worked in a high crime, violent area, they knew there was a better than average chance they may need our services so it was in their best interests to keep an eye on us. We did not cry wolf, so when we called them, we NEEDED them ASAP, and they knew it. Often times they would see us on a scene, pull over and stick around, just to make sure we were OK. I cannot tell you how much that helped our peace of mind. My point is, in busy urban areas you will learn the job. You will see more in a week than many people get to experience in their entire careers. Is it for the faint of heart? Nope. You need self confidence, maybe a bit of bravado, and your patience will be tested on a regular basis. If you treat folks with respect, you generally will get that respect in return. If you work in an area on a regular basis, the neighborhood will get to know you, know what type of person you are, and know if you treat people right. That said, unfortunately you also cannot control what other crews do, or how they behave, so if you have a rouge crew who are acting like a'holes, you end up dealing with the fallout. Here's a little tip that was shared with me years ago by a local gang banger- generally folks in the ghettos are HAPPY to see us and fire suppression. When we show up, we are trying to help someone. Unfortunately, law enforcement does not see that since more often than not, when the cops show up, someone is likely to lose their freedom, or the cops are looking to take away someone's source of "income". When we would arrive in the housing projects, the gang bangers who were lookouts for the buildings would actually announce our presence- meaning we were NOT the police, and to give us safe passage, hold the elevators, clear the hallways, etc. We would even occasionally have the thugs helping to carry equipment, or help restore calm in a chaotic situation. They knew we were there to do a job, not to mess with them or their "business". Good luck- hope it helps. I apologize folks... Can a moderator please delete the extra posts? It seems my browser had a seizure...

Care is not a particle it is a wave. I LOVE this statement, and I think it's dead on accurate. At first blush, this may seem like a chicken and egg scenario, but I don't think so. I disagree with the notion of putting providers before patients- at least in terms of the overall purpose of what we do. Without patients, there would be no need for providers of any type. Should the employer be focused on maintaining a healthy, happy, productive, and competent workforce? Absolutely, and I think that should be enough to make sure the patients ARE taken care of. That is a large part of what an HR department's mission is Obviously the notable exception to that rule is when dealing with triage and a mass casualty situation. One of the first things we learn is that any injured or ill provider is always classified as a red for immediate transport- for obvious reasons. Care is not a particle it is a wave. I LOVE this statement, and I think it's dead on accurate. At first blush, this may seem like a chicken and egg scenario, but I don't think so. I disagree with the notion of putting providers before patients- at least in terms of the overall purpose of what we do. Without patients, there would be no need for providers of any type. Should the employer be focused on maintaining a healthy, happy, productive, and competent workforce? Absolutely, and I think that should be enough to make sure the patients ARE taken care of. That is a large part of what an HR department's mission is Obviously the notable exception to that rule is when dealing with triage and a mass casualty situation. One of the first things we learn is that any injured or ill provider is always classified as a red for immediate transport- for obvious reasons. Care is not a particle it is a wave. I LOVE this statement, and I think it's dead on accurate. At first blush, this may seem like a chicken and egg scenario, but I don't think so. I disagree with the notion of putting providers before patients- at least in terms of the overall purpose of what we do. Without patients, there would be no need for providers of any type. Should the employer be focused on maintaining a healthy, happy, productive, and competent workforce? Absolutely, and I think that should be enough to make sure the patients ARE taken care of. That is a large part of what an HR department's mission is Obviously the notable exception to that rule is when dealing with triage and a mass casualty situation. One of the first things we learn is that any injured or ill provider is always classified as a red for immediate transport- for obvious reasons.

I find it interesting what you say about caffeine. You react the opposite of what one would think, so is that because of ADD, or simply an addiction to the stimulant and you are essentially itching for your fix? Who knows? I "need" my coffee too, but I get the pounding headache, cranky, and I'm dragging my arse if I am subtherapeutic with my levels. LOL As for these disorders, I agree with above that they are over diagnosed because of convenience. We all want a quick ,one size fits all fix to our problems. The kids have a sniffle- give 'em a pill. Have a head ache- take a pill. As was mentioned, I think too often a kid may simply be bored in school, and it's much easier to hang a diagnosis on the kid versus getting to his individual needs. I find it interesting what you say about caffeine. You react the opposite of what one would think, so is that because of ADD, or simply an addiction to the stimulant and you are essentially itching for your fix? Who knows? I "need" my coffee too, but I get the pounding headache, cranky, and I'm dragging my arse if I am subtherapeutic with my levels. LOL As for these disorders, I agree with above that they are over diagnosed because of convenience. We all want a quick ,one size fits all fix to our problems. The kids have a sniffle- give 'em a pill. Have a head ache- take a pill. As was mentioned, I think too often a kid may simply be bored in school, and it's much easier to hang a diagnosis on the kid versus getting to his individual needs. I find it interesting what you say about caffeine. You react the opposite of what one would think, so is that because of ADD, or simply an addiction to the stimulant and you are essentially itching for your fix? Who knows? I "need" my coffee too, but I get the pounding headache, cranky, and I'm dragging my arse if I am subtherapeutic with my levels. LOL As for these disorders, I agree with above that they are over diagnosed because of convenience. We all want a quick ,one size fits all fix to our problems. The kids have a sniffle- give 'em a pill. Have a head ache- take a pill. As was mentioned, I think too often a kid may simply be bored in school, and it's much easier to hang a diagnosis on the kid versus getting to his individual needs. I find it interesting what you say about caffeine. You react the opposite of what one would think, so is that because of ADD, or simply an addiction to the stimulant and you are essentially itching for your fix? Who knows? I "need" my coffee too, but I get the pounding headache, cranky, and I'm dragging my arse if I am subtherapeutic with my levels. LOL As for these disorders, I agree with above that they are over diagnosed because of convenience. We all want a quick ,one size fits all fix to our problems. The kids have a sniffle- give 'em a pill. Have a head ache- take a pill. As was mentioned, I think too often a kid may simply be bored in school, and it's much easier to hang a diagnosis on the kid versus getting to his individual needs.

Dwayne, There is a huge difference between understanding and tolerance and an outright insult to folks who lost friends and family in NYC. I've made this comparison before. Should we have allowed a Japanese memorial, honoring Kamikazi pilots of WW2 to be built at Pearl Harbor? At what point does being magnanimous stop and being plain old foolish start? Spin it any way you like, but EVERY SINGLE ATTACKER on that day was Muslim, perpetrating their crime in the name of Islam. I certainly will not give the Catholic church a pass, but the Crusades was hundreds of years ago. Let's keep it present day. I have no problem speaking out against ANY religion if warranted. Do I paint a broad brush- believe it or not, I actually do with the Catholic church. They have inherent, deeply rooted problems that made me stop being a practicing catholic. Example: When my son was attending a catholic grade school, I found out that the rectory was hiding an "accused"(meaning he had yet to be prosecuted) pedophile priest-living within 500 feet of the grade school. I raised holy hell and soon this pervert was moved on to another unsuspecting parish. I was absolutely flabbergasted they would do such a thing, and I was actually accused of being unChristian for being judgmental and unforgiving. I nearly punched out this priest. The underwear bomber, the shoe bomber, the 9/11 attackers, the USS Cole attackers, the US Embassy attackers, the marine base bombers, the Ft Hood massacre- some homegrown, some foreign, but they were all MUSLIM, either they adopted the religion or were by birth. Not all Muslims are terrorists, but around 99% of the terrorists are Muslim. Unpleasant? I guess, UnPC? Sure, but it's also a fact.

One of my favorite- and frequent- exchanges: Have you had any alcohol tonight? No- only some beer and gin and juice. Or similarly- Have you done any street drugs tonight? No- only some blow and weed. Or to the raging alcoholic who consumes a gallon of vodka a day, every day, with a liver the size of Texas- Have you done anything besides drinking today? No. Any street drugs? In a very offended voice: No way- that shit is no good for you! We get paid to be entertained, folks. LOL

I cannot speak for every faith based shelter, Some are strictly a meal and a cot, while others are more evangelical. Again- these folks know going in what they will face. Unless these shelters FORCE someone to convert to a specific religion, I see no harm. Their messages are usually nondemoninational, and talk about the golden rule, taking responsibility, etc. I've seen the paperwork they provide these folks- very innocuous, and certainly not heavy handed. Religion is a tough subject. I think that over the years, the societal pendulum has swung from us being fairly neutral, to more hard core religious, and now we almost seem to be anti-religion. I think the proper place is somewhere in the middle. (Forgot to finish a sentence)

This is a facebook post from my youngest daughter, who will be 12 this week. I couldn't have said it better myself. She is referring to my nephew-her cousin- who was KIA in Afghanistan last November 1st, while serving in the Army. Rest. In. Peace. to all that were lost on 9-11 and everybody since then. If 9-11 did not happen Andrew Tiger Meari, along with thousands of others would still be with us. Thank you to all who risked their lives to save others. Please do not forget that if 9-11 did not happen, we would still have many people that we love. THANK YOU!! I LOVE YOU ANDY. ♥ :'(

Well, I will reserve my comments about the whole Muslim thing. Way too personal, since I have ex inlaws of my sister who are Muslim- and many in their family are affiliated with a terror group. We are also approaching the one year anniversary of my nephew being KIA by a suicide bomber while serving in the Army in Afghanistan. Based on the comments I have seen here, I can promise you my thoughts would NOT be very popular. I think tomorrow is a day to reflect and remember. Recall the unity- however brief it was- and hope we can one day regain that feeling. We are so polarized politically these days that we respond more as partisan sheep than we do as thinking, rational beings. We had a unifying cause, and a common enemy. That enemy still exists, but I think we no longer have the stomach for the heavy lifting and vigilance we still must maintain. I am also afraid that if- GOD FORBID- we are attacked here again, I honestly wonder if we would have the same unity we saw 10 years ago. I fear we will remain polarized- those who feel we need to be more forceful or aggressive vs those who feel we need to pull back completely and not overreact. In the end, like everyone else, I vividly remember exactly where I was and what I was doing that day. I will remember and mourn the murders of nearly 3000 innocent people- especially the first responders who paid the ultimate price. I also desperately hope our leaders find the wisdom to put us on a proper course to keep this nation as safe as humanly possible.

As doc said, folks can give multiple answers to the same questions, depending on who's doing the asking, where, when, and how. I demonstrated this concept to one of my students, He asked a patient if they had any medical problems, and began to list possibilities- cardiac, high blood pressure, asthma, etc. The patient dutifully replied, no to all. I smiled, then asked the patient what medications he takes every day and he replied with a laundry list. My student was flustered, but wrote them all down. Then I smiled and asked the patient- already knowing the answer I would get from him: "So- you are taking all these pills for your heart, your sugar, and your asthma, why did you say you didn't have any of these problems?" The patient: -looking at me like I was a complete moron: "Because I DON'T have those problems as long as I'm taking those medications." I looked at the student, his jaw dropped and he just shook his head. It was the easiest lesson I ever taught. LOL

Well, making a blanket statement like the tea party is the far right wing of conservatism is flat out untrue. Are there radical elements WITHIN that group- sure- like the religious nuts, but they do not make up the majority of those who agree with their ideas. As for things like reducing defense spending- that's not extreme, it's merely a plank in a platform, and an age old debate. Since 2008, Obama has created dozens more "czars" and commissions who report directly to him and are independent of Congress and the American people. That is GROWING more government, which is exactly what the tea party objects to.

It depends on what type of system you operate in. Our system uses dispatchers who are not sworn department members, they are not in our chain of command, they work for a separate agency, they are in a separate union, we do not report to them, and they have a standard set of instructions- mostly automatic responses for various incidents. They do have discretion in terms of what ADDITIONAL resources they can send, but there are a few of them who think we somehow report to them. About the only thing they can ask us is why we are asking for police support- not to determine if they will send the help, but only because the police ask them to provide that information. Honestly, before we went to a CAD system, they did have a lot more discretion, and for the most part were very good. They knew the city, they knew the crews, and they could actually weed out some of the BS calls. Not any more- we turn nothing down. Now, a trained monkey can do their jobs. The computer tells them what to do, which buttons to push, and which keys to punch.They actually are subject to discipline if they deviate from their protocol and freelance. Stressful at times? Sure, but the machines do all the heavy lifting and decision making for them. So some of the reasons they ask stupid questions may be legit., some of it may be because some folks feel the need to exert and exercise what little authority they may have. Tough to know. I'll never forget one call when we were literally fighting for our lives with a combative patient. I did not have a chance to grab the mike on my portable radio but was able to reach the transmit button hold it open so the commotion could clearly be heard, stated our unit and position, while yelling for a 10-1 police backup, which means an emergency. I heard the question from the dispatcher- "Why do you need the police?" I wanted to reach through the radio and choke the living crap out of this a'hole. At this point, I was finally able to grab the microphone and yell my answer-"Because unless you are deaf, you must be able to hear we are getting our asses kicked by a violent patient!". Obviously profanity on the radio is an FCC no-no, but I wasn't particularly concerned about a fine at the time. The dispatcher actually admonished me for my cursing. We finally got things under control and the police came and took the patient into custody. We had a few bumps and bruises but were otherwise OK. Afterwords, I was told a supervisor paid a little visit to the dispatcher. After the call, I was so irate that I called the dispatch office, asked to speak to his supervisor( who was a friend of mine), and told him that if I ever saw this dispatcher off the clock, he would probably need some time off work because he may find it difficult to talk for awhile. The supervisor apologized profusely and after reviewing the tapes of the incident agreed I had a legitmate beef. If we request a 10-1, no further information needs to be given. I know the gravity of the situation was clear- several of our rigs were actually responding to help us out based on what they heard on the air. The dispatcher was just being a prick.

Ruff had a great idea about the refresher course. Also, as several have noted, every so often we get thrown a curve ball we have never learned about. Example: A couple years ago, we received a notice from a local hospital that 2 patients in our area recently had LVAD's implanted and were being discharged home. (Left Ventricular Assist Devices). I assumed they were similar to balloon pumps, but honestly I had no friggin clue what these things were. Luckily, soon after this, a local hospital offered a seminar- sponsored by the companies that manufacture the devices. It was one of the best decisions I ever made. I got to play with the devices, see what they did, how they operated, learned what to do if the device or one of it's parts failed, how to resuscitate these patients(NOTHING like you would expect) learned what to do if a patient calls and has one,, who to contact to reach out for help on the device, and much, much more. We even met several patients who had the device implanted, and they explained what they were all about, issues they have had with the devices, and how best to help them. There is no way in the world I would have known what to do if I had not attended this class. I ended up educating others about it, but there is no substitute for getting the information first hand, and thank gawd I did spread the word because shortly after that, one of them ended up dealing with a patient with an LVAD. Point being- you'll never be fully prepared for what you will see- regardless of the quality of your education. With all the medical advancements, we need to be on our toes and keep up on current trends. Reread your texts, reread your notes, retake your exams and quizes. Ask people to quiz you to be certain you have a good grasp of the material, and constantly ask questions. You can make up the gaps in your knowledge- it will just take a bit of work. As for the clinical aspect, once you are comfortable with your knowledge base, the skills and confidence will follow. That is always the hardest part- regardless of your paramedic education and training. Good luck.

Off the top of my head- Small pox is a nasty looking disease- not to mention scary as hell. Advanced cases of gangrene

Re-read the basic tenets of the Tea(taxed enough already) Party. Smaller government, lower taxes, reduced governmental regulations and interference. What is extreme about that? Don't confuse extreme viewpoints of individuals with the party itself. Saul Alinsky is an extreme left wing Democrat. Would you say that the vast majority of Democrats agree with his radical agenda? Totally agree, Richard. The Native Americans are the folks who really got the shaft in this country. I see them as the only people here who deserve to get reparations or some sort of break. Everyone else is essentially an intruder, and have the same opportunities to succeed.

That's exactly what happened last year when the tea party picked up a bunch of spots all over the country. People were fed up with the usual BS, and whether or not you agree with their platform, these folks shook up the old guard GOP AND the Democrats. These arrogant old f'cks who have been in power- some of them for decades- simply refused to believe anyone could pose a challenge to their little kingdoms. Many were dead wrong. Nobody expected these folks to win anything- they were not taken seriously by anyone, yet they achieved incredible results. Point being, we need to stop voting party, and start voting for folks with a plan. The bulk of the Tea Party's message was pretty simple- take back control of our government, reduce it's size, and reduce taxes. I honestly don't know anyone who thinks they need to pay more taxes, that we actually NEED more government agencies, or that think the government doesn't spend enough of our money. Tea Party or other party- do some homework and vote for the candidate, not his or her party.

Crees- Most of us have some type of lip balm- especially if we are dealing with cold sores. Carmex brand has a very potent smell, and I put it right under my nose if we get a real stinker. I also breathe through my mouth-I instinctively do this with our homeless folks and DOA's. Works well. I concur with rinsing out the nose(plain saline works OK too) to get rid of the residual smell like burnt flesh and decomp, Those aromas take forever to get rid of and you can smell them all day. Some folks are more sensitive than others, but this is not a good profession to be in if you are hypersensitive. Most people have one or 2 things that really get to them- GI bleeds, vomit, urine, feces- everyone is different. You also can have days where you are much more sensitive than others- a single whiff of something could cause you to gag, and other days you could be knee deep in body parts and not bat an eye. Here's an EMS rule of thumb- At some point, you WILL get the worst smelling patients and severely decomposing bodies IMMEDIATELY after you finish the last bite of a heavy pasta meal. If you can keep from barking at your shoes, you're in the right profession. Extra points awarded for being able to point out the irony of the situation and describe the meal as you encounter that body.

The problem is, philanthropy is nice, but a luxury most people can only offer in small doses. The number of large groups that do charity work- whether as part of their stated mission, or simply as a means to reduce their tax liability- cannot match that of all the religious groups. That means if you take away the tax exempt status of the church, there will be a huge void. Even if a group is a fully funded charity endowed by a major corporation, there are far fewer of them than there are religious based groups, and in this economy, I doubt big business is itching to toss money around unless absolutely necessary. No question, the Catholic church in particular is one of the most corrupt organizations on the planet. They are also one of the richest. We all know the problems they have as of late- molestation, cover ups, ideas that may not coincide with today's society, shady financial dealings, etc- but they still do a tremendous amount of charity work. They provide a parochial education for those so inclined. If they suddenly were forced to pay up, they would focus more on the things directly related to the church- their schools(already in big trouble), the churches, and that's about it. Their charity work would be severely curtailed. Take their tax exempt status away. Fine by me. Problem is, there WILL be real world consequences. Many of the charities, shelters, programs, etc they do support will go away, and I can promise you that one of our 2 major political parties would not be happy that "underserved" folks would be the ones getting the shaft. It would be interesting to see how the Democrats reacted to such a thing- would they step up and make up for the lost charities? Doubtful, since they are religious based, and they already see religion as a bad thing, so it would be an internal struggle- support charitable work, or support the idea that churches should pay their fair share. Could be fun to see... (added another thought)