HERBIE1

I find it interesting how hung up we can get with titles. In the case of the fire service, it's a paramilitary group, which means titles like chief, lieutenant, and sir are used as means of respect for any superior officer. For example- there's the age old battle about PHD's, EDUs- professors or doctors? In my classes, I've had students refer to me as professor, though I only have a Masters Degree. My actual title- according to the university is adjunct faculty,-which means they pay me far less than a "real" professor, I have no office, no clout, and no benefits LOL . Depending on the country, professor does not necessarily mean someone with a PHD, but I was always taught that was the case. In some places., professor is reserved for department heads only, and in others, it generally means the tenured position above an associate professor. But I digress... I agree the distinction between EMTB, I, D, or P's is lost on anyone outside the field. Throw in the titles from other places and things get real interesting. A Basic referring to themselves as a"Medic" seems harmless- unless that person professes to have credentials above their actual training.. No harm, no foul IMHO.

Sounds great on paper, folks but I wouldn't hold my breath on this. We had a $250K, 3rd party study here that essentially came to these same conclusions and a whole bunch more. That was over a decade ago, and little has changed since then. Few of the recommendations ever came to pass, and the same problems exist today. Politics, organizational culture, politics- too many factors to get in the way of change. Will it happen? Someday, maybe, if the stars are aligned, and is as likely as someone who wins the lottery 3 months in a row, AND is struck by lightning 3x's in one day. Am I cynical? Yep. Seen firsthand how difficult it is to implement change. Does it mean we should stop trying? Of course not, but I simply suggest folks- especially ones new in the field- be realistic about what they hope to accomplish and how quickly.

Personal opinion- I think the reason so many providers cannot wrap their heads around psych patients and their problems is because there is so little we can actually do for them. As EMS providers, we want to fix things- ASAP- and there is little we can do for a truly disturbed individual. We cannot "see" the problem, so often times we minimize or even dismiss it's impact or importance. There can be a chemical imbalance, some sort of emotional trauma, or an extended history of personal problems that lead a person to the point in time were we encounter them. If someone is having chest pain, we can "cure' that pain with one pill. If someone is depressed, all we can offer is a sympathetic ear. Sure, if they are exhibiting symptoms from an OD or physical trauma, we know how to treat that. Therapy, counseling, trial and error with various treatments and medications- it's often a long and difficult process to get a person on solid emotional ground, and that process usually includes multiple trials and errors of medication combinations; there is no quick fix. As for suicide in particular- we all know that a legit attempt makes folks far more likely to try again- and eventually succeed. I've had folks with extensive psych histories finally succeed after many half-assed attempts. I also had one guy who immediately after receiving a diagnosis of cancer(unknown type or stage) go from his doctor's office to the high rise building he worked as a building engineer. When he arrived at work, he made an offhand comment to a coworker about receiving the diagnosis, proceeded to the roof of the building and jumped 40 stories to his death. He went from a cancer diagnosis to dead in a matter of a couple hours. (That one was particularly disturbing) Point is, everyone has a different threshold and tolerance for physical as well as emotional pain. A problem that may seem inconsequential to most folks can completely overwhelm another person's ability to cope. As a provider we need to look at psychiatric patients through their eyes- as much as possible. No, we should not begin talking to someone's visual hallucinations, but at least try to understand their stated concerns. Even with seriously delusional folks, there are usually nuggets of truth embedded in their rantings. Yes, many of our suicide calls are not serious. A teen girl takes 4 Motrin because she is upset her boyfriend dumped her. Is she serious about her desire to die? No, but she does need perspective, which is something we can give- at least until counseling can take over.

if they are a danger to themselves I removed this phrase to illustrate a point. This implies the person has either temporary(ETOH related) or permanent- psych problems. That means they are incompetent and cannot refuse- regardless of where they may be. If it's only an issue of POSSIBLE or POTENTIAL problems- "What's if's"- that is a different story.

I understand what you are saying, Dwayne. In the OP, if this guy was so drunk that he needed to be awakened, I highly doubt that he was competent when they finally did arose him- especially since he has no recollection of the incident. Is it possible the person was completely lucid? We all have seen professional drinkers who can appear to be and act stone cold sober and unimpaired- even if they are double the legal limit. To me this is a judgement call, and obviously this is about the purpose of the call. If it is for an injury and the person turns out to be uninjured- yet drinking, what do you do? To me, that's when things get fuzzy. If you are called for the unconscious person, it turns out they were drinking, then yes, they need to go. If they were so drunk someone could not wake them up, then they do pose at least an aspiration danger to themself- beyond the legal issue of being capable to refuse treatment and transport.. That would be when I bring LEO into the picture, if necessary. With these fuzzy scenarios, like anything I would paint the proper picture for medical control, give my reasons why I think this person who admittedly has been drinking IS competent to refuse. I've done it many times, and never once been refused. It's called judgment, experience, and common sense. It's the old cookbook medic syndrome. It's easy to blindly follow rules and SOP's- which often are more about CYA of the agency or municipality than what may be best for the patient-vs assessing the patient, getting the whole story, and THEN deciding on a course of action. Before lawyers become our partners in medicine, cops routinely would take a drunk home or call them a taxi, vs dragging them to an ER, calling for EMS or arresting them. Now, with everyone who has been drinking it is assumed they will go to bed and promptly vomit, aspirate, and die. They must be brought by ambulance- big bill- to an ER- bigger bill- so they can sleep it off. Here is an example of a common issue for most urban providers. You get called for a man down, or something similar. A concerned citizen drives by(never stops, of course) and calls EMS. You find a homeless guy, sleeping on the sidewalk, on a bench, in an alley, etc. You wake them up, they say they are fine, did not call, do not need assistance of any kind. You KNOW this person probably has a baseline ETOH level that would make you unconscious. Does this person NEED to be transported? Not in my book. Done it literally thousands of times. Legal? Probably not. Will I do it the same way again? Yep. Does my attitude make me a "cowboy", reckless, or a poor provider? I guess that depends on who you ask.

Dammit, Dust! ...Cleans coffee off screen. True, and like any skill, practice makes perfect...

Welcome to the CIty.

I am utterly amazed this is even an issue. Unless the OP is trying to claim the hospital staff were imposters, THEY already had the patient. As was noted, how can he take over care from a higher medical authority, and then transfer the care back to that same hospital staff? Our jobs are to get patients to a hospital, provide care at whatever level we are trained to, and to transfer that patient to the medical staff- hopefully in a bit better shape than when we found them. PERIOD. This is not about one company infringing on another's area, or "stealing" a patient in the field, ala "Mother Jugs and Speed:", this is about providing patient care. There is no "turf" to defend, but I would guess someone's ego was bruised. Get over it. Hospital property, hospital responsibility and there are multiple lawsuits that certify that fact. If they needed help with lifting, extrication, an extra set of hands for CPR, holding a door open for them, etc, then provide it, and document it appropriately. Just. Wow.

The hospital staff is the higher medical authority. Ultimately, isn't that exactly what we are supposed to be doing? I fail to see the problem here, unless this is about losing money for your employer.

I love it!

All good thoughts so far. I think kids are certainly more tech savvy, but I believe that skill comes at a cost. Many of the students become so reliant on things like spell check that they do not understand or pay attention to things like the differences between using words like their and there. No spell checker will understand context and proper word usage, and the students assume the program will take care of their mistakes. Part of the problem is the educational process, which starts long before they enroll in EMT, nursing, or paramedic school. It seems that too many kids are not well equipped to handle the rigors of a solid program, much less a traditional college curriculum. It seems to me that many schools embrace and emphasize technology in order to make them competitive in the workplace, but that technology should only be a tool- the basics still need to be taught and mastered.

RIP, brothers.

Horrible situation, cookie. best of luck to you, and be safe. i cannot speak to the individual situation of the OP, but I did learn a bit about this problem on a radio show the other day. I thought it was an incredibly horrible thing for the powers that be to arbitrarily flood thousands of acres of farm land by breaking levees. Then I learned that these areas were bought up by the government years ago as essentially "easements" for this very purpose. They predicted these areas would eventually flood, given the right circumstances. They allowed the land to be used for farming- with the proviso that this exact scenario could happen some day. What I do not know is if people on these affected areas rent or lease their land from the government, what sort of retribution they may receive for losing their crops and homes, and what living arrangements are provided for them. From what I understand, after the floodwaters recede, the land may likely be unusable for a long time because of the toxins in the river water. best of luck to all involved.

Update: Our friend is still alive in the ICU. I have no idea of the specifics- (if he's on a ventilator, any deficits, etc), but hopefully will find out more later today.

Sorry, but I disagree about the caffeine. I'm asystolic in the AM if I don't have my coffee. It's also what allows me to get over the hump throughout the day. Thankfully I don't do energy drinks or those quick energy ginseng/B-complex drinks though.

He's a great partner, a great medic, and I've known him for 15 years- families are very close. The reason for the longevity and close friendship? We are both very sick puppies. LOL

Recently had a patient- a regular who has an incredibly long and complex cardiac history, hypertension, stents in legs, head, and his heart. 53 years old. He has periods where a couple times a week he develops chest pain, unrelieved by his own meds, and calls us. Very nice man, always the same complaint- chest pain. He always meets us at the curb- despite us telling him he should not- and apologizes for "bothering us". This time, we arrive but do not see him. As we start grabbing our gear, he walks out the door and approaches us. Chest pain- radiating to L arm and jaw, 8 of 10. BP 170/120, says he was just hospitalized the prior week for the same thing- it was his BP acting up. I ask him about his meds, he says he cannot remember them all, but if we give him a minute, he would gladly go back into his apartment and get them for us. We tell him that is not necessary, but he needs to write them down on an index card for the future. We begin ALS care, as my partner is starting the IV, I put him on the EKG, and administer a NTG. As soon as my partner enters the skin, he says- "I don't feel good guys, I think I am going to pass out." We sort of chide him, saying he should be used to the routine by now and that the IV will be done in a moment, to hang in there. He proceeds to have a syncopal episode, begins to have a brief grand mal seizure and immediately goes into V-fib. Of course as he begins to shake, we lose the IV in the one peripheral vein he had left. I grabbed the pads, attach them, and defibrillate him back into a sinus rhythm. He does not wake up. I access his jugular vein, and we begin ACLS care. Long story short, he went through multiple rhythms, we got ROSC and lost it multiple times. I was unable to intubate him due to the fact that he had so much previous trauma to his larynx that there were multiple folds of tissue that looked like a maze, but he was oxygenating well with a BVM, Upon arrival at the ER, he had pulses and spontaneous respirations, and the ER doc attempted to intubate to protect his airway. She ended up using a fiber optic scope because of the horrible condition of his airway, so I did not feel so bad for not getting the tube. LOL Bottom line, his rhythm stabilized, soon he was fighting the tube, and had purposeful movement. I will soon check with the hospital to see how he's doing. The kicker-the first time we had this patient was several years ago, he arrested on us back then too, we got him back, and bought him another 4 years. Same guy- 2 cardiac arrests, both saves by the same crew. Of the thousands of patients we have, the odds of this happening must be astronomical.

All sage advice, but I will piggy back on the issue of interpersonal dynamics. Dealing with different partners is not easy- especially when you are new, and still getting your feet wet. Sometimes you aren't even able to discuss simple things like who will carry the O2 and who will grab the quick response bag before you are pressed into service. It takes time, but it does become easier to adapt to different styles of providers. Some are more aggressive Type A folks, while other partners may seem comatose by comparison. Never forget that it's all about the patient, and any squabbles or differences you have with a fellow crew member need to be shelved until AFTER the call. Be upfront about your issues but do not be confrontational. Support your point of view, and ALWAYS base your discussions on what is best for your patient. Any interpersonal issues are secondary. It sounds like you did fine, but I like the fact that you are not satisfied with your performance. A hallmark of a quality provider is that they are always looking to do better, always questioning if there is a better or more efficient way to provide care. Complacency kills patients and careers. THAT is how you earn respect from your peers and hospital staff, gain confidence and become a true professional. Welcome to the city, and as you can see, folks around here take their profession seriously. Here's a little tip- Using texting shorthand is frowned upon here, and although you could be the best provider in the world, nobody will take you seriously. Can you imagine a doctor responding to the impending cardiac arrest of a patient by saying "OMG!" Not professional.

Not a problem to have a first name on a tag with a last initial, but hospital based folks are not in the same situations as someone in the field. A hospital is a controlled environment, folks are generally on the best behavior, and other than occasional skirmishes in ER's, I highly doubt an Ultrasound tech or housekeeping person need worry about angry/unstable patients, bystanders, or family members. Possible, yes- likely? No.

I understand that standard administrative BS- I used to be in management. Problem is, reality often intrudes on that nice little Pollyanna mantra. I was in the middle of defibrillating someone's grandma on her living room floor when I looked up and saw a gang banging mope storm into the house, and run across the floor to attack me. I threatened to turn the paddles on him until another family member finally pulled him off me. I'm always nice, professional, and courteous- until it's time to stop being that way. When I am being physically threatened, I am no longer nice.

Exactly my point, Richard. This surgeon was a soldier wanna be. He absolutely LIVED for paintball. Fully cammo outfit, goggles, top of the line weapons, and from what I hear he was a raging lunatic at these paintball games. I saw a picture of him in full attire and he looked like he was posing for a "Redneck Monthly" magazine cover. LOL I think the poster is simply trolling here, and I'm not playing.

We used to have name tags, but no longer. We now have our last names displayed on our bunker gear coats, but nowhere else. Have I had a problem with a patient or family member in the past? Yep. Working in the ghetto, we had a preacher have a massive MI while at the pulpit, and he was triple zero upon our arrival. (Probably dead when he hit the floor- he was around 300lbs with an extensive cardiac history) It was the usual chaos and insanity at the church, we did the best we could, but to no avail. I have no idea how, but one of the "God-fearin" church folks tracked down my name and phone number(he had to have had help from someone within the department since that information is not readily available) and found my home number. I began to receive threatening calls, claiming we "killed his reverend", and he would kill me and my family. AT the time I was single, but I figured if someone was able to find my information, they may be able to find my family. I filled out a police report and also notified the local LEO's. After a couple more calls, they stopped. Nothing ever happened, but I was fairly paranoid for quite some time and was indeed looking over my shoulder at work, as well as at home. In the ghetto it is not uncommon to be threatened while working(warnings against saving a rival gang banger, "do your m' f'n job or else", or "save my momma!"). All part of the fun of working in a busy urban setting. This was different- it was personal. Point being- there is always an element of risk involved in what we do. Does it generally go beyond work? No, but it is possible. I see no purpose to having name tags, nor do I give someone my full name. i don't give a rats behind if we are "public servants" or not. If something can put my family in harms way, I draw the line- rules be damned. If someone has a beef, I always give them our ambulance number and with that and the date, it's a simple matter of finding out who we are. I even give them the number to call to file the complaint. On a couple occasions I actually offered to dial the number for them- they really didn't know what to do about that. LOL

Not playing. A thumbnail picture, with no context? Forget it. In the real world, we DO make snap judgments about people- based on appearance, what they say, how they dress, what situation they are in, how we meet them, etc. So yes, we do unfairly characterize someone based on initial impressions, but we also have other information such as visual and auditory cues. Example- the picture of the biker, among hundreds of other bikes. Could be from a huge biker rally as in Sturgis, or it could be from a gay LeatherMan's convention. Context. Guys dressed up as hunters? Rednecks? Could be a well respected trauma surgeon I know who dresses exactly like that when he hunts. Based on your prior comments here, pardon me if I don't believe you do not have an ulterior motive with your "social experiment". State your point.

The abuse of drugs is one thing, but that is not the only issue. If a provider is an addict, obviously any controlled substances we carry are at risk, but it's so much more than that. A patient's belongings, valuables in the home- anything is fair game to be stolen and sold to support the person's habit. As noted, there are plenty of ways to pilfer the stock of narcotics. As the addict's problem escalates, they get more bold, ie more and more patients seem to need analgesics. As we know, until and unless someone is ready to accept help, even the best employee assistance programs are of no use. It's a tough problem, in some ways I think we are no different than many professions, but the difference is we have access to, as well as opportunity to satisfy our addictions. We all know this can be a highly stressful job, and coping mechanisms can range from healthy- increased excercise and/or social diversions, to drug, alcohol abuse, and unhealthy eating habits. I think the bottom line is watching out for each other. Look for signs of someone who is not coping well. Changes in attitude, demeanor, sleeping habits, social behaviors, personality issues-anything out of character can be a warning sign. Granted, some folks don't have regular partners, but we can still see changes in casual acquaintances and peers.

Beautiful tribute.