HERBIE1

A bear hugger is a warming device for hypothermia patients. It's basically a blanket filled with tubes of warm air that wraps around the patient. I'm sure there are plenty of similar devices with the same idea.

Bingo. That is the million dollar question. This isn't an issue that can be legislated away or solved by throwing millions of dollars at the problem. Do some minorities have difficulty achieving success because of factors beyond their control(family issues, where they live, etc)? Yep. So do some Asians, Native Americans, Poles, Italians, Germans, Greeks, and every other racial or ethnic group. There are also examples in every group of people who defy the odds and achieve success DESPITE their environment and upbringing. What about the folks who achieve success WITHOUT any special consideration- whether it's available or not to them? How do you explain that? I think in many ways, this economic meltdown has been a great equalizer. Middle class folks have found themselves struggling to survive- struggling to pay their rent or mortgages, to put food on the table, to pay for an education for their children, or even to find a decent paying job. Problem is, they are also competing on an uneven playing field. There are programs that provide special assistance ONLY for those who are of a protected class. The irony here is that the middle class funds these set asides with their taxes, yet can never take advantage of them- even though they may be just as "needy" as anyone else. Grants, scholarships, financial aid, hiring set asides, job promotions- all designed to address past inequities. Well, thanks to the horrible economy, the gap for those differences in opportunities has narrowed significantly, and in many cases has actually been reversed. Things like affirmative action and set asides were never about FIXING anything, they were retribution and paybacks to a very specific group that has had a horrible history of mistreatment here. That said, many other groups also have had tough times starting out in this country, and although they were never slaves here, they were also mistreated and discriminated against. From the mid 1800's and early 1900's, Irish, Chinese, Italians- nearly every ethnic group faced not only discrimination, but had the added barrier of having to learn the language to succeed here. For years, "No Irish/Poles/Italians need apply" signs were common in every major city. Accommodations and assistance has morphed into entitlements, and I'm sorry, but there is no way in the world you can justify lowering the bar or having 2 sets of standards. So, to your statement- how about not placing unfair barriers- or giving an unfair advantage- to further isolate and marginalize one group over another? Every person has an OPPORTUNITY to succeed here, but there are also no guarantees- for anyone.

Sorry Ruff, but the mere fact that you brought this up makes you a racist. Sadly, this is business as usual in many places. Not only is the concept accepted by many, but encouraged and legally mandated. This topic has been beaten to death, but nobody has ever been able to explain to me how lowering the bar helps anyone. I'm also quite sure a certain poster here will somehow justify this ridiculous idea.

I can think of plenty of black guys I admire and respect- including a former boss. I'd also bet the famous ones on my list wouldn't even register on your radar. They do not use race as a crutch, they do not play victim, and they obtained their relative levels of success via hard work- just like everyone else.

So a test to define racism means you need to shag someone of a different ethnic, cultural, or religious group? Really? That's your measuring stick? LMAO Thanks, crochity- you never fail to amuse- or amaze. Jesse Jackson would be proud of you. He's also fond of making outrageous, inflammatory, and ridiculous statements.

I have no problem with the exercise that was presented- as long as the instructor facilitated a good discussion after it. Unless the issue of stereotypes, bias, and prejudice was dealt with- at least in terms of nursing care, it would have served little purpose other than making some folks uncomfortable.

I think the point was that although this type of charting allows easier access, standardization, legibility, etc, it IS more time consuming. That means the nurses have less time to provide patient care, the workload backs up, and with a high census and the usual staffing shortage, the nurses can easily become overwhelmed. This is not a simple black and white issue- there are many factors involved here.

Why does it seem we are getting a lot more spam on the board lately? Has the bulletin board provider changed their policies, are they tweaking the system, or have the spammers gotten more clever? Maybe I'm not bright enough to understand, but if you need to register to post here, how do these folks get past all this?

Dwayne makes a good point. Since it was lay CPR, we have no idea if the person really was pulseless and apneic the whole time. Maybe, maybe not. Good story, anyway, and if it encourages more folks to participate in a similar situation, it's a good thing. I had a rocket scientist actually tell me that he woke up in cardiac arrest and did CPR on himself until he felt better. Of course I played along and told him he did a fine job. I relayed the story via the radio to the hospital- and I played it completely straight. My partner had everything he could do from bursting out laughing. When we arrived at the ER, we told the doc and the nurses we wanted to credit the guy with a save and give him an award. More proof that bystander CPR actually works!

Working conditions for nurses vary greatly from place to place, and even within the same hospital. Looking at an ER vs on a med-surg or gyne floor is like night and day. An ER may be swamped 24/7, but because their patient's acuity may be low, most patients are not admitted to the hospital. Thus, an ER could be overcrowded, yet there may be entire floors that are like ghost towns. I cannot speak for DC, but knowing their EMS system is overwhelmed, I'm thinking the hospitals are similarly afflicted. Too many question marks about health care right now. We don't yet know the impact Obamacare will have on hospital census and staffing levels, but based on what we know so far of this abomination, it does not look good to me. I'm thinking hospitals will be forced to do more with less, and that is a dangerous combination when dealing with people's lives. The "economy" is not responsible for poor reimbursement, nor is it to blame for the overcrowding in ER's, nor is it to blame for nurses being overworked in many places. Nursing shortages and staff burnout are age old and cyclic problems. Many nurses quickly become disillusioned when soon after they become new grads, they realize their ideas of what nursing is all about are quite different than reality. That's why those with the capabilities, drive, and money move up to a management position or take jobs in home health or education. The ones who- for whatever reason- cannot advance their careers are stuck working in the trenches, and can easily become overwhelmed. The problem with nurses in unions are similar to any other union job, The union protects the slugs, and the diligent and responsible workers can become abused. I have a friend who is a surgeon, and did part of his residency in a large local county hospital. Most of the hospital was unionized- from the clerks to the physical therapists, to lab workers, to Xray techs. If he needed a test result, often times he would run into the issue of union mandated breaks. Want that blood test stat? Sorry, I'm on break. Need a CT or Xray to be done or read? Sorry- I'm at lunch. With the volume of patients they had, most of the time there would be a horrendous backlog of test results, and patients would often wait hours before definitive treatment could begin. Often times he was forced to track down test results himself, run a test, or read a film just so he could begin treatment on a patient, and not wait for 8 hours to get the results of a simple CBC. I don't know the specifics of this DC hospital, but this issue is far more complicated than you portray it.

Looking at some of the scenarios and treatment done by "prehospital" providers in places outside the US, it's clear many areas hold their paramedics(or whatever title they may hold) in much higher regard than around here. That's fine, but it also forces that person to make moral, ethical, and medical decisions that are way above their pay grade. Not saying the right decisions aren't made, but if I'm acting like a doctor with little or no direct MD involvement, I want to be compensated in pay and perks as a doctor AND have the full legal backing of a hospital or organization if someone starts asking questions later. That said, maybe our counterparts in other places are not working in such litigious societies as we are and the rules are different, but the pucker factor here would NOT make me happy. I realize that in rural/remote areas normal rules may not apply, but still...

Kudos to all involved. More proof that we do not make the rules and that if it's your time, it's your time, but when it's not, someone can defy all odds.

Well done. When I teach this topic to firefighters, I get the usual- "Why do I need to know this stuff?" I explain to them that during the course of their FF duties, unless they commit a crime, they have essentially zero chance of jeopardizing their career. If they make a mistake, maybe a room sustains more water damage than it should, or an extra room is damaged because they did not get the building ventilated quick enough. Most mistakes are forgiven- fire is unpredictable, and unless you are familiar with fire ground tactics, few folks would ever know a problem occurred. An error would mean retraining, increased drills, maybe good natured ribbing from rheir peers- but nothing that would mean a loss of income or their job. I then show them examples of the bad things that can happen within EMS- and the concept of EMTALA is a big part of that- especially with private providers. I teach in the context of being an administrator, so I also frame the discussion on potential liability to their organization/municipality. Besides EMTALA, In EMS we also have medical protocols, local, state, and federal guidelines to follow, with various consequences for failure to abide by those rules. That means anyone associated with EMS- full time, cross trained, part time, volunteer, or along the periphery of the profession needs to be fluent in the rules which govern our job.

Unless you are talking about the type of football you play with your feet, I have never seen a trainer or medic doing cartwheels on the way out to an injured player. Do the players sometimes "oversell" their supposed injuries? Absolutely- especially when they blow a big play. Can't speak for soccer- cannot seem to wrap my head around that sport.

If I were that injured player, lying on the ground- I don't care if I was seriously hurt or not- as soon as I was physically able, I would proceed to beat the snot out of that medic.

Those are moral and ethical questions, not legal ones- at least in terms of our scope of practice and our obligations as health care providers. So you report the consensual sex. Then what? Does your moral or ethical obligation end there- especially if the nurse seems unwilling to act on the information in a manner you deem "appropriate"? Should you then call in a LEO to report your findings? If you are unsure, I suggest asking a LEO and get their opinion on the matter. If we find out about this consensual sex, do we have an "obligation" to report it to the parents to ensure they are aware? To me, the patient confidentiality issue is a HUGE one we cannot ignore, but I also feel that a parent is legally and morally responsible for their minor child, and they have a right to know what is going on. Clearly if the patient is upset about what happened, then I would encourage her to tell her parents, a family member, a priest- SOMEONE they trust. In our line of work, we see all types of illegal activities. From illegal cable TV hook ups and illegal apartments, to illegal gas line splices, extension cords running from one apartment to supply another who's electricity has been shut off. Clearly if there is a danger, it is our moral and legal obligation to report these things, but how far do we go with that? A parent asks why their teen daughter has been brought to an ER, and we know it's because they were drinking and passed out somewhere. Aren't we obligated to tell them that? To me, patient confidentiality is about medical issues, not ethical or behavioral problems, but in the case of a minor, the parent has the right to know what is going on with their child. Implied consent tells us we are supposed to act in the best interests of the child. In other words, we are supposed to act in a manner that any prudent parent would. Well, my idea of parental responsibility may be quite different than in another family, so my intentions and ideas may be quite different than someone else's. Maybe they have no problem with their 15 year old getting drunk, or having sex for money. Maybe they are completely uninvolved with the raising of their children. Maybe they think you have no right to infringe on their personal/family issues. Lots of gray here- interesting questions...

Mistakes and mix ups happens even in an urban area. We have people who SWEAR to dispatch they have given the right address, yet we are standing at that location and it's an empty lot, or nobody there has called. They mix up Street and Avenue, Place and Street, floor numbers, etc. I've had people give their old address, and forget they have moved. Cell phones are a help, but they are not associated with a fixed location. That means even with a CAD system, you cannot verify that a phone number corresponds with a certain building. The matter of triangulating their call or contacting their carrier is not a simple matter, plus it takes time you may not have. Then again, in the vast majority of such cases, the call was anything but an emergency- foot pain for 2 weeks, ran out of their meds, help me change the batteries in my home BP machine, pain in my legs for 2 years... There is really nothing you can do. You need to be familiar with your area, but if we don't get the correct info, there's really not much we can do. The most difficult situations are 3rd party calls. People SWEAR their friend or family member is home, they cannot get reach them, and when we arrive, there is no answer. I've had more than a few cases where we ended up doing a forcible entry into a home, destroyed a door lock, jamb, or a window, and find out the place was empty. A couple times the resident returns home while we are there and are horrified that their property was damaged. I feel bad, but explain that someone was certain they were in trouble and needed help. About 20 years ago, a crew had a similar situation, but were assured by a neighbor they saw the patient leave the house. The crew did not do a forced entry, left, and returned several hours when the husband came home to find the victim dead on the floor. HUGE lawsuit. I'd rather apologize to the resident later than have to face a lawsuit and justify why we didn't make every effort to gain entry and confirm a person's status. I can't speak to other areas, but here the city actually compensates the person if we do make a "mistake" such as this. Still cheaper than a wrongful death lawsuit.

Not our job to worry about the underage sex. Are we mandated to report it? No, not unless it's an abuse, but if this was consensual sex, I'd mention it to the hospital if pertinent, but are we obligated to "report" every single law we see broken? As for drugs: Real life- I'll never forget the first time I found crack cocaine on a patient. I showed the cop and he couldn't have been less interested, Unless it was a piece the size of grapefruit, it simply was not worth their time, effort, or paperwork. Kinda deflated my ego- I thought I was being a junior cop and scored a huge win for the good guys. LOL I will say that if we have a patient who exhibits an altered mentation or is injured, I WILL document and related to the ER that I saw drugs and/or paraphernalia on the scene, especially if the patient denies drug use. In that case, the issue of drug use is directly related to the care they may or may not receive from us or the ER. Drug users and especially dealers- are wary of admitting anything to us. Although we are not LEO's, we are authority figures and they assume admitting this will lead to their arrest. Even when we KNOW a person has been using drugs, even when we say- we are not the cops, this is privileged information- they simply do not want to be honest with us.

Welcome, and good luck in school.

Welcome, and jump right in!

Nice. Was she still on the job, Richard or was she terminated?

After 4 years as an EMTB, you certainly know what's going on. So as several have said here, the only question is do you want to be a paramedic? If so, NOW is the time. Don't stop, because chances are you may lose your motivation, and too often life gets in the way, not to mention the fact that advanced training opens up many more doors for you.

I like these. I would also add: -Never be afraid to stand up for yourself and defend your actions. -Never be afraid to question authority- as long as you are on solid ground, and have a viable alternative to offer. (Example- a lousy policy that adversely impacts the patient, you, or how you do your job)

A PLANE IS ON ITS WAY TO CHICAGO WHEN A BLONDE IN ECONOMY CLASS GETS UP, AND MOVES TO THE FIRST CLASS SECTION AND SITS DOWN. THE FLIGHT ATTENDANT WATCHES HER DO THIS, AND ASKS TO SEE HER TICKET. SHE THEN TELLS THE BLONDE THAT SHE PAID FOR ECONOMY CLASS, AND THAT SHE WILL HAVE TO SIT IN THE BACK. THE BLONDE REPLIES, "I'M BLONDE, I'M BEAUTIFUL, I'M GOING TO CHICAGO AND I'M STAYING RIGHT HERE." THE FLIGHT ATTENDANT GOES INTO THE COCKPIT AND TELLS THE PILOT AND THE CO-PILOT THAT THERE IS A BLONDE BIMBO SITTING IN FIRST CLASS, THAT BELONGS IN ECONOMY, AND WON'T MOVE BACK TO HER SEAT. THE CO-PILOT GOES BACK TO THE BLONDE AND TRIES TO EXPLAIN THAT BECAUSE SHE ONLY PAID FOR ECONOMY SHE WILL HAVE TO LEAVE AND RETURN TO HER SEAT. THE BLONDE REPLIES, "I'M BLONDE, I'M BEAUTIFUL, I'M GOING TO CHICAGO AND I'M STAYING RIGHT HERE." THE CO-PILOT TELLS THE PILOT THAT HE PROBABLY SHOULD HAVE THE POLICE WAITING WHEN THEY LAND TO ARREST THIS BLONDE WOMAN, WHO WON'T LISTEN TO REASON. THE PILOT SAYS, "YOU SAY SHE IS A BLONDE? I'LL HANDLE THIS, I'M MARRIED TO A BLONDE. I SPEAK BLONDE." HE GOES BACK TO THE BLONDE AND WHISPERS IN HER EAR, AND SHE SAYS, "OH, I'M SORRY." AND GETS UP AND GOES BACK TO HER SEAT IN ECONOMY. THE FLIGHT ATTENDANT AND CO-PILOT ARE AMAZED AND ASKED HIM WHAT HE SAID TO MAKE HER MOVE WITHOUT ANY FUSS. "I TOLD HER," FIRST CLASS ISN'T GOING TO CHICAGO "

That must have been great CPR- not only ROSC, but good enough to allow the patient to tell the police to call her husband. This is not strange at all, Dwayne. I've had several people assure me that they were in "cardiac re-rest" before I arrived. LOL Look, is it tragic this woman died- of course. I'm quite sure the investigation will point plenty of fingers, a hefty lotto settlement will bring the family comfort and justice, a circular firing squad will ensue, and in the end, little if anything will change. (Can you tell I'm just a wee bit cynical?)