HERBIE1

Although there are national standards of care, there are enough variations among EMS systems to make many of these questions difficult to answer. For instance, with more than one trauma patient, triage and treatment would depend on your available resources, skill level, distance to hospitals, availability of air transports, trauma center capabilities, etc. It seems to me that this study is about trying to either justify or vilify the memories of EMS providers- at least in terms of being able to provide quality care. I honestly don't know of any competent provider who provides care with a reference or protocol book WHILE in the presence of their patient. Look over protocols later, possibly check enroute to a call, but NEVER in the presence of a patient.

I generally don't glove up until I get to the scene- with one exception. When we are going to a known bonafide shooting or other potentially bloody situation, I double glove enroute. It is far easier to take off a pair of heavily soiled gloves and have another pair still on to use. I find it is very difficult and time consuming to put a new pair on after your hands are already sweaty.

OK- not sure why everyone is fixated on the "hero" thing, but whatever. Silly, stupid, unnecessary- yeah. Should they have ignored that car fire and drove past it? Maybe, but if that were my car, I would be glad they at least attempted to help. Using a hand line from a distance is really not much of a risk. Now if they decided to go into a structure fire like that- well obviously they should all immediately submit to a drug and alcohol test, and if they passed that, a full psych exam. I have no problem bashing FF's when the situation warrants, but I am not sure why we have all the hate here on this.

We were talking about PPE- risking your life one way or another. In fire, it's an immediate thing(we'll forget for a moment the inhalation of toxic gases during overhaul, which will catch up with you later, etc), and with EMS it's the possibility of contracting an illness. If you neglect to wear the right gear or take the proper precautions, you end up just as dead. Yeah, actually there IS a very good excuse.Unless the crew is on duty and temporarily doing a special event with their apparatus, if they are assuming a parade, social, or ceremonial function, they usually do NOT have their gear with them. They still may have a fully functional apparatus(hose, water in the booster tank, tools, all fittings and other equipment), but it is simply not in service to respond to emergencies.

I guess my question is- where WAS their bunker gear? Was it in their personal vehicles, since clearly it was not on their rig. Apparently they were not in service, so they assumed they would not need to put their gear on the apparatus. Let's look at it from this angle. You are driving with your family, and happen upon a bad accident- motor vehicle, fall- whatever. It happens right in front of you- nowhere to go. It's pretty bloody, and you have no equipment or PPE with you. What do you do? Ignore the situation, jump in and help as much as possible until an EMS unit arrives- knowing full well you don't have a pair of gloves to protect your hands? Could you just walk away from something like this when you know you could possibly help? I couldn't. Has anyone ever done mouth to mouth on an infant because there was no other choice? I can't speak for anyone else, but I do not have any equipment in my personal car- never did. I've also never been a volunteer where I may be called out anytime, anywhere. Have I attended to someone off duty, without gloves or any other equipment for protection? Yep. And I would do it again. Do I go out of my way to put myself in such situations? Hell no. Look- these guys jumped in and did their jobs. Is it an ideal situation? Nope, and I'm sure they would prefer bunker gear over dresses if they had a choice. And God forbid if something bad happened, it would be up to the insurance companies and/or pension funds whether or not they would honor a line of duty death. LOD is also defined differently by the folks who may need to pay benefits, and by the organization they work for. Sometimes we take calculated risks- it's what we do.

HARMLESS??? Happiness- how COULD you? How cruel and insensitive can you be?? Those toothpicks are potential foreign bodies in the eye, potential choking hazards, lawsuits waiting to happen... (Sorry just yanking your chain-trying to being as ridiculous as some folks here have been in this thread. Not easy to do...)

Like was mentioned, we have no idea of tone, inflection, or body language of this student. With anything, be honest, use plain language, explain what is going on, and the basics of why(based on the S&S's, EKG, and PMH, you appear to be having a heart attack) and what you plan to do about it. Remember, depending on the severity and location of the blockage, this could be a potentially fatal event, and the patient and family needs to know the truth and prepare themselves mentally. Unless this student related this information with a sneer, I see nothing wrong with what he/she did.

Wow. Looking at some of these posts- Did I fail to get the memo? It appears that happy hour has started early... LOL

All I have to say is that I thank gawd I work in a place where folks have a sense of humor. Do these pranks happen every day, 24/7? Of course not. Are they such that they are criminal or potentially harmful? No. Worry about a KY allergy because a door handle was lubed? REALLY? If it weren't for the occasional gag- usually when things are at their worst to lighten the mood- we would all end up in a nuthouse. (Oops- that term was probably unprofessional, too.) Doing 25-30 runs a day, if you cannot take a couple minutes to have some fun, you will end up in an early grave. This is about a little harmless fun between coworkers during downtime- nothing more. How does that make you "unprofessional" or diminish what you do when the bells go off? Lighten up, folks- you'll live longer. Some folks are just wound WAY too tight.

Incredible. It's so nice to hear GOOD news for a change. Very happy for you and your friend. Interestingly- I have a coworker who had the same thing- same problem, in the same place. She also had a coil inserted, and the only residual problem is a droopy eyelid that is now clearing up. In fact, I was playing "Words with friends" with her on Facebook as she was recovering in the ICU. LOL Modern medicine(and a lot of luck) is an amazing thing, isn't it?

LMAO Those were great.

Based on a 19 minute transport time to a Trauma center- First and foremost- LSG(Lights, siren, and gas) This guy needs a surgeon 5 minutes ago if has is to have any chance of survival. Textbook example of load and go and do everything enroute. Whatever treatments you can do ENROUTE- fine, but do not waste time on scene. Address the breathing issues,address the tension pneumo, 2 large bore IV's wide ENROUTE- he's already lost 300 cc's of blood, plus internal bleeding- you need to buy some time so he doesn't crash before he gets to the OR. An engine company is fine for help- bring them with since this guy is likely to code enroute. I'm thinking there will not be a good outcome for this guy- it all depends how quickly they can get him to the OR.

So sorry to hear that. Hang in there.

Done. I know EXACTLY what you are going through- similar situation with a nurse I have known for 20 years. Same c/c- head aches, nausea, dizzy. Drove herself to the ER,Collapsed, emergency craniotomy- HUGE bleed- was not expected to survive. Everyone essentially wrote her off- included all our medical community friends. Spent 1 week in a coma, woke up, and now 3 weeks later, she is currently in rehab, awake, alert, with some deficits, but can speak and move, and walk with assistance. In other words, ANYTHING is possible for your friend and I will keep him in my thoughts.

Poor taste? Only if you miss- it wastes ammunition. Already there. Good idea.

Outstanding post. Well Wendy, it would seem that we posted at the same time, addressing similar issues, albeit from different perspectives. I agree with you that around here, anything related to FF's is almost certain to generate at least a "few" negative comments. Where I work, for the most part, we can joke around about things like this: Well, I'm just a stupid firefighter, but..., or I'm just a "doctor", so what do I know. Example: Not long ago, a firefighter/coworker who is assigned to a very slow apparatus- had some cardiac issues. We would joke around, he would complain about aches and pains(he has 30 years in the department) and we would tease him that the only injury he should have is carpal tunnel or blisters from using the TV remote, and he would ask for a bandaid for his injured remote control finger nearly every day. We were the pain in the ass "doctors", always whining about how busy we were. All good natured, all in good fun. To make a long story short, one morning we convinced his stubborn ass to let us work him up and transport him, based on his very vague, nonspecific symptoms. Turns out he had nearly 100% occlusion of one of his coronaries, but no MI and no damage. After his PCI/stent, we visited him in the hospital. We obtained an extra remote control, taped a couple bandaids to it, wrote him a note, and left it in his room while he was having a test done. Later, he said of all the cards, flowers, and visits, he appreciated ours the most, but had a hard time explaining to his wife what it meant because she thought he still worked hard. LOL When he came back to work, it was an awkard and emotional moment for us- he said his doctors told him he was just about ready to have the widow maker, and lucky to be alive. He really appreciated what we did, paid for our meals for the day, brought cookies from his wife- and threw the remote we gave him back at us and told us to stick it up our arses. Point being- broad brushes are bad, and like you said, shooting the messenger is not the answer. We need to focus our energy and attention at the policy makers, NOT the foot soldiers. It would be like yelling at an Army infantry soldier for the policies that led us to the wars in Iraq and Afghanistan. Bottom line- we have far more in common with the fire service than we care to admit. It would serve us well to remember that fact when we are trying to elevate our profiles with the public and the policy makers. Now if such a FF "foot soldier: shows up here and starts spouting nonsense, then all bets are off, of course...

Not sure why, but I had passed on reading this thread. WOW. Talk about a major derail and right- and left- turn. Amazing that this poser was caught here- I guess the online EMS world is smaller than I thought. As for the derail with the illegals- Since I have no real dog in this fight (and before someone gets their undies in a bunch about this silly little phrase, I do NOT advocate dog fighting, I think it's barbaric and disgusting, but I am making a point here) I will simply say this: Although we all may be involved in EMS in some fashion, threads like this remind me of how different we really are. In my area, a comment about picking off illegals would be taken exactly as it was intended- a rude, tasteless, and unPC JOKE. It would be looked at in the same light as a crude or off color joke about women's or men's body parts, the intelligence of a blonde, or a "you might be a redneck if...". NOBODY thinks the person who utters such a phrase/comment/joke really does shoot illegals as they cross the border, or REALLY thinks all blondes have lower IQ's than everyone else, or that all folks who live in rural areas or the Southern USA are not too bright, or that all Catholic priests are pedophiles. That's what often makes these comments so funny- they may make us uncomfortable, unPC, are ridiculous, exaggerations, and yes, stereotypes that are ripe for picking apart because they are so outrageous. Is there a time and place for such humor? Yep, and I think most folks are able to figure that out. I'm all for elevating our status as a profession, but I fail to see how a few comments or jokes here somehow derails that pursuit. Should an EMS provider presenting a research paper at a conference start off his talk with a redneck joke, or tell a blonde joke? Of course not, and if someone doesn't realize that, they must be a blonde or a redneck... My opinion-after 30 years in this business, some folks simply take themselves way too seriously and/or have a hyperinflated sense of self worth and self importance. In my experience, they are indeed the rare exception, as most people I know and have met possess similar laid back attitudes. When it comes time to work, they are all business and completely professional. Off the clock, between calls, amongst peers in private- that's another story. Life is too short people- lighten up. (Note- this is not directed at anyone in particular, just a general observation, and probably triggered by some recent interactions in my current position.)

Not a slam at all, bud. Just pointing out how a FF from 20-30+ years ago is nothing like the ones just starting out today-and was not sure how familiar you were with them. Some of the changes are good- (generally more educated, broader knowledge base, more safety conscious) while others are not- less experience, different mindset and attitudes towards the job and life in general. I agree about the arrogance and pompous stuff, but we are talking abou apples and Buicks here. EMS and Fire fighting are 2 entirely different ideas that years ago were often thrown together for the sake of convenience and expediency. Has EMS gotten the short end of the stick since then? Absolutely, but because this is such an entrenched and ingrained system in so many places, changes to the status quo are not easy, as we all know. Until those changes DO occur, we will still get the occasional dick measuring contests and chest thumping that does zero good for anyone and only fans the flames of animosity.

Honestly, I really don't think those of us in the EMS business do too much bragging. The truth we see is generally stranger- and most of the time a lot funnier- than anything we could ever make up. Let me qualify that first sentence- most of us who have been in the business for any length of time. It does not take much time at all before we realize that fate/Karma/God/deity of choice- has a twisted sense of humor, and as soon as we get too big for our britches, we get a call that reminds us how little we know about this process of life and death.

Funny stuff, Wendy. I know we have a long standing division between nurses and medics, but some of these old school nurses are incredible sources of knowledge and practical experience. In most of the hospitals I have worked, some of the nurses do as much instructing of med students and residents as the doctors do.

I think there is a huge difference between some good natured ribbing, and mean spirited hazing designed to denigrate and belittle. I really think a good sense of humor is vital to lasting in this business with your sanity intact. I also see nothing unprofessional about some teasing. That said- what the OP was describing wasn't hazing or teasing- his preceptor was simply being an asshole.

The only time I have heard similar attitudes is during political debates on a current events board that I frequent. The elitist liberals of the board seem to think that public sector union employees do not deserve the pensions and benefits we receive because we did not "earn" them. I have never had anyone address me personally with such comments. Too much prednisone, maybe?... LMAO

I was making the point that people are dying because someone burned the Koran- by accident. Problem is, the REASON they burned it was because it was now contraband ,not just a holy book- they were being used as carriers of extremist messages. To me, they can get as pissed off as they like-it's no different than someone fashioning a prison shank. One of the acceptable methods of disposing a Koran- at least according to the Saudis- is indeed to burn it. Clearly the officials had every right to remove the Korans, and we can quibble about how they should be disposed of, but for the president of the USA to personally apologize for this is patently absurd. Have the commander of the base involved issue an apology, but that is as far as it should go. It reminds me of last year when the POTUS actually stepped in and called that lunatic in Florida to plead for him not to burn the Koran. REALLY? Since when does it fall on the POTUS to adopt Islam as the religion he deems worthy of defending at all costs? Further- the reaction to someone burning a flag may be severely pissed off Americans, but does not include rioting, murders, and executions, nor do I see the leaders of foreign countries apologizing for the actions of their extremists who burn our national symbol.

I'm surprised our president didn't apologize to the Muslim for his "inconvenience" of being arrested. He's apologized to damn near everyone else on the planet- including the idiots who are upset that their holy book was accidentally burned- even though it was used by the prisoners for sending extremist messages back and forth. It's also amusing that nobody is supposed to write in the Koran, but if they do or it somehow gets defaced/marred/ruined, the only acceptable solution is to burn the book. So who apologizes to the military guys' families who were shot by the same Afghani soldiers that trained them and supposedly were our allies? Sorry- tangent and soap box. I'm just sick and tired of how we bend over backwards because the left thinks things like this makes us appear tolerant, yet our enemies simply see it as a sign of weakness. I simply cannoth fathom how anyone can defend this.

Let me preface this by saying I work in a VERY conservative system- think 25 years behind the rest of the world. I have had several attending and EMSMD's tell me they would never allow someone like this to refuse prehospitally- for the reasons I mentioned. I get what you are saying about the kidnapping part, but I happen to agree with our docs on this. I would HATE to have to defend myself on a case like this in court. I would much rather have to defend why I took someone for definitive care who SEEMED to be fully awake, then have to explain how I "knew" the patient no longer had narcotics in their system and would not have a "relapse" but still ended up dead. By receiving a response to the narcan, it's essentially proof they were under the influence, and unless we do a tox screen, how can we know if they have metabolized all the drugs that clearly were in their system when we encountered them? In the case of any refusal of transport, all we can do is go by our assessment, of any evidence they are under the influence or incompetent in any way, but when we KNOW the person was under the influence, how can we assume their competence? The kidnapping idea has been drilled into our heads for years, yet I have never heard of a case where such a thing was charged, much less been proven. For years we would do the routine narcan pushes on chronic OD's, they would be fine and ready to do it again, but over the years, the strength/purity of the drugs seems to have increased exponentially. A few years ago we had a rash of OD's here where the heroin was laced with Fentanyl, and it took "gallons" of Naloxone just to get some of these folks breathing again. We saw many times where they would become fully awake and seemingly competent- only to see them nearly go apenic again. No, not every OD is so profound and intractable, but how can we be sure? Seems like a huge liability issue to me.