HERBIE1

Well, I guess I'm just a kid at heart. If patients or family are not compromised and nothing is actually damaged, I see no harm. It's been a long time since I actively engaged in this stuff, but I still appreciate a good gag. As we get older, we apparently become "too mature" for such childish humor. Overall, I think people need to lighten up (often times, myself included)- our business is serious enough. There's nothing wrong with having a little fun. Life's too short, folks- and I don't think anyone knows this better than us. Enjoy it while you can.

Not my forte, but I would be thinking some type of metabolic issues. Baby feels hot- initial thinking was febrile seizure. Field Tx would be supportive, O2, IV, and have anticonvulsant ready PRN. Eyes bulging is strange, but I have seen that in simple febrile seizures too. BGL isn't a real concern to me, but periods of apnea still suggest some type of seizure activity. Possible mass- need CT, blood cultures, complete lab work up, UA, lumbar puncture to rule out any CNS issues/infections. I hate pediatric calls- scary, too many variables, and they cannot tell you what's going on. Other possibilities- accidental ingestion of a chemical, medications, illicit drugs, etc.

Like any business, sadly, morons do slip through the cracks. We'll always get our share of thieves, junkies, and psychos- and those are just the managers...

Agreed. Always did it while the rigs were at hospitals, after they delivered their patients. Never interfered with patients or family members who may be riding with. I may be a smart ass, but I'm not ignorant.

Unfortunately in many areas, it's the cost of doing business. Like most of the mopes, I guess the shots were probably meant for someone else- they rarely hit who or what they are aiming at. Glad nobody was hurt. As for Kevlar vests- I have mixed feelings on these. When I was working full time in the ghetto, I purchased my own vest, but only wore it when there was a nasty gang war going on. The city refused to provide them- as with anything, the liability issue was their main concern. What if someone was not wearing their vest and gawd forbid got shot? Would the city still cover them as a duty related injury? Would they be mandatory for EVERYONE, regardless if you worked in a ghetto or an upscale area? What if one of those upscale rigs was called into a ghetto and did not have a vest? My fear with the vest- with my bad luck, I would take a head shot, and vest or not, would be just as dead. At work, my head is always on a swivel. I look for potential situations that can turn ugly- a neighbor, bystander, family member, friend- who suddenly appears out of nowhere. Some of the scariest situations I have ever been in had nothing to do with a GSW victim or some other violent act. Thankfully, we are usually NOT the targets, but could easily end up in crossfire.

Good one- I like that!

Ruff alluded to this in another string, so I thought I would continue on that theme. What dirty tricks have you played on coworkers? The K-Y on the door handles is a good one, turning on all the lights and siren- especially in an enclosed garage or ER bay, baby powder on the visor, so when they pull it down they end up looking like a ghost, pour some baby powder in the vents outside so when they start the apparatus, they get a talc shower. One partner loved his remote fart machine. He'd set it up under his female partner's seat and control it from the back. It was especially embarassing on nonemergency transports when a family member thought the driver had some serious GI issues, and the driver thought the family member had chili with extra beans for lunch. One day he set up his machine at a favorite ER we frequented in an area where nurses and docs do their charting- away from patients. We watched from a safe distance and I honestly cannot recall ever laughing so hard in all my life. Docs looking at nurses, nurses looking at docs, residents and students pretending they didn't hear anything, unit clerks blaming everyone else...We finally busted ourselves when we were caught literally doubled over guffawing, with tears running down our faces. One of my favorite pranks- Years ago we had a department inspector who's sole job seemed to be checking door handles to ensure your apparatus was locked. Obviously a good policy, but when someone got in trouble because after delivery of a cardiac arrest(a save, no less), they forgot to lock one of the ambulance doors. It was an enclosed ER bay, fairly secure, but yes, technically still wrong. Well, as the inspector was gleefully checking the doors of the apparatus, someone noticed the doors of the inspector's car were open, key in the ignition, and the engine running. One guy- who became one of my personal heroes thanks to this- jumped in the inspector's car and drove it 3 blocks away. He turned it off, locked it up, and returned to the ER bay with the keys. The inspector was FRANTIC and they let him sweat for about a half hour until someone "found" the car for him. That was the last time the door checker bothered anyone. Childish? Sure. Unprofessional? Maybe. Hysterical? You bet, and great for morale. \\So-is anyone else a kid at heart? Just thought of another favorite. In the busy summer months, we used to carry those large 100CC Toomey irrigation syringes like guns. We'd fill them with water and when we pulled up on a crew and they opened their windows, they'd get a bath. Harmless, but also hysterical. Sadly, those pranks were old school and I have not engaged in them for years but they sure bring back fond memories.

Trust me- I worked with more than a few RN's who were "impaired" as well as docs. One was even fired for playing games with the narcotics logs to support her habit. This was also before drug testing, so it was a lot more commonplace then. I even knew a pharmacist who readily admitted she had a substance abuse problem- although her's was alcohol, and I never saw her impaired at work. Damn shame, too- this woman was drop dead beautiful, brilliant, and a helluva good time to party with. LOL Problem is, they show House popping pills like they are M&M's as he's walking around the hospital, working. I've NEVER seen that.

You are truly an evil person. LOL I bet they have vodoo dolls with your likeness and do nasty things to it when you leave... What's an "rta"?

My family LOVES House. Personally I think it's a ridiculous show. Every day they deal with some bizarre disease or issue that nobody has ever heard of. A doctor who everyone knows is a drug addict, but happens to be a brilliant diagnostician, so they ignore his problems. He walks into surgical suites with no gown, mask or gloves, just to bust the chops of some flunky resident? Bull. I realize it's TV but come on- how about at least a LITTLE realism, folks?

I realize this is a resurrected string, but still quite amusing. When working in an ER, we NEVER used the "Q" word- it was a crime punishable by death. As for working on the streets, I am considered by many to be a shit magnet. If it's crazy, huge, strange, nasty- it will happen to me. It seems to have rubbed off on my partner since when I am not there he has his share of insanity as well. Example: I can honestly say that in the history of my big city, very busy urban department, to my knowledge, I am the only one who has ever had to deal with a lion attack. Can anyone top that?

Grrrrr.... I get to enjoy EMS week- and then some- at home. Slipped and fell down the stairs at home and fractured a rib(Officially did not get the word but does not matter since the treatment is the same.) Based on the location and type of pain, I'd bet the mortgage it's a fx. (They asked if I really wanted the X-ray and I declined) The dilaudid worked well with with Toradol and Valium in the ER, but Vicodin and Valium at home are NOT cutting it. Waiting for my doc to call back and have pity on me for something better. Thankfully the break is low, posterior and lateral so breathing isn't affected. Had one of those before- no fun either. Still hurts like a sonofagun when I move the wrong way. NOT a good time for this- way too many things planned in the next couple weeks. Hopefully my partner will collect any goodies the ER's happen to be giving out.

Agreed, but unless their HIv/AIDS was relevant/pertinent to their injuries and situation and thus their treatment, I would simply leave it out in the radio report. Obviously you would document the whole story and fill in the hospital later, but I see no harm in leaving it out of the radio report. I've done this in the past and was told later by the hospital it was the proper way to handle it. I've had young girls reluctant to talk about being on Birth control pills, or males taking things like Viagra- especially if the patients happen to be only casual acquaintances. That's their prerogative, and often for no particular reason, patients don't give us an accurate description of their PMH anyway. In MVI's, your radio reports are generally abbreviated anyway- many times you only give basics like stable/unstable, triage color, ETA and basic treatment, so omitting specifics isn't a big deal. Just make sure that when you arrive at the hospital, you fill in the ER's on any details you may have omitted.

A big hit in the classes I taught to kids was some type of a demonstration. When my daughter was in 2nd grade, I spoke to her class- the usual safety ideas- helmets, traffic safety, simple rules of the road, stop, drop and roll, meeting points, smoke detectors, basic first aid, what to say when calling 911. The biggest hit- using my daughter as a guinea pig. I set up a scenario- going to baseball practice/dance class/the grocery store, etc, and you get into a traffic accident, someone calls 911, and they see what happens. Be creative and dramatic with the scenario- the story was important to the set up- they all love drama and a good story. I showed them what would happen to them once the ambulance arrived. Quick exam, vital signs, etc. I put on a C-collar, splinted her broken arm, and secured her to a backboard, and wrapped up her injuries. I even got the kids involved. They LOVED it. 3 years later I still hear how much the kids loved that day. My daughter earned major brownie points with her friends because she was so brave. LOL You can even tailor the scenario to the older students. On the way home from a date, the driver was DUI. Make the injuries severe enough to scare them. Use the cardiac monitor, pretend you are starting an IV, "check" their glucose levels, etc. I saw a recent You tube video that showed a bus accident and how unrestrained folks fly around. It was VERY dramatic and showed the forces involved in an accident. I found that just lecturing them makes their eyes glaze over- especially the older ones, but object lessons tend to get their attention. Of course, handing out goodies- stickers, pencils, books, fire hats, etc are always a big hit too.

No, because it's a liability issue. If you are responding to an emergency and do not have your lights and siren activated and get in an accident, you will be at fault- at least in terms of department policy. I honestly don't know about law enforcement's side of the equation. Even though you could present a strong argument to defend what you suggested, it would still be a loser. If- gawd forbid- someone was injured or killed as you were sneaking down the shoulder, the lawyers could easily say that the victims had no idea an emergency vehicle was coming and go after the city and department for damages- and they would win. Like I said-riding the shoulder is a last resort and when done, it's only at a crawl.

I tend to agree with you about the volunteer bashing here, but I also do not work with volunteers. I've always held the opinion that because we have so many models of service in this country- paid on call, fire based, private, county, hospital based, volunteer- that a one size fits all solution to problems in EMS is impossible. We have various levels of certification and every conceivable combination of providers. What works for one area will NOT work in another. What I will agree with is the fact that in most cases, fire based EMS is generally NOT the best solution- and certainly no friend of single role EMS providers. The emphasis is always on FSR- funding, training, PR, equipment, apparatus- and EMS usually gets the left overs. I don't know what the answers are, but I do know it would be silly to bash a system I do not work in, and have no idea about. If an area cannot afford to pay providers, but some folks are willing to step up and help their own community, it seems to me that they are extremely valuable to that particular community.

Horrible. This is EXACTLY the reason you always pass on the left. Even if you have to sit behind someone and blare on the siren and air horn, you wait until THEY pull over. One situation that I HATE is on the highway when traffic is backed up and the only available access is the right shoulder. It's dangerous but cannot be helped since there is no way to move multiple lanes of gridlocked traffic over onto a single shoulder. I cringe all the way to the scene and pray that nobody from the right lane decides to move over and cut us off.

Let's put it this way. Too many variables. What if the victim's skin is wet- sweaty, water, emesis, etc? That would conduct the electricity away from where you want it to go. What if the pads are not entirely snug against the skin- gaps, cracks, etc? What if some of the gel gets smeared as the pads are applied? No way am I putting my hands on someone while they are being defibrillated. There is no reason why you cannot pause for the few seconds it takes to deliver the shock. I do know of a guy who was accidently shocked when the floor of the rig was wet and the provider received a shock via the floor. Anecdotal? Yep, but good enough for me. The guy spent 23 hours in an CCU with arrythmias, but luckily no permanent damage.

Wow. Tough spot to be in. Wait for the results, and by all means get MULTIPLE opinions on DX's, TX, and prognosis. Good luck.

Gotcha. Not exactly scientific. Good luck with the paper, dude. Let us know how it goes.

Obviously if your response area includes multiple cities/towns/counties, then knowing each grid system(if they have one), local eccentricities, hot spots, buildings, etc will be impossible. The point is, you need to know the areas you work in most often. Every day try to learn something new about your area- a new street, a new access road, a better route to get to a hard to find area, etc. Taking an extended period of time to arrive at a call because you got lost makes you look silly and puts your patient in danger. Many times dispatch has a large map or computer display even if your apparatus does not. ASK them if you are unsure of where you are going. It's a helluva lot better than driving in circles because you can't find an address. Have dispatch check with the caller if possible to see if they have special access instructions on locations that are unfamilar or hard to reach.

You are right- there is no substitute for feet(or wheels) on the pavement- figuring out best routes, ingress and egress points in large complexes, best doors, elevators, parking issues, etc. It is also essential to know your area when requesting additional resources, assigning hospitals in an MVI or mass casualty situation. Here's an example of what happens when you become too dependent on technology. About 15 years ago, we went to a computer aided dispatch system, coupled with triage dispatch protocols. Before we went hi-tech, the dispatchers knew the city like the back of their hand. Response districts, landmarks, and they even knew which crews could be counted on to come up early for runs if things were getting crazy. A couple years ago, our disptach system went down for about 8 hrs and everything needed to be dispatched manually. Dispatchers needed to keep track of calls, crews, locations, etc. The vast majority of the dispatchers now were hired AFTER the automated system was implemented, and they had NO CLUE what to do. Within about 30 minutes, the city was up for grabs- crews crossing each other, passing one call enroute to another, duplication of responses, etc. Dispatch would ask a crew's location, but when they got an answer, they had no idea what it meant, or how far away they were to an incident. Response times soared, and luckily, to my knowledge, no untoward outcomes or lawsuits occurred, but it was a major cluster f**k. The old timers(now supervisors) had to step in and take over because they were the only ones who knew the city and what they were doing. These days, our dispatchers are like monkeys- a couple keystrokes and everything is handled for them. There really is no skill involved- responses are generated with the touch of a button.

Mistakes happen. Vanity addresses- buildings with special numbering that honor the company or builder can be confusing. New subdivisions spring up and are not listed on any map. Missing signs, poor lighting, bad or incomplete info from callers, 3rd party calls- there are a million reasons why things like this can happen. As was mentioned, the best way to avoid these problems is to be familiar with your area. Do REGULAR area familiarization- keep an eye on new developments, buildings, new streets, road closings, etc. It's as much a part of your job as your medical knowledge- you can't help someone unless you reach them in a timely fashion. For those of us old timers who started long before GPS, ONSTAR, and AVL's, we needed to learn where hospitals were at, nursing homes, the numbering system of the city, major landmarks and tourist attractions. Then, when you were assigned an area you needed to learn details specific to your district- dead ends, one way streets, cul de sacs, new buildings, alternate routes in case of road closures. Depending on your system- if you live in a large area, you can also easily travel great distances when call volume is high, so the more you learn, the better off you will be. It takes time, effort, and experience (just as with the patient care aspect of your job) is critical to being an effective, PROFESSIONAL provider.

Tskstorm- I'm not sure what you will do with the data, but unless this is a truly anonymous survey, I think most of the answers will be PC. Clearly this is supposed to bring out any biases folks have. I would be fascinated to learn the demographics(age, location, sex, race,ethnicity) of folks who respond to a survey such as this. I'll try to answer these questions honestly, based on my experiences of working in this area for over 25 years. Clearly this is unscientific, I'm not using official census data, just anecdotal evidence and personal experiences. I will also refrain from giving a simple yes or no answer since I think it is impossible to give an accurate answer in that manner. I also do not like the universal descriptor "all", since that leaves you with a false choice. I will also define "poor" as someone who can probably qualify for and collect government assistance, meaning not just someone who is homeless. Again- answers are based on this area and my experiences- 1. What race are poor people? All races, but predominantly black here. 2. Are poor people all alcoholics? No, although a significant percentage seem to have substance abuse problems of some type. 3. Are poor people all drug abusers? See above. 4. How old are poor people? All ages 5. Do they live in city or suburbs? Both, but the poor have far higher concentrations in urban areas- more social services to help them. 6. Are more poor people male or female? Both, but for different reasons. Women often have dependent kids to support and take care of. 7. Are poor people lazy? No. Leaving substance abuse issues aside, it's more like a mindset that has been programmed into them. Bad choices, bad influences, no support, etc. 8. Do all poor people have one or numerous kids? Generally numerous, but not as many as 10 or so years ago. 9. Is lack of education a reason for being poor? Yes, in large part. 10. Is low minimum wage to blame for being poor? NO. 11. Are all poor people unkept? No. 12. Is government assistance enough for poor people to survive? YES. In fact, in many cases, it's why people remain poor. 13. Is social mobility (moving up or down in class) possible for the poor? Yes- anything is possible if you want it bad enough. 14. Do the poor pay taxes? Predominantly sales taxes. 15. Do all poor people steal? No.

Damn funny! I'm stealing this one: Firefighter: The only job where you WAKE UP when it is time to go home. Completely accurate.