HERBIE1

Happy Birthday ITKU2ERI! 29 and holding, right??

Well, if they are pushing the amnesiac effects, then I see problems with this. The conscious mind may not recall the trauma, but I would assume at some level, there is a stored memory that could resurface at any time. I read the article too and found it interesting. Simply blunting the pain can't be the answer either, since many PTSD events aren't due to physical trauma or injuries. We simply know so little about the brain and how we form memories, this is a tough subject.

I was already in the business for about 10 years when I met my now wife. I got a step son- immediate family, and we had 2 more girls, now 10 and nearly 13. My wife is in education- administration at a university, so she has nothing to do with this business. You'll hear positives and negatives about relationships within the business. I had dated people in the business and outside, and I have to say it really depends on the person. How accepting are they to a spouse who works hours other than 9-5 and is often gone all night, or for an entire 24 hour period? How flexible and empathetic are they? Do you want to talk about the business 24/7, or do you want a break from it? What are your other interests, hobbies, and ambitions? I think the fact that I was already in the business when I met my wife helped- she KNEW what she was getting into. We are a different breed- irreverent, generally outgoing, and risk takers, and a spouse needs to not only accept that, but understand and embrace it. It's part of who we are and why we do this job. My wife still thinks I am insane. LOL The kids understand about dad's schedule- it's all they know. The positive in this situation is because I work a 24 hr platoon schedule, I am around during the day for school activities, to be a chaperon for field trips, be active with school issues, after school activities, etc and when they were infants, I was Mr. Mom- still am, I guess. I know all their teachers and they know me, and am on a first name basis with the principal and vice principals. Was it difficult at times- hell yeah, especially when they were infants and I had to try to stay awake to care for them after work. There were many times when I would go nearly 2 days with little or no sleep. You do what you have to do. I was able to see my kids grow, was around for many of their "firsts", and when I was growing up, few dads could say that. Certainly not mine- he worked long hours in a traditional job. I am also able to keep tabs on their personal problems, "tragedies", and triumphs. So far they are top students, involved, well adjusted, and happy kids. Fingers crossed... Do you miss the occasional event, holiday, familyproblem, etc? Of course, but you adapt. We made special arrangements with Santa and the Easter Bunny to stop by early or late when I was working. They were OK with that. Sometimes an entire day away from home is also a mental health break I desperately need. As understanding as a spouse may be- and mine is- without being in the business, it really is impossible to truly understand the stressors of the job. There are times when I come home after a bad shift and they know I simply need some down time- whether to sleep or just chill. You need to separate the two worlds(home and work) as much as you can, and sometimes it's impossible. A SIDS baby is always hard, but even moreso if you have a baby at home. Conversely, if you are having a spat with your spouse, try not to take those problems to work with you- it's usually impossible to do anything about it there. Be clear about your career goals, and what the demands of the profession will be on you and your relationships. I know you are new, but it will quickly become apparent what it's all about. This business becomes an integral part of who you are- as it should be.

Good luck and be safe down there.

Leslie Nielson: "Nice Beaver!" Priscilla Presley: "Thanks. I just had it stuffed!"

I was about to ask how many providers routinely immobilize GSW's and SW's until I read this: "In the national data used by his group, only 4.3 percent of shooting and stabbing victims were immobilized before being taken to the emergency department." Seems like a no brainer to me. That would be like doing a complete cardiac work up on a patient who has a lacerated hand- just because they have a cardiac history. The only time we immobile these patients is if the injury or mechanisim of injury is suspected to involve the CNS or vertebrae in some manner. I understand about ballastics and the unseen damage a bullet can cause, but let's be realistic here. In a severe trauma, time is of the essence and fully immobilizing every GSW, SW, or other penetrating trauma seems like a waste of precious time. We do use BB's to assist in rapid patient movement, especially if the scene and/or PT is particularly bloody. Easier and safer to pick up a backboard then an unconscious, slippery patient who is full of blood and body fluids. You can then transfer them to the cot or ER bed as needed.

Yep. Old man Joe was an original bootlegger. The mafia(the Italian mafia, not the Kennedys) became incredibly powerful and wealthy. Of course the system is corrupt, and the irony here is the people who are most sleazy (politicians) are the ones who are allegedly trying to stop the corruption. Insane, isn't it?

Agreed. LEO's here know that if god forbid they go down in a shoot out, we are the ones that respond to them. They take care of us, and vice versa. I agree, running into a shootout with no weapons or training is NOT a good idea, but I think most of us have been known to take a calculated risk or 2 when we know someone needs help, and thought afterwards- "Gee, maybe that wasn't the brightest idea." Think about some of the situations we find ourselves in- an MVA on a deserted highway where the scene may not be secured. Crawling into a mangled vehicle, hole, etc- we do what needs to be done.

As we know, bans do not accomplish anything other than providing a revenue stream for "entrepreneurs". Here in the states, Prohibition (alcohol ban in the early 20th century) only provided a means for the Mafia to come to power. Drug "bans" have only caused gangs and drug traffickers to make BILLIONS of dollars. Gun bans- same result. Regulate, tax, decriminalize small amounts- there are ways of reducing the profit motive, which drives this whole thing. Like you mentioned, it's not likely to happen, and if it does, then doesn't it also mean we are still throwing up our hands and giving up on the issue? Tough call, but how can we put people in jail for years for drug offenses, but turn around and offer free needles to junkies and even show them how to "properly" use those drugs? It boggles the mind and seems pretty darn hypocritical, if you ask me.

If it's a nonlifethreatening situation, then there is no reason why someone cannot wait. If a system decides it will respond to and transport essentially every call, then barring unlimited resources, what else can you do? If someone c/o a lacerated finger, I'm thinking the odds of it developing into a life threat after a few minutes of waiting are essentially nil. Again, unless a crew can downgrade or offer alternatives to an ambulance transport once they assess the problem, people will still abuse the system. Leg pain x's 3 months turns into chest pain, but if the person has underlying medical problems, you could argue all day about the "potential" for a DVT or other serious problem, and the person is transported anyway. The problem is a societal issue. Unless there are consequences for misusing an emergency system, nothing will change. If I call 911 and my problem is NOT a life threat, my insurance will not cover the ride. Same for getting prior approval for an ER visit- if I simply show up with a sore throat at an ER without making the proper notifications, I eat that bill. Even for someone on public assistance, there needs to be some central clearinghouse/screening process that assesses the need for an emergency response and gives prior approval. We do not have that threshold to funnel nonemergency cases away from the emergency system for anyone who does not have private insurance. Obamacare will not change this problem. I admire what Cleveland is trying to do, but I think their city lawyers may be getting really busy.

Gotta love Ray Stevens. Funny stuff.

Royal Canadian Mounted Police.

People who seem to be perfectly healthy also drop dead every day too. Obviously this is something that can easily be abused but as anyone in a busy system knows, there are many calls each day that are NOT emergencies by anyone's definition of the word. I kinda like the idea of offering those nonemergency calls a ride at non peak times- as in after 0300 on weekdays. I would bet that most people would find alternate transportation rather than wait until the middle of the night. I also agree with CB that many more citizens will have SOB and chest pain. The public has gotten much more sophisticated and know enough terms and catch phrases to defeat dispatcher's triage protocols as well.

I never said all drug abusers were street scum. Problem is, once someone starts abusing drugs they are engaging in the behavior that puts them at risk for contracting all the diseases associated with that behavior, as well as the associated traumas you get while living that lifestyle. Do some people infect their spouses with HIV or Hepatitis- yes, but does anyone really think this is anything more than a small subset of this group? Legalizing may be too much, but I agree with decriminalizing a small amount of it to where profits are not worth the effort anymore. Obviously that would save BILLIONS of dollars, which could then be spent on prevention and treatment.

LMAO How about getting some prisoners to do this on a work release program? If they keep a provider safe for 3 months, you knock off time on their sentences. Whatcha think??

This will be an unpopular view and I can't wait to see how many people give me a negative response to it. Don't care... To me, this is like throwing up your hands and giving up on the problem. This whole notion of things like handing out clean needles to addicts or putting out a how to inject heroin manual is insane. How does this really help the drug addict, or even society in general? Of all the friends, coworkers, and acquaintances I have, from all walks of life, I know of NOBODY that has become infected with HIV or even things like Hepatitis B from anything other than engaging in at risk behavior. Treat the addict, come down HARD on the dealers, or decriminalize, which takes the motive out of the equation- profit. If we are treating this idea- putting out a pamphlet- as a PSA and a public health initiative, then why don't we hand out info on ways to get free booze to alcoholics too? After all, people engage in all types of illegal activities to support that habit which results in injuries and health problems to them and to others, costs millions of dollars, so what's the real difference here? We're OK with the notion of handing out free needles to drug addicts yet someone with a legitimate medical condition like diabetes needs to BUY their own needles. Doesn't anyone else think this is crazy? Let the flaming begin...

Yep, but they rarely even hit the groups they are aiming at either.

K- I'd agree with the idea of lawyering up. As for not posting, as long as you don't violate company policy or PHI issues I see no reason to stop. My only question- If you are posting while working, is it against company policy to do so?

I just had a horrible visual: Oprah pole dancing. \\\\Shudders...

Dust, I have enough friends in the sticks to understand that you are exactly right- that's why I mentioned pot farms and meth labs. I KNOW you have guns, but you also know how to use them. The thing is, when folks in the boonies shoot, they generally hit what they are aiming at. In the city, the intended target usually gets away and innocents get hurt. I always say that the best case scenario is if for some reason I am a target, I hope a gang banger is actually aiming at me because I have a damn good chance of getting away without a scratch. As a public service, I advocate sending gang bangers to school to learn to become better shots and how to handle their weapons. I've had more than a few idiots shoot themselves in the legs, butts, and even "privates" because they don't understand how their weapon works(ie a bullet in the chamber, safety's, etc), or are showing off.

Wow. I work out at the wrong gym. Pole dancing?? I think I need to pay a visit to the suggestion box at Bally's... I'd be in the best shape of my life- I'd be at the club for hours at a time! LOL

Even a few miles makes a difference. The kids I teach are from outlying areas, and the issues they have are much different than I face. Folks who work in well to do areas have to worry about things like taking off their fire boots when they enter a nice house for a medical call so as to not damage an expensive carpet, or a freshly waxed marble floor. " Do you know that it costs more to clean this carpet than you make in a year!!" They actually get complaints from the citizens and are reprimanded for not being more respectful of people's homes. LOL That would NEVER fly around here.

Totally agree, but what about the 5 foot 1", 110lb provider? Their options are limited. Years ago I worked with a girl about that size, but had the mouth of a trash talking WWF member. After hearing her go off on someone in the middle of a crowd of hostiles, I went bananas on her. I said she has every right to speak her mind- except when it endangers me, and if she was instigating a fight, I would NOT be backing her up. She was incredulous- "You can't leave me alone like that!" I told her- "Try me." It's the old line- your mouth is writing checks your body can't cash. She never called my bluff. I told her that I have a family to worry about, and even most scumbags have ethics- they won't go after a girl. They would probably knock her out of the way to get to me and kick my arse, so she had better learn to keep her mouth shut. Gawd knows I've been in my share of scuffles over the years, but I'm too old for that crap anymore, and it's not worth the hassle. Our society is far more concerned with protecting the rights of "victims' these days, and everyone has a camera/cellphone. We lost a medic a few years ago because he was caught on a security camera beating up a patient. The medic was way out of line and although the patient apparently initiated the fight, that is not what the cameras saw, nor how the incident was portrayed in the media. The medic was fired and the "victim" got a nice settlement.

I disagree about this. Treating the patient wouldn't be the problem, but every area has hazards unique to them and you need at least someone familiar with these issues. Known drug houses, areas with active gang wars going on, hazards of drug houses, meth labs, drug farms, farm machinery incidents., etc. Would a rural medic understand about a kill zone when knocking on a door of a house in a ghetto area? Would a city medic understand about how a combine works if you had a person entrapped in that machine? Obviously you learn these things, but simply treating the patient is only part of the equation here. Scene safety and situational awareness is only as good as your knowledge of what the potential hazards may be.

Lots of good ideas here, and as always because of differences in training, protocols, sizes of patients/ providers, transport times, back up availability- there is no one solution to a problem such as this. Experience will tell you what you need to do, and as has been mentioned many times, self preservation is the best policy- whatever it takes to stay safe. Also- listen to that little voice inside your head. He gets more and more brilliant, the longer you do this job. If you have a feeling someone may act up- BELIEVE IT, and be proactive. I'm always hesitant to use restraints for several reasons. First, in order to safely apply them, you need tons of help. Trying to tie up a combative patient with just 2 people is a recipe for disaster- someone is going to get hurt. Couple that with the confined space in the back of a rig and even if you have tons of help, you quickly run out of room, especially if you only have access to one side of the patient. Another reason- I have seen PCP ingestions where the patient treated leather restraints as if they were toys and snap the buckles. ideally you would apply them in a more controlled setting with plenty of space and assistance, but patients don't always present that way for you. Working in an ER, we would have at least 6-7 people to safely apply restraints. One for each limb, another to secure the torso, and 2 or more to actually apply and secure the restraints. Unless your rig is the size of an RV, that's too many people. My favorite restraint in a pinch- wide rolls of Kerlex. Yes, old school I know, but there's a reason it's so widely used- it works. It's readily available, quick to apply-especially if there's only 2 of you- and you don't need to fumble with keys, straps, and buckles. All you need is a couple quick slip knots and the job is done. Couple that with your seat belts and that person is not going anywhere. Yes, most places frown on this now, but I have yet to hear a hospital complain that a person has been restrained in this manner. They would much rather have a person present to them under control and be able to calmly assume care of the patient then to have them flailing and flopping as you roll through the doors. You simply need to ensure the gauze is wide enough as to not impair circulation or cause injury. It's also easy to remove- simply cut it off when you turn the patient over to the ER. A suggestion for new providers- talk to law enforcement people and/or a martial arts pro and get some tips for yourself or have an informal session for your people. I learned long ago from a partner who was a martial artist a couple simple techniques to control someone-- basic judo holds, pressure points, blocks, etc, and they have come in handy countless situations. They are also not for someone out of control- a novice use of martial arts moves will end up getting you hurt. These tips are very helpful for someone who is beginning to get squirrely- often times if the person feels you are in control of them- a simple arm lock, for example, gets their attention, shows that you will not tolerate them acting like a moron, and they tend to settle down. Unless someone is psychotic, even a drunk usually realizes when they are in a no win situation. The first time I saw the guy use a simple grasp of a person's thumb to render an idiot completely cooperative, I was a believer. No fighting, no wrestling, no injuries to anyone- problem solved.