HERBIE1

Hey- I used to LOVE Qwisp. It was just Cap Crunch shaped like a saucer, but I liked that little dude. LOL

Couldn't you say the same about a guy who was a governor, and the wealthy son of an auto executive? Not saying the guy's qualified or not, just saying "insider" is a pretty relative term.

I think that's a question you need to ask the medical directors of those systems, not the crews who merely follow their protocols.

Not to bash your or anyone else's religious beliefs, but isn't this the "beauty" of religion? If you can't explain something, it's God's will. If you CAN explain something but don't like the outcome- it's still God's will. To me that makes it too easy to absolve yourself of responsibility for your actions. Do we not have ANY free will or choice in our lives or are we just puppets performing according to some master plan? I know there are plenty of folks who believe that but I'm sorry- I just don't buy it. I hear it all the time- a dirt bag gang banger gets killed because he chose a life of crime, violence, and drugs and finally ends up on the wrong end of a bullet. They interview the grieving mom who says it was God's will that he died. NO- it was his stupid choices that made him dead- God had nothing to do with it, unless you think God wanted this kid to sell dope, kill other people, and ruin countless lives. If that's truly God's plan, I'm thinking he has a sadistic side to him. I get what you are saying,but "all things are possible" is a bunch of malarkey. We as human beings have limitations. We are fallible, we make stupid choices, and even among the best of us, sometimes bad things happen we have no control over. (posted before i was finished) In the topic at hand, if we make choices that save, fix, alter, or even end someone's life, that is essentially playing God to some religions, which is why some eschew modern medicine, others refuse blood products, others simply rely on praying so God can fix their diabetes, cancer, MS, or any other problem they may have, That's fine- your choice, but I'm glad I was not raised that way- I'd probably be blind right now. Thankfully my parents took me to a top notch eye surgeon who saved my sight instead of praying away the problem.

LOL I think you might be delirious- pretty whacked out. Hope you feel better. To answer your question whether or not life is ours to tweak. I guess it depends on your point of view about a God, and evolution.

Thanks for the scenario, ny. Because of the history of a TIA, prehospitally I would definitely be thinking some type of cerebral event. As for age- I've had 35 year olds with massive hemorrhagic and thrombotic strokes. In fact, recently had some poor guy= 42 year old who had classic appendicitis signs- still need to follow up on him. What was remarkable about this guy was his comment to me: "When it rains, it pours." (He's an over the road trucker, and he was in town on a delivery. I asked him what he meant and he said he just found out his wife- also 42- just had a stroke today. Apparently she had her first MI at 32, her 2nd MI at 37, and her first CVA at 40. Wow.

Herbie goes back to when I got my first 386 computer, with a dial up modem. I was looking for something to do besides play games and write my fiction, and found an online forum where folks discussed current events. Sounded interesting, so I joined. I needed a screen name, and had no idea what to pick. At the time I was working on the privates and our company shared the radio frequency with a trucking company. One of the drivers name was Herbie, and had a very strange sounding voice on the radio. We used to make fun of the guys' voice and began calling each other Herbie, in that same odd voice. That's the name I picked, and use it on many sites including this one- simply for my own convenience. Although that forum has gone through a few hosts, but it's the same administrator, and it still has quite a few of the same members- over 25 years later. Stupid- yep.

Yes it is, but from a purely biological standpoint, animals have sex to procreate, and we are simply a more evolved animal(or at least some of us are...) LOL I read somewhere that possibly dolphins may have sex for "fun", but I'm not quite sure how you would prove something like that. Good point, I guess. LOL

If by aberrant, you mean not "normal", then yes, it would have to be. In a biological sense, the only reason to have sex is to procreate. Species would not survive if male/female sex was not the norm. That said, there are all types of dysfunctional issues- physical, mental, biological- that would prohibit some within a species from completing that act. Animals in heat will hump anything- legs, each other, fences- it does not matter. Unlike humans, they are not having sex for the pleasure of the act- recreationally- they are simply preprogrammed to do it. No argument, although there are a surprising number of folks who experiment. I worked with a woman who changed teams almost daily. First she said she was hetero, then she was bi, then she was a lesbian, then she went back to hetero and married a guy. Seriously screwed up in the head, but that's another story... I do believe there is no doubt people are born with their sexual orientation. How you may chose to ACT is another issue. Here's where it gets sticky, if you ask me. As I said before, we are changing an essentially eternal definition- marriage. Up until recently, there was no question about how you define a marriage. NONE. In the traditional sense, the VAST MAJORITY of people got married to share their lives, and to start a family. Again- until very recently- in terms of mankind- the only way to have your own biological family was via heterosexual sex. We'll leave adoption out of this mix for now. Yes, many people now define marriage as more of a business arrangement, but again, I'm talking traditional definitions. So- now we have new technology to go along with our new attitudes towards homosexuality, and as a result, gay couples no longer need to worry about not being able to procreate in the traditional sense. As a matter of fact, you no longer even need a partner- as long as you have enough money for in vitro or maybe a surrogate, or adoption. Nontraditional families. We now have sexual reassignment surgery to completely change what sex you are. Add to that divorces and remarriages which can lead to tubal ligations and vasectomies(as well as their reversals), and we are now redefining not only what a family is, but how we are procreating. My point is- we are playing God. No, not in the religious sense but as in a mother nature way. We are tweaking life, creating it in artificial ways, and my gawd- even decided that the sex we were born with can and should be changed. That is incredible when you think about it. Is it wonderful that some sterile couples can now conceive? Sure, but there is so much more involved, and I honestly don't know if we have considered(or even fully understand all the ramifications (social, [political, emotional, sexual,religious) of trying to "fool" mother nature. To simply say- people of the same sex are no different than anyone else is simply not true. Should they be discriminated against? Of course not. I'm just saying that we are redefining a basic tenet of society, and I think we are being too cavalier with that. Calling it a civil union I think demeans the notion of what marriage was supposed to be, and it will indeed be a business arrangement- regardless of the intent of the parties involved. Just because we CAN do something does not mean we SHOULD. Now we note the difference between us and animals. If we are biologically programmed as males NOT to be monogamous, then why are we so picky about who we copulate with? I doubt a simple social stigma would deter many folks if this was such a base desire. I know of no normal hetero male who gets horny and decides that if no women are immediately available they hit the gay bars or a zoo since any hole will suffice to satisfy their need. (Yes, our standards may drop in desperate times, but we generally stay within the same species, and with the opposite sex) We make choices based on societal standards, moral and ethical concerns. If we are married or committed to someone, it is not acceptable to stray from that partner. We make choices to suppress these urges to stray(most of the time) if we have them. Maybe at some point, but now our laws seem to be more about protecting us from our own stupidity. I think the religious aspect developed later. I'm quite sure spouses existed long before there were any religious connotations associated with the act. I don't know why the religious rite became linked to it- would be interested to know though. It's much more than simple morality because some folks feel it's completely normal to step outside their marriages- it's their "right". I just think there is a continuum that we have moved along where it has become perfectly acceptable to challenge, alter, and even eliminate parts of our society and culture for no damn good reason other than we can. I suggest these changes have not been good for us either.

I totally agree with your last point. I guarantee there is more to the story- as in the family is contemplating litigation against the originating hospital. I asked in my original post why this patient remained in the hospital for so long. My guess is there were complications during the surgery or post op, and there is a real- or perceived- issue of a future lawsuit. That could also explain why the hospital staff was so reluctant to help and/or give a proper report- they were in full CYA mode. This is not a case where I would want my arse swinging in the breeze. Reach up for help, pass the buck- whatever phrase you like, but this is a classic example of making sure all your i's are dotten, t's are crossed, and you get multiple folks to sign off on what you are doing and document the hell out of everything. The transport itself is easy- assuming the patient is stable, but the peripheral issues make this a minefield you do not want to navigate alone.

Incredible voice. I would love to know what that song was.

Agreed. What about those of us who occasionally wear kilts? Traditionally, women aren't even supposed to wear them , so there's nothing feminine about them. LOL Of course there's no "law" that determines whether or not a company can enforce a dress code. Problem is, that is not enough to keep someone from someone to challenge the validity of such rules. Enter discrimination, harassment, and bias lawsuits. Obviously there are very good reasons for these rules, but too often they are taken to an extreme, and.or taken out of context, resulting in some ridiculous decisions. You're missing the point. I'm speaking to the fact that society has changed to the point where these breaches of etiquette, protocol, decorum- whatever term you like- have become so commonplace as to necessitate a response. Yelling or swearing at a teacher in class? Nobody is talking about banning anything, using religion as a tool, or increasing governmental involvement in this. I was referring to societal standards or norms and what is considered acceptable today vs prior generations. Polygamy IS against the law. Why? It doesn't affect me or anyone else, right? This society has decided that this behavior is unacceptable to the point where it has been criminalized. How about growing your own dope and smoking it. It affects nobody but you- assuming you are not driving or working while impaired, right? I'm just pointing out that what we consider "normal" today would be unheard of in prior generations, and I do not think this is a good thing. How do you think things have become so causal, informal, etc? Yes, society changes, but I submit than not all of these changes are positive.

One thing I missed in the original scenario was that you guys did not establish contact with the receiving hospital-or a telemetry call to give them a heads up. This situation was BEGGING for more folks to get involved to CYA. I agree about the insurance stuff- if the person leaves AMA, I thought insurance does not cover the ambulance bill, but maybe I am mistaken. In my private days, I know we wouldn't have touched the patient unless we had cash, a check, or an approved credit card. The other issue I am not clear about is the mentation of the patient and if the family had power of attorney to make medical decisions for the patient. That seems like a potential liability as well- maybe the patient WANTED to stay and the family disagreed. You simply never know what family drama you are getting into with situations like this. Folks may SWEAR to you grannie is too confused to make her own decisions, when in fact she may be more alert than the providers. Tough situations to be sure.

Sorry- referring to the USA. Not speaking for the folks up north. Everyone knows you guys are much more civilized than us barbarians to your south. LOL As for Robin Williams- one of the funniest guys on the planet.

Well, it's also difficult to apply our ideas of right or wrong to entirely different cultures. Think fundamental religious groups- from Jews to Muslims. Each group has very strict sects within their ranks who adhere to ideas many of us think are excessive or extreme. Restrictions on food, behavior, clothing, hair, dating, religion, marriage, work, etc. There are many places who think the US is puritanical in our views on not allowing topless women on beaches, or enforcing a 21 year old rule for consuming liquor. On the other hand, the radical Muslims think we are infidels and hedonists, and this nation is just one large den of iniquity. Point is, I think we need to be careful about who we view as being barbaric, wrong, or primitive. There are many who would say the exact same thing about this country.

It's not the gay marriage issue itself, as much as it's what we accept as being the new norm. Someone mentioned polygamy- to me, it's the same argument. Why not legalize it- a man who has multiple wives does not affect me, so why not let it happen? It's the exact same argument most everyone here has used to justify gay marriage, isn't it? I'm not advocating a return to the Scarlet Letter days when you became a societal pariah for any transgression outside the day's norms, but should the "Well, it doesn't affect me directly, so why not do it" mentality really be the yardstick we use to measure acceptable behavior and/or adopt new standards? Is that all we really should expect from our fellow citizens? To me that's setting the bar pretty damned low. The celebrity "marriages" are a symptom of the problem, not the cause. I also suspect the divorce rate for gays would be no different than for hetero couples- and for the same reasons. We have trivialized the notion of marriage to the point where to many, a divorce is about as traumatizing as ruining a pair of new shoes- irritating, inconvenient, and will probably cost you more than you want to spend to fix the problem.

Im width doc on dis. I fale to cee a problum wif dis.

Shame on the cops. Looks like they need to be better shots and this lawsuit would have never happened. Who says we need tort reform? There's nothing wrong with the system, is there?

Well, I hate to be the lone voice of dissension (actually, I don't really care LOL) but I will take an opposing view on this issue. Although I am not as adamant about it as I used to be, I do not agree with the concept of gay marriage- and it has nothing to do with religion. Marriage to me- and to everyone I knew growing up- had one definition- a man and a woman. Calling it a civil union does not change the basic concept either. (Does calling an illegal immigrant "undocumented" really change anything, or does it seem less objectionable somehow?) I tend to be conservative in my views- more of by convention on this issue than for any other reason. It seems to me that in this country, many traditions, societal norms, etiquette, and customs have fallen by the wayside in recent decades. Not a dramatic shift, but certainly a slow, steady change in what we consider to be acceptable behavior. We've gone from a more conservative norm all the way to a "if it feels good, do it, anything you say or do is OK, and nobody has the right to disagree with you" attitude. Examples include- what we accept as appropriate language in public today, on the airwaves, in a business or social setting, or interpersonal communications. Relaxing of dress standards in the work place, relaxing of proper manners in formal and/or casual settings, etc. Sexting, sending dirty pictures via your phone or lap top, forwarding dirty jokes to a dozen people at a time- this is pretty damned bold and would be considered perverse compared to just a few years ago. Over the years, it has become increasingly "wrong" to point out these changes-including gay marriage, and folks who point out these things are then labeled as intolerant, old school, out of touch, or in the extreme- bigoted, homophobic,racist, xenophobic, etc. For a long time, I think many people were afraid to speak out about these changes for fear of being branded as intolerant. I realize this is an age old issue with each generation bemoaning the "deterioration" of standards and acceptable behavior of the ones to follow. For better or for worse, we have become a much more casual society, and while I think some of these changes are harmless, as a whole, I think change for change's sake is not a good idea either. I am certainly not Puritanical, a prude, nor am I a bible thumping evangelical, but I think certain conventions simply should not be ignored. Not every single societal norm or custom needs to be challenged and/or changed simply because someone, somewhere, in some fringe group disagrees with it. Over the years, marriage has gone from being a life long commitment- due to religious doctrine as well as societal convention- to being little more than an elevated form of a long term relationship that can be ended almost on a whim. We have gone from lifelong commitments, to marriages measured in days, and sometimes even hours, Obviously there are cases where a marriage probably SHOULD end- abuse being one of the biggies, but I simply think we are too quick to discard/change/eliminate something we deem as inconvenient, difficult, or bothersome. I simply think there does not need to be a data set to prove or disprove some societal norms. Does it mean the end of the world that many companies have casual Fridays, that 2 men can "marry", or that men no longer are expected to open doors for ladies or that prime time TV now shows more T&A than a porn magazine from the 50's? Not necessarily, but I do suggest that adding all these changes up, I think there is a cause and effect between acceptable behavior/societal standards, and many of the ills we face in our society today. Does society change and evolve over time? Of course, but I suggest some of those changes are NOT a positive sign. I'll don my Nomex suit now...

Interesting. This supports the anecdotal evidence I think most of us already knew about motor vehicle accidents. Seems that intrusion damage into the patient compartment area- which for many EMS systems is a determining factor in trauma center transport regardless of vitals or corresponding injuries- is NOT an accurate predictor of NEED for trauma center services. I'd like to see more patients evaluated, but this is a start, One thing that disturbs me about this- and many other EMS studies- is there always seems to be a qualifier about how many prehospital reports are either unavailable, incomplete, or illegible. If we want to be taken seriously as a profession, we need to put more emphasis on documentation, folks. Prove it: Mechanism of injury accurately predicts who needs a trauma center http://www.ems1.com/research-reviews/articles/1190216-Prove-it-Mechanism-of-injury-accurately-predicts-who-needs-a-trauma-center/

Good for that receiving ER doc, but I believe the originating facility was LEGALLY within their rights to wash their hands of the patient. I suspect they threw out HIPAA simply because citing only liability concerns would have been a crappy thing to do. Clearly there are moral and ethical issues at play here, but witholding paperwork- then more importantly the receiving hospital would not have the benefit of any current lab/procedure/exam results once the patient arrived- they would be starting at square one until they could get a hold of the PMD and treating MD's directly.

I would definitely upgrade this patient to an ALS rig. 7 weeks post op and still in the hospital? The patient may have stable vitals now, but the nurse was just disconnecting all the drips, IV's, and monitors that may have kept this patient stable. I would also contact my medical control for direction ASAP. If the hospital staff is uncooperative, ask the family about PMH and medications. Assess the patient as if you would in their home or on the street. Is the surgical scar healing, or is it infected? Febrile? LOC? Arousable? Was the patient competent pre-op? Were there complications with the surgery? What type of open heart surgery- valve, bypass, etc? Why the Fentanyl patch? . I would be nervous about other issues- the patient is not competent, and what if the family is doing this against the wishes of the patient? Does someone have medical power of attorney? Does the patient have advanced directives? I see no reason why an ALS crew couldn't take this patient to another hospital. Unusual? Sure, but not unheard of. Done a few myself back in my days on the privates, and no, I never received documentation/discharge papers from the hospital- other than the signed AMA release.Do lots of documentation, lots of witness signatures,etc, lots of involvement from medical control. As long as you are taking the patient to another medical facility- and they are stable enough for transport- and not home, I see no problem here.

Talk to someone and seek professional help- doctor, clergy, PTSD, counselor- whomever is available. Things happen, and we all have calls we remember, but if they haunt you to the point where it affects you and are unsure you can get past it, you are in trouble, Sadly I have witnesses some incredibly horrible things in my career. Some I vividly recall, others are a bit more suppressed. Point is, you need to figure out a healthy coping mechanism and develop empathy, but maintain a detachment, especially if your personality tends to be one that gets more emotionally involved/attached to people. I am going to say some fairly harsh things here, so beware.. I am inferring that this was something you saw in an ER clinical time, and not a patient you responded to, That concerns me, since simply watching this should not be so traumatizing to you without even the connection of talking with the patient, responding to a scene, their family, bystanders, friends, etc . Sad- sure. Tragic- no question. Maybe even shed a tear for the family at the time. To the point of worrying about getting it out of your head? No way- that's a pretty extreme response. Bottom line- unless you are doing IFTs for your whole career, you WILL see things like this and a whole lot worse. Child abuse, elder abuse, nasty accidents, suicides, senseless brutality, children all but incinerated in a fire. Some may cause you a few restless nights. That's OK- it comes with the territory, but you need to figure out now how much you can tolerate. One coping mechanism I would suggest( it worked for me, but everyone is different) is this. If I witnessed a horrible situation doing clinicals very early in my career as a student, I recall feeling overwhelmed, watching a nasty trauma, or a chaotic cardiac arrest- I focused on watching the various players in the room. What was the attending MD doing? How did the patient's vitals respond to interventions? What about the nurse doing charting? How about the Respiratory Tech? The ER techs? The residents? What medications/procedures were being performed and why? Think about your protocols and how you would handle such a patient if they were presented to you? LEARN from such things, so when you are faced with a similar situation, you can be better prepared to handle it, and your response to it. Maybe this explains what I mean. Over 30 years ago, shortly after I became an EMT-A(now called a B,} I was in college and volunteered to staff a senior Olympic event. Pretty cool, and it was one of my first "official" duties as a newly minted EMT. Of course, a 70 year old man who was competing collapsed after a run and arrested- the first time I ever witnessed one- even during clinicals. There were lots of trainers, docs, etc, on scene, and I did some compressions until the paramedics showed up and relieved us. I remember stepping back watching them work this guy, and feeling very helpless and lost- I realized that after CPR, there was little I could do for this guy- which motivated me to continue on with my education in EMS. Was I sad? Sure- it was the first time I saw someone who had just died, but I was frustrated that I could not do more. Challenge yourself. Take each situation and see how it can make you a better provider. What can you learn? What tips, tricks, information can you gather that you were not aware of? You'll be OK- just keep your focus- the tragedy is NOT yours, it's someone else's.

I'm thinking the animal won't be allowed to room the halls at the hospital-stroll through the OR and watch a surgery, down to CT, maybe a quick trip up to see some folks in the transplant ward... Look- unless you live in an area that has an inordinate number of visually impaired folks who have service animals, how many times do you think you will encounter this problem? I worked in a a busy Level 1 trauma center for 15 years and only recall 1 instance where we had this issue. If I recall, we had the do with the patient until he went to CT, had security watch him for a few minutes, and eventually the patient was sent home. Not a big deal at all. As for cleaning the rig in case someone has allergies, well, what if one of your patients has some communicable disease you aren't aware of? Don't we clean our rigs anyway? I've averaged around 20-30 calls per shift for over 25 years. I can count on one hand how many times this issue has come up with me. I realize that part of what we do here is dissect and analyze situations to death- and often times to an extreme- but I really think we are making a mountain out of a molehill here. (This post was not entirely directed at you, HLPP)

In the absence of a glucometer, I recall reading about giving sugar of some type to a known diabetic who has an altered mental status. The rationale being that a few more grams of sugar won't significantly impact someone's hyperglycemia, but it could save someone's life if their sugar was low. If we KNOW the person's level is high, then I have NEVER heard of giving more dextrose, glucose, fructose, or any sugar compound. That makes absolutely no sense.