Dustdevil

Then do nothing. That's right. Stand back with your hands in your pocket and say, "Go for it, dude" when your partner says he is going to do something that is wrong. You are not obligated to participate. If he asked you to defibrillate a conscious, alert, oriented, non-distressed patient, would you do it? Hell no. So why would you willingly participate in any other form of inappropriate patient care? The answer is, you shouldn't. And if you do, you are just as wrong as he is. So what happens? He reports you for not helping him, and you in turn report him for inappropriate patient care? Yes, I know that when he complains, you will be the one that the supervisor or manager makes out to be in the wrong. That is why it is important for you to be the first one to complain. First rule of EMS survival: he who gets his story in first is right. While he is trying to single-handedly extricate this person, you get on the radio to request a supervisor.

She's already a member here. We just have to all chip in to pay her airfare from Israel.

Yeah, combine that with ncmedic309's comprehensive plan, and you have my answer. Although, I think there is definitely something to be said for blaming the firemonkeys. As long as somebody gets blamed, that's all that really matters, isn't it? At least, that's what I learned in supervisor training. Oh and... minus 5 for posting in the wrong forum. And minus 5 for a horribly inappropriate subject title. :wink:

Oooh! We'll have to include that on the schedule of the EMT City convention in 2007! We'll sandwich it in between "Mother, Juggs & Speed" and the "EMERGENCY!" marathon.

College GIRLS too! You know who I'm talking about, Rid! :twisted: Good times!

Hmmm... lemme think here. No matter what, the patient is not going to get to keep this money, so the concept of stealing from him is a non-issue. So my dilemma is this; does the city get this money to split with the Federal Government in order to buy more fancy guns and SWAT team training for more jack-booted Nazi tactics against American citizens, or does my mom get a big chunk taken out of her mortgage? I'll just say this. I love my mother more than any cop or drug dealer, and I won't lose a moment's sleep over it.

Just curious what grade you pulled in Microbiology. It doesn't appear that you learned much in that class. Or, more likely, you never took it and haven't a clue what you are talking about.

It went to the toilet. For the last twenty years, subsidies and response times have done nothing but gone up. Predictably, no contracted provider has been able to make a dime off of the operation as Stout promised they would, so the city and county now pour in record breaking subsidies. All of the companies that have run it (the biggest and best in the business) have gone tits-up. No matter how many times they re-program SSM, they still come up with unacceptable response times. And now, the city itself is running MedStar. It is now basically a third-service without any private provider involvement. And, of course, the response times and the subsidies remain high because despite what the city thought, it was not the providers who were at fault. It is simply the failure of the PUM and SSM, as well as the theory that it is possible to do more with less. Not a single promise that Stout made came to fruition. What more proof do you need? And I ask you again to please quit re-quoting entire messages in your replies. It is uber annoying.

As Malignant stated, that is almost such a silly question as to not even warrant a response. In fact, it is a good argument for college Physics being a mandatory pre-requisite to EMT school. But if you don't have time for all that book learnin', just try this. Have some of your nimrod partners wrap you up in a KED, stuff you into a car, and then extricate you onto a long board utilising all three of the routes mentioned here. Afterwards, you'll be able to answer your own question. And I guarantee you that you will never want to be lifted out of a peeled back roof again in this lifetime. And yes, I have done this myself. Back when EMT school was actually a semi-serious programme in the US, an entire weekend was dedicated to extrication training and we got to experience what our patients would be experiencing. I guess these days they have replaced that practical experience with studying all those drugs you have no business giving to anybody.

You do not have a licence. You have a certificate. Therefore, you have nothing to lose (except for your volunteer "job," if you can call that a loss) and it is a rhetorical question. Good luck, and welcome to The City!

I understand that. But then again, what you actually mean isn't entirely clear. You go off on a tangent about "overtreatment," and then state that the patient did not meet your criteria for spinal immobilisation. Although you didn't outright say not to board the patient, you certainly implied that you would not have yourself. How do you figure that? Not being oriented to the precipitating event is a neuro deficit. Again, I am appalled that you don't think it is important when all reputable medical standards say it is. All extrications are not equal. If the patient has to stand up to sit on the board, or if her body must be over-manipulated to be extracted, that is important! It matters! How can you possibly think that it does not? Now you are contradicting yourself. Let me quote you something a wise [but sub-literate] man said earlier in this discussion: Remember saying that? Why would you say that earlier, and now abdicate your responsibility to be an advocate for your patient's care and safety? You do not have to be an "extrication specialist" to recognise the superiority of one technique over another. YOU are in charge of that patient's care and safety, not the "extrication specialists." YOU need to be that advocate you spoke of earlier and assure that others are not taking the lazy way out just for expediency. It sounds to me like all this adds up to you copping an attitude that, "this patient probably doesn't have a spinal injury, so I don't really care if her immobilisation is efficacious or her extrication is optimal," or worse yet, "It's not my job." Either of those attitudes are firing offences in my book. Again, how do you figure that? They recognised the MOI, the altered level of orientation, and the distracting injury and chose to immobilise. The patient clearly met the criteria, and it only takes one positive to do so. If you want to talk about things that don't matter, knowing the name of the NEXUS, or Maine, or Ottawa spinal protocols would be very high on that list. I don't care what my partner calls the protocol, so long as he knows how to apply it. Anthony did. And speaking of Anthony, let us return to his question. I agree with you. Yes, he should have been a patient advocate for proper care of this victim. He was thinking correctly and his partner was being lazy. He should have called the guy on it. But I also remember what it was like to be a n00b, constantly questioning and second guessing yourself because you do not yet have the experience to validate your knowledge. I remember many times watching my senior partner doing something I thought was incorrect, yet thinking silently to myself, "Well, he has more experience than me, so he must know something I don't know, so I'll keep my mouth shut." It's damn hard to tell somebody with more experience than yourself that they are doing something wrong when you are fresh out of school. Not only do you run the risk of looking like an idiot when they show you why you're wrong, but in any case, you risk alienating your partner who now thinks you are either an idiot or a smart arse. So yeah, I totally understand the concept of just staying silent and going with the flow in many such cases. But remember, you run almost as much risk by remaining silent, because if the scene goes bad, the powers that be will be looking at BOTH of you wondering why neither one of you knew wtf you were doing. Then your claim that you knew better but didn't want to rock the boat isn't going to save your job. I'm just glad I am not a rookie anymore!

Incorrect on all points stated. I was there in 1985 when he came to Fort Worth to peddle his snake oil. I heard the claims directly from his mouth. I saw his written proposals. I saw his rantings to the news media. He damn sure wasn't qualifying any of his claims with population requirements at that time. And he was not presenting other options to us as alternatives that might better meet the needs of our population. He simply swaggered in and laid his one and only plan down on the table, claiming in no uncertain terms that it was the end-all be-all of EMS system management, that one size fit all, and that within a few short years, the city would never again have to pay any subsidy to their EMS provider. I was a journalist at the time and I wrote a half-page editorial about the dubious nature of his claims. A photo of then-paramedic Bryan Bledsoe starting an IV on a patient inside an ambulance was posted with the article. I received letters and phone calls from EMS professionals all over the state praising my foresight. I received nothing but contempt and rolling eyes from the city council and city manager. After all, I wasn't some hot-shot management consultant. I was just a 12 year paramedic. What did I know about EMS? So, has he altered his claims since then to cover his shite covered arse? I am sure he has! But retroactive revisions of his claims do not change history. They only suggest that I was wrong about him being an idiot. He's not an idiot. He's a scam man. A liar and a thief. His claims were crap then, and they are crap now. He was wrong. I was right. End of story. P.S. Please learn to edit your quotes. You're bogarting too much space by repeating every post prior to your replies. It's annoying.

Ah, well then in that case I still don't fully agree with you, but I do at least disagree with you less. This is what was stated in the original post: There ya go. Two points, with no stretch necessary. That's a bit like asking of it really matters whether we take the dirt road or the paved highway. Of course it matters. I am concerned that you don't seem to realise that.

Exactly. SSM isn't the only rotten egg he laid. The PUM in and of itself is equally putrid. As Rid pointed out, it was all smoke and mirrors. SSM was supposed to maximise resource utilisation while minimising resources themselves. Uhh... do I even have to explain the fallacy of that theory? Had you ever worked one week in an SSM system, we wouldn't even be having this conversation. And the PUM was supposed to reap such a phenomenal profit for the contractor that government subsidies would never again be necessary. Here is the long list of systems who adopted the PUM and subsequently made such a profit that they were able to eliminate their subsidies: So the verdict on Stout and his brainstorms is split. Some believe he was and is a charlatan. A flim flam man. A scheming fraud who knowingly and willingly sold people a load of utter bollocks, full well knowing that his numbers would never work out, but that he would have already cashed the cheques years before anybody figured it out. I, on the other hand, prefer to kindly give him the benefit of the doubt and simply surmise that he's a farking idiot.

Say hello to my new signature line!

Yeah, that's the word I was looking for. :thumbright:

Wow. She was transferred to the NYC convent just before 9/11. Almost makes a non-believer like myself consider the possibility of divine destiny. God Bless and welcome her soul as she contiues to serve humanity, even in death.

Minus five for an incredibly ignorant post. Judgements are properly made based upon scientifically validated criteria. We don't just fly by the seats of our pants, and take wild guesses, pulling our judgements out of our arses. We evaluate the scenario and facts we are presented with, and then we compare those with the known standards we should have learned through quality education, and only then do we make our so-called "judgement calls." Apparently, Ghurty and Neuropathy either received a better education than you, or else they are just smarter than you because they understand that the assessment of this patient adds up to a mandatory c-spine precaution extrication based upon *at least* the following: 1. The patient is not fully oriented. 2. The patient has other painful, distracting injuries. That's it. The patient just bought herself a KED. And she is going to lose the car door (and probably the steering wheel) too. Any other "judgement call" you make will not be supported by the literature, the research, PHTLS, ITLS, the Maine Protocol, the Ottawa Rules, or any other reputable and widely recognised standard of care. It is good to know that you are so focused upon "assessment skills," because you obviously have a lot to learn about them.

It has gone up considerably since Jay Fitch and Jack Stout crawled back under their rocks.

At the Pearly Gates, perhaps. But not in court.

Ah, okay. Well, that certainly covers the issue of time being wasted on a hand-off. It does, however, seem to be a mismanagement of resources though, nontheless. The costs compounded by staffing and responding that many units surely adds up to enough to simply hire more medics so that hand-offs are not necessary in the first place. I know that if I were a physician, I would not put my licence on the line by allowing my medics to hand-off 911 patients to BLS. Not with the state of U.S. paramedic education being what it is today. No way. Anyhow, I forgot that this was LA County that was being discussed. Quite possibly among the most horrible systems in the country. Weird.

One of the reasons that we are friends is because we think so much alike. I don't need his encouragement or approval to believe the things I believe. Anybody with any experience and common sense can figure these things out with neither me nor Dr. Bledsoe having to tell them. After all your education, I am disappointed in your failure to grasp the basic concepts of the scientific method. One need not prove that a theory is invalid. The theorist must prove that his theory DOES work. That has not yet been done. If it has not yet been shown to be effective, why would you even waste a moment's time looking for evidence that it does not? That's just back asswards. That is clearly a move of desparation, which is what your UMBC friends are down to. The realm was already well recognised and understood. Mental health professionals have been dealing with it for decades, and have effective strategies for doing so. All Mitchell did was to throw together a half-baked theory that if you have lay persons with no formal psychiatric education give half-arsed, cookbook psychotherapy to people before they get the disease, they won't get it at all. And, as we have all seen, it's total bull$hit. It's like giving people chemotherapy in hopes that they won't get cancer. You won't prevent the cancer, and you will kill some people trying. Wrong. The generally accepted industry standeard for critical care transport is to send an ICU RN along with the patient. And so long as the merit badge course for medics remains as woefully inadequate as CCEMTP, ICU RN will remain the standard. Regardless, if it is some kind of "standard," it is only because it has no competition. Hardly a ringing endorsement. Oh, right... and "accelerated" EMT and Paramedic courses are wildly popular too. So I suppose they are the "standard" that all others should emulate? Get real. You and I both know that the fast and easy way will always be "popular" in EMS. Hell, if I were to start a course that competed with CCEMTP, but was only half as long, my course would be the "industry standard" within a month. Popularity does not define excellence in medicine. I have no idea what you are even talking about here. I made no statements regarding research from anybody. In fact, I did not use the word "research" at all.

I can't comment upon what attitudes exist Down Under, but I can tell you that very same attitude exists even among the two-week EMT school grads here in the US. Consequently, I have to give big props to those who spend four years developing that attitude, and wish them the best.

Minus 25 for bumping this sacred thread. The last man to post in this thread last year is now parked in that big ambulance bay in the sky. He said everything that needed to be said back then. His contribution is how this thread should have ended. http://www.emtcity.com/phpBB2/viewtopic.ph...712&start=0 We miss you, Bob!

Damn! Rid beat me to the punch! In the future, if you want to tout UMBC's credibility, you should be very careful to specifically leave CISM and CCEMTP out of your statements. Both are a joke, and nothing to be proud of. In fact, both diminish the credibility of UMBC.