cosgrojo

I certainly didn't mean to denigrate City members by my inability to remember their handle's. As soon as I hit send I remembered about 6 that I meant to say. I'm sure that all good posters at the city know who they are and can place themselves under my umbrella of awesome... anyone ever hear from our little Australian first responder Timmy? Haven't read a post by him in a while.

I've learned that I am a no good Basic that doesn't belong anywhere near an ambulance... But really, I've learned a tremendous amount from these forums... despite my sporadic involvement. I've learned what EMS used to be, come to understand where it is in the present, and learned what people's hopes are for the future. The most important aspects of learning in these forums as far as I am concerned is the vast perspective difference between providers of all ages and levels of experience. It always suits me to try and see things from someone else's point of view. I have learned about Medicine from MD's, RN', LPN's, Medics, and Basics. Some of the old time posters I always like to see on these forums when I make an appearance... spenac, RichardBtheEMT, AK, itku2er (I've always wondered what that stands for), Dust, ERdoc, LoneRider... and many others (chbare frightens me sometimes with the stuff he knows). I like to be challenged, and I like my own views and perspectives to be put through the ringer every once in a while. I never take it personally... but I do sometimes get nervous about what type of reaction I might get. Some of the people on this site have soooo much knowledge and experience that it is sometimes daunting for me to intellectually spar with them. I think that I sometimes hold my own though... mostly because of my awe-inspiring grasp of vocabulary, and less because of my actual medical knowledge. I am glad that I have learned from the amazing providers in the City, and hope that in some way I have helped others in their own quest for learnedness... I totally made that word up... but I like it. I am a much better provider now than I was back in '05... and I owe that to all of you. Oh... and Admin helped a little bit too (don't go getting a big head over that Admin... you already can't wear hats).

No reason why - Pennywise Why do I hear the sound of collective sighing?

Painful - Staind What should be the last thing said to end this thread?

Herbie- Not arguing with you... you may very well be right. I just felt like defining my comment so nobody thought I had some sort of partisan agenda. And nothing is dependent on political ideology (now I'm arguing with you). Politics is something that human kind invented. Intrigue and deception and promises not kept to gain advantage... those we created as a species. Social ideology on the other hand... you are correct about that one. Social classes exist in all live beings, have since the beginning of life itself. If the current state of politics actually affects your view of "right & wrong," then you are a very lost soul indeed. Those should be developed through personal contemplation and careful understanding of "social" norms, not political ones. Oh, and I didn't mean to say that I agree with John McCain about his policies... I only meant to say that he is a bad-ass... and I like it.

Thy Will Be Done - Deborah Cox There will be no more questions... or will there?

Dang it... Bobby.

My comment was completely apolitical in nature. Only social commentary on the vagaries of what is "right" and what is "wrong." I am neither Democrat, nor Republican.. I am not Independent, and I don't belong to the Green party. Libertarian I am not... and in case you were wondering, I have no love for the Tories or the Whigs. I dislike all politicians equally...If they had any honor or redeeming value, they wouldn't be politicians. Except... well... I was watching C-span yesterday trying to fall asleep and they were re-airing the house committee on Health Care reform. John McCain was offering up his bill on foreign prescription drugs again... he forced a vote on it... basically told everyone in the room that if you don't vote yes, you are a shill for the pharmaceutical companies... and then he left before the vote... He did everything but give them the middle finger as he walked out. That man is a Bad-ass, and I think I might like him. Oh... it didn't pass... so you Canadians get to keep your cheap drugs to yourself for a while longer.

Wow. MD's come out in the field and then end up with some respect with the unique challenges that face everyday EMS... I like the sound of it. I may not have gotten the respect I deserved after I started driving a BMW... but maybe this article will help.

It was only a matter of time before the pendulum began to swing back the other way. The world is round, and everything goes in cycles.

Rare spelling misshap... iatrogenic... not iagenic. -10 Called on myself. *I am very disappointed In myself... I hope the city can forgive me.*

Wait a minute... This strike is over not getting raises secondary to not having more education? The government is finally giving the paramedicine world the kick in the arse to make it a legitimate profession... and they are striking over it? Boy... doesn't this fly in the face of all the emtcity.com grandstanding about education is the only way? We get a chance to make the dream happen and we are not willing to step up?!?! Go get the degrees that the government is asking of you and lead the way for the rest of the world's desperate EMT's and Paramedic's need for substantiation. This situation could be the tipping point for bringing EMS out of the bastard step-child role and prove to an entire nation that you are true educated professionals that need to be looked at the way Doctor's and Nurses are looked at... with similar pay strategies. Lead the way Canada! Fine neighbors to the North... If you can pull this off... then in maybe 10-15 years we might see something come of it... or are you really just looking for the quick buck? If that's the case... STRIKE brothers and sisters! Strike!

Well this topic has brought back some old memories. I was once certified in the great State of Maine (and happened to grow up in vacation-land, until I was able to escape at the age of 18). I remember when the c-spine rule out came out. Personally I was excited to have something progressive to do in the field that relied on my own assessment and ability to ferret out patient and scene specific information. At the same time I harbored more than a little bit of consternation over allowing some of my fellow co-workers the same amount of latitude. It seemed like a big deal to me. The service I worked for participated in the training and rolled out the protocol for the providers... but was less than enthusiastic about fully pushing the changes. It is not difficult to imagine that they were concerned with possible litigation and liability. Also the service in question is in a tri-state area with employees that are tri-state certified and work in all three systems. Only Maine had the protocol at the time, and the service was worried about people doing the wrong protocol in the wrong state. New Hampshire has since added it as a standard, and Massachusetts does not have an official c-spine rule out... but the ER docs in the area I work in are fine with it if you are able to support your decision appropriately. FL-Medic - To your seemingly soul consuming quest to validate or invalidate cervical spine immobilization as a whole... I have not done any research at all on this subject and cannot give you any references at all for any of my statements. However... I have to believe that c-spine must be important/effective/beneficial on some level. I believe in pre-hospital c-spine rule out and am happy that I have the ability to practice it in the field. I work in a region that calls for me to quite frequently transport trauma patients to some of the World's best hospitals... Mass General, Brigham and Women's, Beth-Israel, New England Medical Center, Boston Medical Center... and any time that I have brought them a patient that the community hospital I transported from cleared c-spine and authorized transport without re-immobilizing... they have lost their ever-loving mind. Some of the best trauma teams in the country believe that we should have transported the patient on a board for the hour transport + however long they sat at the original ER. Which should clue you into their feelings about iagenic injuries vs. c-spine precaution. So is my evidence circumstantial? Sure... is my conclusion Evidence or Fact Based? Depends on your definition. As smart as I like to think I am, and as much as I defend the role of Basics in the EMS community, and rail against ALS elitism, I must admit when I am being trumped. I am intimidated by those Doctor's in Boston... they are smart, they are educated, and they are aggressive. When you drop off a patient that to them meets trauma-team activation status... you are not handing care over to just one Doctor... you are continuing patient care onto a TEAM of Doctor's frothing at the mouth to ask the lowly EMT a bunch of questions that may or may not lead to that EMT's cardiac arrest. It may sound simplistic, and in no way am I saying that your research is not a noble endeavor (I encourage all aspects and avenues of learning), but if c-spine is effective and important to a team of MD's who have the combined experience and education to make me change the color of my underoo's... then it is good enough for me.

Heck, I practically took all of '08 off... so I know what you mean.

I Will Always Love You - Whitney Houston How many times have you fallen in love?

I've always pictured Dust as a kind of Evil Santa Clause... always double checking the naughty list and leaving three times the amount of required coal. And BTW... anyone that takes these forums seriously (i.e. personally) needs a vacation from the keyboard... and possibly some trazadone. What am I getting for Christmas this year Santa Dust?

My turn to laugh out loud... no one could confuse you with kiwimedic.

People getting paid to do EMS.... in MAINE! Crikey!

I hope you have many decades of happiness ahead of you. I have nothing funny or ironic to say... which makes me uncomfortable... Good Luck!

Maybe he's just making a generalised (canadian spelling) statement about your level of cantankerousness, unrelated to this topic... Cuz' you were down right fatherly to this kid... for you. I suspect ol' croak may have some unresolved frustration with you.

I Have No Clue - Terra Skye What are you jealous of?

I am the Walrus - The Beatles Where do babies come from?

Only by those incapable of showing off... please do not couch your expertise because some people are intimidated by it or jealous of it. If they do not want to read the technical aspect to your posts... they can skip it and read one of spenac's posts *hoping spenac has sense of humor... I do it for the comedy... *

To provide my opinion on the question you posed... I do not think that mechanism should be the sole deciding factor in calling a trauma alert. Where I work in Northeastern Mass. they have been trying to go away from this trauma/treatment modality. The problem with the system up here is that the state is is broken into regions that like to run things their own way, and that tends to wreak havoc with the providers that work in multiple regions. Also throw into the mix that not all providers keep up on what the region is requesting of you... and we run into many situations that the local EMS and the Local hospitals are at odds. That being said, I think that mechanism should play a part in the algorithm, but maybe a slightly lesser role than the physiological and anatomical concerns. In the example you brought up of the death in the car, passenger trauma alert... I would probably err on the side of caution and call an alert. If the one patient is so dead that he's not being worked, I would play it safe... if the dead guy is being worked... heck, you already called an alert... throw another shrimp on the barby! But in most other situations, I would rely on what you see and what you find, as opposed to the suspected force involved in the mechanism. I know that is the direction the system I work in has been headed... and I'm on board with it. Nice topic BTW.

Are you implying that the only way to learn is through the classroom? Or are you saying that learning is done better in the classroom than in the field? Either way... yes I disagree. VentMedic- Kudos on the explanation (incredibly well stated)... and thank you for the support.