DwayneEMTP

Welcome to the City!! You're certainly off to a good start with your few posts! That's awesome!! We can be hard of vollies here, as well as fire sometimes, but in time I believe that you'll come to see that often it's justified, other times we're just being assholes, but mostly justified I hope. And none of that will reflect on you as a student or effect your opportunity to thrive here. We've got many, many members here that are well respected despite being infected with the volly or hosemonkey virus. Jump in, be brave, ask question, answer questions when you can, and even more important, try to answer them when you think that you can't. You'll do fine! Have a great day! Dwayne

Simple, decent human respect. I was 40 years old when I was going through clinicals, and I can't tell you the rage I felt when some 20-30ish something medic would point at a chair and say, "Sit, and wait there until I get back." I would never, ever put up with such shit again. Let them know as much as possible what is expected. In my first stage clinicals I wasn't spoken to unless we were on a call. If the crew went in to eat somewhere, I wasn't welcome to come. If they went back to quarters to watch tv for a few hours I had to stay in the truck. Not just nonsense, but very destructive nonsense. "We're going to stop and grab something to eat, you're welcome to come in with us if you'd like, or if you'd rather stay in the truck and study, that's ok too. I'd just ask that you don't lay down and sleep while on duty." That was my thing, you may have no problem with that of course. Remember that mistakes are much more valuable than successes. We may learn 1 or 2 things from a success, if we're luck, sometimes 50 from a mistake. Allow your student to make mistakes if possible, then teach the mistakes away instead of trying to punish them away. In my opinion the most productive, as well as kind thing that you can do for a new student is to teach them that you understand that mistakes are inevitable and part of the learning process. That you expect them and are not waiting to pounce when they occur. This allows them to be very brave, and aggressive as they know they are free to try anything and to learn as opposed to spending all of their time feeling like they're tip toeing through a mine field. Not long ago we had a new hire that was starting an IV on a pt that I thought looked challenging. She got the IV on her first attempt, was excited, and I gave her a smile and an 'atta boy, but inside was thinking, "Dang it, too bad she hit that, first try. That would have been a great patient for her to locate secondary sites on." Revel in successes, but revel even more in failure! Teach the way to accept failure and learn from it instead of allowing students to be so timid so as to never have to face it. It sounds to me like you're off to a good start. Helping them develop a routine for pt contacts, priceless! As long as it works for them, and not just for you. From your few posts here it sounds as if you'll do really well! Be kind, be patient, be realistic...the rest you'll get figured out. Dwayne

Welcome to the City! As Mobey said...But you're certainly welcome, and yeah, we have some Jersey folks hiding around here somewhere... :-) Don't let the false start hold you back. Jump in, post, ask and answer questions. If you're looking to share, and learn, and teach, then you've come to the right place. Dwayne

EMT155, I hear you man. As you may have noticed I'm not a huge fan of either long time EMTs or Vollys, yet one of my dearest friends happens to be both. He's also the fire chief for his local district and tells the same story as you. It's so hard to walk away when you've taken it from a bunch of beer guzzling yahoos to something that actually means something. I really get that. Unfortunately there comes a time when you have to figure out what it actually means. Most vollys I know would claim, though I don't believe them, that they do it as a service to their community. Yet, your community has shown you that they care so little for your 'service' that you're not worth a few hundred bucks a year in bonus'. And those that you report to care so little that they didn't feel you deserved to be notified of this. It sounds as if you don't even have the equipment needed to respond adequately? Trucks in disrepair, antiquated AED, etc. Do you then have an ambulance that works? And there is truly NO ALS in your area? Anywhere? Amazing. People are dying in this community because of the ideals of the EMS leadership, and you know what? They deserve to be dying. You get what you pay for in some things, and most often EMS is one of those. I get that you're pissed brother. And dang it, you should be really, really pissed!! If I was your fiance?? Oh yeah, I'd tell you to decide if you'd rather spend your extra 60hrs/wk fighting for Tshirts for your squad or be with me. But, then I'm not a chick and she seems to be way more understanding. I guess my point is this. You need to do what you need to do to feed your soul, but don't kid yourself that you do this for your community, because you community has told you and your buddies to go and fuck yourselves. I think it's time to identify why you really 'need' to do this and consider whether it's worth it or not. All of the above is meant in the Christmas spirit, despite how it may sound in print...grin. Good luck to you man. I look forward to your posts, as there is almost always something in them to make me think, and make me smile. Dwayne

Why offline?

You go babe! And party it is!! Forget all of that shit for a few weeks...You've earned it.. Dwayne

I'm going to take the opposite tack from Ruff.. I don't know why you don't walk? The community obviously doesn't respect the effort enough to pay people to protect them, the powers that be have no respect for you as shown by not making even the slightest effort to reward anyone for their efforts... What causes you to stay and beg to provide a service that it's obvious no one cares even one little bit about? Screw em brother. No One Cares! Dust posted a paper about a hundred years ago I think showing that it cost less to provide professional fire/EMS or just EMS, can't remember now, than it does to have a scheduled trash pick up. So not only CAN your community afford to pay you for your service, but they choose not to, and on top of that they can't be bothered to buy you a ticket to the park? Yeah....I don't see your loyalty. Dwayne

Great posts all! Hopefully walking through scenarios makes it easier for you to imagine using these tools, and allows you to see the reasons for or against so that you can make your own more rational decisions and not always be a slave to the opinions of others. And Ugly, good on you for reviewing your answers. My goal in these things is to try and get you to look at these questions the way that you would look at them if you were on scene...with only the logic and knowledge that is in your head. You're really brave about doing that, most of the rest of us need some practice. Pulses...in these types of injuries once we've done our basic life saving things, airway, O2, IVs, etc, it all comes down to pulses and reassessment, right? Great job all.. Dwayne

Yeah FP, thanks for filling in the blanks.. And for me the loss of distal pulses is a huge issue. Life before limb, but we're going to save the friggin' limb if we can! Thanks for playing all... OP, did this help to answer your questions? Dwayne

You know, I thought that maybe I should research the video before posting, but then decided that it didn't really matter to the lesson. Fact or fiction, the 'truths' behind the scenario are undeniable. One of those rare times that we don't need a study to prove that the intuitive conclusion is perfectly correct. Thanks for looking though, and reporting back. Dwayne

That is the best answer right there! Medicine here varies greatly from place to place. If you want to be a medic, as tcripp says, find a good place and move there, don't move and then hope that you will be able to do good medicine... Welcome to the City! Dwayne

I knew that you'd be one of the first to jump in here Ugly! But I think you answered some questions too fast. I'm glad that you like critical thinking, because I'm going to be critical of some of your answers and ask that you allow others to do the same before you jump back in to recover... :-) Warning! Some of the answers below are intuitive to me and based on my own line of logic mixed with myriads of sources that I can no longer even remember. I can't direct you to the answers in 'the book', or the studies that they came from, so all should be considered, as always, at least partially if not completely in error and fair game for attack and critique. Really? I'll bet that if I check your book I'll find a different, more specific indication. I know I will if I check the traction splint docs. Uh oh, again a little quick on the draw.That is the only absolute or relative contraindication? I'm thrashing you a bit on this brother because I'm willing to bet you know these answers off of the top of your head yet posted without completely thinking the questions through. But that is why we're here, right? To develop more, better habits? As below, this is more commonly known as an Open Fracture now. Though the medical literature is still full of Compound Fractures. Any idea why the fall out of favor with CF Doc? Excellent answer. The risk of infection increases when you bring the dirty bone ends back into the tissue, but the tissue isn't likely very clean anyway, right? You can sort of guide the bone halves externally when pulling them back through the skin to keep them from banging terribly, and you haven't, in my opinion, violated your ethics when the temporary pain will result in longer term comfort as well as decreased morbidity. There is one significant assessment finding here that would absolutely cause me to continue manipulating this leg, meaning traction as opposed to leaving it in place. And this should absolutely be at the very front of your mind with this pt for BLS providers. Not talking about pain, though that would probably do it. Something more important. Can you think of what it would be? You didn't, and you did, at least with me. I agree completely. When I was going through medic school pharmacology was just kicking my ass. I've never excelled at memorizing large amounts of data, and had never had the occasion to improve that skill before that time. What I found was that I just couldn't do it! But one day, in these very forums, someone mentioned context hooks, which you've maybe noticed became a favorite phrase of mine. So instead of trying to memorize them I began to imagine the pt that I would use a drug on, what would that pt look like, what kind of things would they say,what would happen if I gave it despite their contraindication, what happened if I gave too much? Too little? Combined it with another drug with different effects? And soon my little pea brain began to make pictures I could see of the different systems effected, and how they were effected, what happened when I misdosed, or boneheaded it in some way. It works really well to me to this day. Thanks for playing brother. Give the guys and gals a few hours to 'one up you' before you reply, ok? You can take it... :-) Dwayne

Hmmm. Interesting. I guess if you, as the OP states, work for an ILS service that that might get you bump in pay while you continue with your education? I wonder though if that is also why there seem to be so many intermediates? Get their I cert and say to hell with it with the rest of the pressure of medic school? I don't know...Though I know that many, many took it as another step in their education to medic I'd be curious how many drop after getting their I cert. Thanks for your thoughts JT Dwayne

Of course I agree with those that say that we don't have enough information to really judge here... I do find medicgirl's observation interesting as I've noticed the same thing in myself. I have never, not a single time that I can think of, been 'grossed out' on scene, needed to turn away, or have failed in caring for my patients because of their situation or the condition of their body. But I have been grossed out by pictures. I continue to be bothered by some images, not a particular class, but some that seem to be random...and that seems weird to me, as I would expect it to be the reverse. Anyway, as MG said, because you can't look at grody pics doesn't meant that you can't handle gore, especially if you've been exposed before and had no problems. One of the strongest lady medics I know can't walk into the morgue without passing out, yet she's worked a gazillion bloody, ugly calls from all age groups. "Association does not equal causation.." or whatever that quote is. Because it seems like there should be a relationship doesn't mean that there is. Though Wendy made a really interesting point with her comment on cumulative exposures... Dwayne

Instead of a definitive answer, or going to protocols, lets see if we can walk through it and decide for ourselves what the best course of action would be, and why, OK? What is the indication for a traction splint? What are contraindications for a traction splint? What is a compound fracture? Why would you NOT want to use a traction splint with exposed bone ends? Why might you choose to ignore the issues with reducing a fracture with exposed bone ends? I'm asking those of you that know the answers to let those that are learning do their thing here, and for you not to spoil it for them. Please feel free to help, but not solve. Thanks. Dwayne Note, I found the list below on accident and thought that some might find it interesting and useful. Different types of bone fractures: - Open Fracture : An open fracture is a fracture where the broken bone is exposed. That is dangerous because of increased chances of infection. Closed Fracture : A closed fracture is a fracture where the bone is broken, but the skin is intact. Simple fracture : The fracture occurs along one line, splitting the bone into two pieces. Multi-fragmentary fracture : In this the bone splits into multiple pieces. Compression Fracture : A compression fracture is a closed fracture that occurs when two or more bones are forced against each other. It commonly occurs to the bones of the spine and may be caused by falling into a standing or sitting position, or a result of advanced osteoporosis. Avulsion Fracture : An avulsion fracture is a closed fracture where a piece of bone is broken off by a sudden, forceful contraction of a muscle. This type of fracture is common in athletes and can occur when muscles are not properly stretched before activity. This fracture can also because of an injury. Impacted Fracture : An impacted fracture is similar to a compression fracture, yet it occurs within the same bone. It is a closed fracture which occurs when pressure is applied to both ends of the bone, causing it to split into two fragments that jam into each other. This type of fracture is common in car accidents and falls. Stress Fracture : It is a common overuse injury. It is most often seen in athletes who run and jump on hard surfaces such as runners, ballet dancers and basketball players. Compression fracture of the spine : It is common in individuals with osteoporosis. Often no identifiable injury causes it. This results in significant pain and disability. Rib fractures : If you experience pain while breathing you probably have a rib fracture. In this condition you also have tenderness and shallow breathing. Complete Fracture : in this the bone fragments separate completely. Incomplete Fracture : in this the bone fragments are still partially joined. Linear Fracture : in this the fracture is parallel to the bone's long axis. Transverse Fracture : in this the fracture is at a right angle to the bone's long axis. Oblique Fracture : in this the fracture is diagonal to a bone's long axis. Spiral Fracture : in this at least one part of the bone has been twisted. Comminuted Fracture : in this the fracture results in several fragments. Compacted Fracture : in this the fracture is caused when bone fragments are driven into each other. http://www.buzzle.co...-fractures.html

I guess I don't understand how this would work...You will have a long enough break during your medic program to allow you to get your intermediate? I've not heard of a break like that, but the things I've not heard of...well, it's a lot. My medic program went straight through, spring/summer/fall/spring/summer/fall, and each semester we were pretty much buried in material, so I guess I'm having a hard time envisioning this. Does your medic program require college level anatomy and physiology? If it does, then intuitively I can't see any harm in this. If it doesn't, spending your time in those classes I believe you will find much more valuable to your practice, and find more enjoyable, then the redundancy of the I class. Dwayne

I'm kind of on the fence here.. I get what Lone Star is saying, that people should be exposed if they're going to want to be in a field that might leave them caring for these types of people, but also I have no trouble seeing an ass hat coroner bringing in his grossest material for the gag factor. I don't think that you should be protected from such images when you choose to go into this field, but as Mobey and tta said, there is also no need to beat you over the head with it. In fact I always distrusted most the kids that would laugh and yell, "Look at the guts falling out!! That is so cool!" Much more than the students that I caught looking at their desks instead of the screen. The question that I have for you girl is this, why did you look at the screen until you were so upset that you had to leave the class? Why didn't you choose to look away? During my studies I often chose to look away from the screen when the images made me feel, I don't know, unhealthy? At the end of the class I would hope that you would have been more able to care for your own well being. But I know that that is hard when you're new to something. How many pictures were presented? How many of kids, and how many of those were 'brutal'? I'm curious if you were overwhelmed by a ton of photos, or by a few photos that simply kicked you in the ovaries? See what I mean? I'm interested to see how this thread moves forward. Dwayne

These answers from my previous service, as they don't strictly apply to the service I work at. I also think it depends on the type of service. ALS/ALS, ALS/BLS, or BLS/BLS trucks? I don't believe that BLS should call an arrest short of obvious signs of death and even then, to include decay, especially if they have very short transport times. These guidlines can also reflect the amount of respect that a med director has in his/her medics as well. If s/he thinks they're schmucks, then you're going to be working all of your codes to the ER. 1.) Do you transport cardiac arrests? Only with ROSC, or if they're really cold. 2.) Do you WANT to transport cardiac arrests? Only as stated above, or in the rare case where evaluation on scene would be dangerous because of possible violence. 3.) What are the benefits gained? With the exception of those cases above, you gain a CYA (cover your ass) level of comfort. It also allows you the benefit of not having to deal with the family of the pt, and/or possibly removes you from danger. 4.) What are the risks? Possible unnecessary needle sticks, death by MVC. 5.) Should any code blues be transported or should they all be called in the field if no return of spontaneous circulation? Cold arrests, ROSC, provider safety issues, should be transported. All others, and in my opinion, yes, this also includes children, should be left on scene and attention redirected to the families. Dwayne

Yikes! And Medicgirl comes out swinging!! Duck boys and girls this thread is becoming full contact!! :-) Great points, but we really should try and make them, in my opinion, in ways that don't send the new folks running for higher ground. But as we all too often have the, "I just want to hang out and not be judged" crowd, it is nice to see things slanted in the professional direction this time... Carry on! Dwayne

But I do see Crotchity's point. How can a B student be expected to understand how increased education can value EMS when he's not really a part of EMS yet? Has been presented with nothing to date that required more than skills, and certainly not education. I've not been able to make that point to basic/medic firemen that have a generation in the field! So though Edison didn't need a license to invent the light bulb, he certainly needed education and experience with electricity to make it happen. Also Crotchity's suggestions let the kids comment on something that they are experts in, how the experience translated physically, emotionally, and mentally for them. Forcing them to evaluate their behavior as well as the clinical. I like it. I get what you're saying Lone Star, and do see the value in having them research a larger issue. But it's basic class, and a 5 min presentation, not much time to get too deep into anything really.... Dwayne

LMAO