DwayneEMTP

Hey Courtney, Welcome to the City. Why are you transferring out of nursing school? How far along were you? And I think what spenac was referring to was that unless you are in an area that has available Basic positions at quality agencies then ignore the "Should be a basic for a year before going to medic" nonsense. A year at a yahoo volly fire dept is not going to help you in achieving your goals, it will simply give you bad habits that future employers will hate. Good luck on your chosen path, we'll be happy to help if we can. Dwayne

Hell, I asked you to explain because I was in a hurry, but it turns out I didn't know the answer anyway. Cool, clear explanation from both you and Zippy, thanks for taking the time to do that! Dwayne

That's a great addition. Can you define the difference for the benefit of the thread? You're explanations are always way better than Google... Dwayne

My posted comment on the newspaper website... "I think the foolishness for EMS personnel in this scenario is obvious, but I can't believe that law enforcement is any too happy about it either. Their jobs are dangerous enough in these situations when they have to care only for their own. How much more dangerous does their job become when they must now not only protect, but work around, untrained responders in the middle of their scene? I do believe that there will be untold numbers of wanna be whacker heros that will be willing to do such an idiot thing, but I won't be amongst them. I have never had law enforcement ask me to compromise my safety or give half assed patient care while they've been on my medical scene. I will not ask them to compromise their safety, and/or ability to do their job while I am on theirs. Given this mandate, I would walk. Dwayne "

Holy shit Herb, if it's good enough for you then I don't feel like such a dork! That song is awesome! And part of epic movie making.... Dwayne

I wouldn't think of it...Sounds reasonable... But I'll tell you what I just can't let pass.... Wouldn't that be both + 1? What kind of screwed up language do you freaks use in your part of the world! This kind of stuff just burns my ass..... Dwayne Just sayin'.... :-)

Whacker alert! Let 'er rip...I can take it... :-) My last partner, who I miss terribly, and I worked the night shift and on each emergent response we'd play one of the two songs below...really loud! Forget the intended message of the lyrics and listen with an EMS slant. I think you'll get it. (Those equipped with a penis, and even some equipped with an innie instead of an outie, (Wendy, should that be innie/inny?) should you choose to explore the links, should do so the first time with your eyes closed.. I find that watching the videos seems to short out several vital brain functions on me and when It's ended I can't really remember if there were words or not... just sayin') Pink U+UR Hand http://www.youtube.com/watch?v=UqUtEXmSHfAhttp://www.youtube.com/watch?v=UqUtEXmSHfA Dorky I know, but I did find that it put me in kind of a cocky, (in a good way), happy place, ready to face any call that came down the pipe. I have a habit that tends to drive my partners a little batshit. Though I don't think of it as strange. When dispatched to an emergent call I get really relaxed and don't think of it at all. I think I developed it as a student, when I'd get all worked up over the dispatch report, try and think of everything, and then the actual call would have nothing at all to do with what we were dispatched to. So now, when I'm dispatched I just sort of zone with Pink while we drive to the call. If it's something that might be hinky my partner would say, "So, what do you think?" And I'd answer, "about what?" To which he'd reply, "You're such an asshole." I wasn't really trying to be an asshole, I just truly have no opinion on a call until we get at least close enough to see how much commotion is occurring outside. Other than a few superstitions, that's about all I can think of... Dwayne

Not EMS related, but some funny stuff I like none the less... Hell...guess I'm going to need a primer on inserting pics... I can't seem to get any more to load... Dwayne

I like your point a lot! No I'm not, and yeah, I mentioned to them that pararescue medic is a pretty specific term that should be reserved for the few hardcore Air force studs that have earned it. But they don't care brother..they had already printed up hundreds of badges and were not about to reprint a bunch based on my opinion. I absolutely agree with you though that some titles should be held in such high regard that they are strictly off limits. I am no more likely to show this badge to anyone than I am to buy a USMC hat and wear it. I'm proud of my accomplishments, and am slowly accomplishing more as I go. I'm happy with that and have no desire to try to ride the coat tails of my betters. (And of course I know that that is not what you were implying. I'm simply explaining in the first person.) Great post...I like your attitude a lot. Dwayne

There was no other resource, not a book, not any individual teacher, that came close to the value that I found here. I hope that the same will be true for you. Except for giving me way more credit than I deserve, Ruff has hit it right on the head. In fact that is a perfect description of this site in my eyes. (It seems that I'm just following you around Ruffster. Awesome posts today!) You're going to do well brother. And reread Ruff's post...If you follow that advice you will soon be disappointed at how little your classmates actually understand from their studies. Dwayne

Man, what a great thread, I've got not useful to add except to say that with the exception of IOs being brutal (I don't think they're fun, but not chest tubes either) I agree with Ruff's post down to the word. If good assessment skills were used and a rational decision made, awesome. If it was done 'because I can' or as a punishment? I hope the shithead is getting struck by lightening as we speak. One thing I would like to add though is what a joy it is to see a thread where every single person gave an opinion and then explained their opinion! (well, except me I guess, who piggybacked Ruffs opinion) There's not a single "screw it, take her to the hospital if she's breathing" or some like bullshit in the thread. It's the best of what we do here, and it sets an amazing example for those that are younger or newer here. Thanks to you all for the education that you've given and continue to give me at the City. Dwayne

You guys are so funny...Truly. And I loved the squirrel! I think I may use it as my avatar! Herbie I'd have to start it on one card and then give them another one to finish it! All of the time and effort I've put into trying to be a humble professional, it doesn't seem fair to have whackerdom thrust upon me.... :-) It's great to see so many of our tried and trues posting more. Or perhaps you have been all along and I just wasted my chance to see it by not being on more. Have a great day all... Dwayne

I'm curious as to your level of certification? No dissing you brother, but it is relevant to your story. I get suspicious of these kind of stories as they seem to contain just enough information to make the point. If you want to do a case review on such a call I like to have more information before I can get on board calling these guys dumbshits... Would I RSI a decompressed talking pt? Sure, if I felt that physiologic degradation was imminent, there were other injuries that that I felt might compromise the airway, If the pt was unruly to the point that I believed that they were going to further their injuries and chemical restraints were not practical, If despite the fact that they were awake and talking I felt that they were to exhausted or injured to continue breathing on their own for a long trip to the hospital, etc. My point being that while it sounds good to say that these idiots wanted to RSI a pt that is awake and talking, in real life if you use 'awake and talking and her vitals were fine!" as your main criteria for whether or not to employ such a valuable but dangerous intervention then you really shouldn't have access to it. I'm not saying that you missed any of the above conditions, nor that you don't know when to employ this intervention, only that if you are at the basic level, you're talking out of your ass when you make the statements given with the information provided, and if at the medic level you really didn't include enough information for me to know if I agree with your opinion or not. See? Dwayne I'm on the oil spill in the Gulf of Mexic and we just got re-badged the other day...(ID badges) My new badge says, "Pararescueman Technical Specialist." Ta Da!! I said, "You know, I don't think that is really a title." They didn't care, as they were badging people and not medical people. So I said, "If we have to leave that title, is there some way that we can add Ninja to it? You know, Pararescueman Technical Specialist Ninja? That would be so hot!" Turns out that badging people seem to take their jobs very serious and don't enjoy badge making humor.... Dwayne

Would it change your answer if you knew that she had really hot, sexy junk? Dwayne

Thoughts of peace and healing for those that loved him from the Womacks in Colorado... Dwayne

Yeah, like Herbie said, costs are relative, and I have mixed feelings on that. One of my favorite shows ever was West Wing. It was a political/White House show for those of you that didn't see it. A liberal and a republican were talking about the death rates in Africa due to HIV/AIDS I think. One one said, "It just pisses me off that that people are dying because they can't afford to pay $1000 for a pill that cost .30 to manufacture! (I don't remember the exact conversation, but you'll see the point.) The other said, "C'mon, you know it was the second pill that cost .30. the first one cost 500 million." Do we pay way to much for everything? Sure. But the vast majority of the tests that you required were developed in the private sector. For everything they attempt to 'discover' they have hundreds, or thousands of possibilities that fail, and none of that research is cheap. Do they make billions/year? Again, of course. But they aren't going to do any of that research as a hobby. They make the breakthroughs and produce the drugs so that they can get paid. That is their primary responsibility in a free enterprise system. I finally have good insurance, and praise the Gods for it. The system is broken, and about to get way, way more broken I believe, but unfortunately it is what it is so all we can really do is get rich, or consider the insurance options offered by potential employers as a deal breaking option instead of the 'nice to have' option it used to be. Dwayne

All of that is such awesome advice! I listen to every patients lung sounds unless there is something preventing it, (time restraints, higher priorities, etc) for this very reason. When I was a basic I was so excited that I got to follow the RT around and listen to all of these sick people! I was going to know every unhealthy lung sound known to man!! He had me listen to this one old man who looked sickly and it sounded like there was a friggin' tornado in his lungs every time he breathed. I said, "Holy crap! What was up with that guy!?!" And he said, "Those were normal sounds...hehehe." He was teaching me that knowing sick sounds didn't mean shit when I didn't know normal...It was a great lesson. Seems like I'm just following you around Herbie. If I wasn't in such a hurry to post and get gone I could have skipped my post all together. I think you hit all of the big stuff. Dwayne

I wonder if it has so much to do with the job, as I don't think I had less stress as a contractor, or UPS tech support person, etc, in fact, almost certainly more. I wonder if it has more to do with our close quarters as well as regular access to privacy? Dwayne

I created a post earlier, that might have actually had something interesting in it (Yeah, probably not) but nuked it somehow before I got it posted. I don't have time to recreate it now, but I wanted to say a couple of things.... First. I'm not of the crowd that believes there's no such thing as a stupid question. I've heard millions of them. (Why do I have to stay awake during clinicals even when we don't have a pt? As he uses his book for a pillow) But not only is your question not stupid, it is not even close to being silly. I'll tell you why. I have never known anyone to the best of my knowledge that was good at hands off resp rates on those patients that aren't at least slightly obvious. It's hard. Sometimes you simply have to put your hands on the patients to get it. I wish I had a tricky, reliable, tried and true answer, but I've never heard of one. Sometimes it's easier to watch the stomach, sometimes easier and more pleasant to watch the high point of the breasts, sometimes you can see them breathing through their pursed lips, but not always. The other thing I love about this question is that 99% of basics have this question coming out of school yet only about 5% (These numbers come from a very famous study that involved a gazillion subjects, so I'm confident that they're accurate. And no, I can't remember the name of the study. It was really famous though. The doc in the ER even told me about it. So famous so that if I need to cite it for you...well, just forget it then.) will ask the question. The vast majority of those that choose not to ask are simply going to put 12 for all of their 'well' patients, and 18-20 for all of their 'sick' patients. They are going to lie, because they don't have the balls to learn. It takes guts to ask a question that you think people are going to think is stupid on a subject that seems as if it should be so friggin' easy! But it's not. But how can that be?? Everyone else can do it, right? Yeah, not so much. Most everyone else pretends to do it...and that should be unacceptable. You're off to a good start brother....Welcome to the family! Dwayne

We get lost a little bit I think when we focus our concern on stomach contents. In fact I don't think that I've ever really considered protecting myself from the stomach during intubation. There are plenty of evil looking little critters living in the lungs too! (Think TB, HEP/HIV infected blood from diseased lungs, etc.) And they can, during intubation, vomit nearly as well as the stomach! I had a younger man that O.D'd on a whole pharmacy of things..When I listened to his lungs they sounded something like what you'd expect from a really old cement mixer. They were really, really nasty with what I assumed was aspirated...something. I decided to nasally intubate him instead of trying to wake him up and then let the doc figure it out in the ER. I got my tube with little trouble but when I asked my partner to bag so that I could verify lung sounds I couldn't hear anything on the first breath. The second breath was the same and I was becoming concerned that I had missed my tube. On the third attempt at ventilation I'm not sure if the tube move down a little bit, I don't know, but a blast of nasty shit came up the tube, into the BVM and sprayed out of the BVM vent all over the pts head. Yeah...it was disgusting. I could immediately hear lung sounds following the eruption and called it good as his SATs began to climb and we drove him the few minutes to the hospital. It turned out that he HAD ODd, but that he was unresponsive due to a CVA, at 28 years old. Not only a stroke but he was HEP +, HIV +, and one or two other things...I can't remember now. But I really, really don't like to think of the post exposure treatments that would have been necessary had that sprayed in my mouth and eyes. Since, I've kind of come to regard the ETT as a loaded gun. Even with the safety on (face shield/goggles) I don't point it at me or my partners if at all possible. Great conversation! Dwayne Edited to fix those typos that seem to be invisible until after I hit the post button. No contextual changes made.

You know, I was typing the same time as Herbie so didn't see his post before posting mine. The reason I mention this is that as I review the thread it appears to me as if I created my post as a snotty contrast to his. And that is just not the case. Herbie has been doing this for a few weeks, me, only a few days in comparison. We came up in completely different EMS cultures and that makes a difference when debating these types of topics. The vast majority of people, at least that is my belief based on casual observation, that come to EMS in the more recent years consider BSI to be a higher priority at times than nearly anything. The earlier cultures were much more macho and pt over provider focused I believe. So all I'm really saying is that if I disagreed with Herbie, which is uncommon, I certainly wouldn't have stated my disagreement in such a way...I hope. (Sometimes I screw the pooch on tact.) We're fortunate to have members such as him that give the honest answers that allows us to compare and contrast as well as learn about the history and common changes in EMS instead of the politically correct answer that was likely to have a bunch of people hitting his + button. Well then, for what it's worth, there you have it.

Awesome man!! Good on you... And I hope that you are serious about celebrating. Step away from it for a while. If the test shut down at 88 questions then you did really well, which to me makes it likely that you've been working your ass off. If this is going to be your chosen career then you've got a long time to continue studying...Now, make sure that you reward yourself for a job well done. Welcome to the EMS family. Dwayne

Hey Noah, welcome to the City! Reaching for glasses won't make you look like an idiot, though you really should have them at hand on every call, but exposing yourself to unneeded risk will absolutely make you look like an idiot to every good provider I've ever known. The yahoos may moan, and the good providers may be disappointed if you take forever to find a vital piece of equipment, (yep, still talking goggles), but you need to become immune to the opinion of others when it comes to personal responsibility, morals or ethics. Set high standards and follow them and let the others do as they will. I make fun of hose monkeys on a regular basis, but I was actually convinced of the need for goggles during intubation by a fire medic. I was a hotshot, had maybe 20 live intubations without a miss...a true hero in my own mind. On an arrest I intubated, got my tube no problem, was feeling good. After we transfered care of the pt the fire medic asked to speak to me privately. He said, "I'd like to ask you a favor. I notice you don't wear goggles when you intubate, next time would you use them, and then after, hold them up to the light? I'd like to know what you think." I told him I would, and I did. Next intubation was the same as the others, no trouble, no mess, no exchanged fluids. I got done and remembered to look at my goggles and I could have fainted. It looked as if they had been left in a barn for a few months, know what I mean? Covered with fly specs? They were filthy! Not heavy enough droplets that I could feel them making contact, nor enough to be able to feel wetness, but they were obviously terribly contaminated. And I had been taking that shit home to my family, kissing my wife with my dirty face. I was disgusted. I didn't get the fire medics name, because I was confident when he said it that he was full of shit, so I didn't know how to find him. I spent the next week or so talking to every fireman and every medic describing him until I was able to identify him. I bought a bottle of wine and a card of thanks and took it to him. He set a standard for me not only for wearing goggles when necessary, but in watching out for our brother and sister coworkers...helping them when we see them putting themselves in danger. So the answer for me is simple. If you purposely do things that could bring you or others harm then I have no interest in you or anything you choose to do. But, judging from your post, you had no intention of doing such foolish shit anyway. It seemed that you were actually looking for the silly reasons that others might actually justify such things....good question!! Dwayne

I love this advice. And I'll tell you why. I think that there is every chance that the signs were there, and that possibly someone else might have seen them, but as LS said, that's just being human. Does it make you a bad human? I don't think so. As time goes on I believe that we don't necessarily ignore our mates, but we do begin to stop 'seeing' them. I've been with Babs a quarter of a century now. I've seen her laugh, walk, cry, sleep, watch TV, clean...everything for 25 years so I didn't necessarily 'see' them any more. I saw a study once that said that the reason people, 'specially men, are so bad at noticing that someone has changed their hair, or shaved their mustache, is that we don't look at them each time we meet. Our brain notices where we encountered them, how they walk, the sound of their voice (I'm just making shit up, but you see my point) and plugs in a picture of them that we're used to. I think we even do this with our mates, perhaps more so, on a regular basis. It's likely the signs were there, but you were unable to 'see' them. But I do believe that with some help you will be able to see them next time. I have a game I play in my head sometimes. I pretend that I've never seen Barbara before. I watch how she walks, how she moves, what she sounds like when she talks, the shape of her boobs and bottom, just like it's out first time meeting. I used to do it to see if I would still chase her as hard as I did in the beginning...(and I would) but I do it now because while I was doing that I discovered that she changes. The Babs of today will have many, many significant differences from the Babs of a year from now, and the one from a year ago. And it showed me that treating the Babs of 2010 the way the Babs of 2005 liked to be treated wasn't really working the way I thought it should... Anyway, I don't mean to preach. But I do believe in something I heard on a Dr. Phil commercial one time. "Today we do the best we know how. When we know better, we do better." Or something like that.. I know it hurts your heart to see that someone you love suffered and you didn't help. But you would have if you had known, right? So now is not the time to convince yourself that you're a cold hearted bitch. But it is the time to decide that tomorrow you will make sure that you know better, so that you can do better. See? And in a terribly long winded fashion, that takes back to the above advice Hugs to you girl. Give yourself a break. Being angry at yourself makes you unhealthy, and you can only really care for those that you love if you make sure that you're healthy first. (Wait..that sounds familiar for some reason....?) Dwayne

Yeah, I've tried that, but I must use the wrong version of Word as the editor hates the formating. I'm not sure what the deal is. I used to think it was happening because I use Safari as my browser, but today I had to cut it out of IE and put it into Safari to get it to post. Maybe it's just bad karma? Dwayne