DwayneEMTP

Holy shit! (no pun intended) that is brutal Ruffster! (Funny as hell, but really brutal none the less. You better repent brother....) But truly Dina. I'm guessing you won't see it, but there is actually a lot of kindness and good advice in this thread. As long as you continue to justify silly behavior, to make excuses as to why not you, but God, is responsible for your poor conditions, nothing significant is likely to change. People commonly need to villianize others so that they can see the line between us (the good guys) and them, (the bad guys.) Admin is not responsible for the fact that you won't/can't pay for chat, you are. You can afford a computer, and I'm guessing that you're not logging in from a cardboard box, so at least be honest and admit that it pisses you off that you can't have everything you want for free, not that you're being victimized by a few dollars for a chat room that seems pretty dead anyway. I wish for you to be healthy, and happy, and mentally sound, but I don't see any of those things happening until you begin to take responsibility for your own actions. Dwayne

Man...great question. I'm going to take a differentroute, as sometimes happens.. I don't believe that all of the pt statements are covered under HIPAA. In fact,I believe that very little of the information that they may give me in the backof the rig is. About a hundred years ago akflightmedic and Dust convinced methat I was a shithead if I operated under a legal document that I hadn'tactually read. I agreed, and did so, but can't really remember much of it now.So I'm thinking I've returned to being a shithead by default. :-) But I'mpretty confident that HIPAA is concerned mostly with personallyidentifying and insurance information. Having said that I'm not sure what is covered legally. I can't claim to be asprofessional as the others here as I often talk about personal information withmy coworkers concerning my pts. Not with malice, most often, but it happenedregularly. I was running in a small community where the odds were great thatthe others in the crew were going to be transporting the same patients that Ihad so sometimes information that I would normally consider morally, if notlegally protected was shared. "If you run on Bob be aware that he has a'special' towel next to the bed. You may not want to touch it any more thannecessary." "If you get dispatched to Mary at X address her healthhas been failing so she mostly wants someone to come and change her O2 out andvisit for a bit. She keeps her spare O2 bottles in the garage, but forgetssometimes. She's likely to be relatively hypoxic before she calls, so you'llwant to watch for that." And the like. Would this be morally and ethicallyprotected information? I'm not sure, as it's shared with the intention ofeducating people that I believe to be future providers for these patients. Also, of the information given, how much is given because the pt is in anambulance? And would this somehow affect the legal standing of thatinformation? Again, I'm not sure. I had a really good medic coworker who ran a car accident, truck off in theditch. She found one pt, covered in blood. Loaded him up, did her first ratemedic thing as always, but after cutting off his clothes couldn't find anywounds?? As she's getting his history he tells her that "I just killed theguy that owns that truck. I'm ok, none of this is my blood." She calleddispatch to get some police assistance and was told by dispatch that as she wasout in the county she would have to call the Sheriffs dept directly, and no,they didn't have that number as they always dispatched them by radio. Nice. She of course told what she had heard, they did in fact find a man beaten todeath, and with a supervisor in tow did the mountain of reporting involved. Ithink that this case is pretty clear cut. Man..I like this question a lot...I look forward to hearing from those that aremore versed in the law. Dwayne Sorry all...formating was completely hosed. While trying to fix it, (The editor doesn't seem to like long quotes or many multiquotes) they got out of order and well...you'll see...

Playing devils advocate... What happens if your HEP positive pt is an angel until loaded into theambulance and then spits in your face while you take their blood pressure? Yourestrain them and put on a spit mask..yadda yadda. Next time they swear theywere in a bad place last time,(all sweet and doe eyed) that it will neverhappen again, but it does. Do you tell the crews that you think likely to run on this pt to be aware thatthis pt is a terribly sneaky spitter? Or protect that information and let themlearn, and be exposed, on their own? Dwayne Edited (God only knows how many times it will take) to fix formating.

Shoot Mike, no hatchet to bury. Sometimes we just disagree. Dwayne

Your entire whiney rant makes no sense at all. Admin charges for chat, therefore Admin doesn't believe in God? If God wanted him fed, then he'd feed him so there is not need to charge? Are you insane? When you take a job do you then refuse your paycheck because you're confident that God will feed and care for you? Perhaps God doesn't want you to chat and that is why He's allowed you to fall into such a position that you can't afford a few dollars for the chat room? Or maybe, he simply wants you to stay out of the chat room and go outside where you are most likely to resolve your financial issues? If you want to beg your online friends to buy your membership, show some self esteem and simply say, "I've fallen on hard times, can someone buy me a membership?" instead of trying to come up with some ridiculous religious based charade. I wish the best for you, believe it or not, but sometimes enough is just enough. Dwayne Edited for typos. No contextual changes made.

Dwayne

I hope he's fired, assuming he's not a volly, which seems likely. Sued, and then I hope dad tracks him down and beats him to death. Nope, I'm not exaggerating. If this type of thing came to me of Babs or Dylan's last moments on earth the very next time you would see me I'd be on Court TV while they decided whether or not I'd earned the death penalty for my retribution. Taking a video for education? Ok, with the families later permission. For the ER? Of course. To show your idiotic wanker buddies that you were actually in the vicinity of a nearly dead person? Holy shit.... I mean...Holy shit!! I'm finally coming to believe that EMS is not salvageable. But of course, we all know that if he's not a volly , the Chief or Captain or whoever is supposed to supervise these assholes will be disappointed in him for being a fucking moron and then give him a few paid weeks off while the press dies down, all the while speaking of how he's been "severely punished." Makes me sick... Probably can't tell that this pissed me off a little... Mike, do you have a link to the story? Dwayne

Wishing for peace and healing for those that loved them from the Womacks in Colorado... Dwayne

I hear what you're saying brother, and I dig your tag line! But as stated elsewhere, if you truly need to gauge responsiveness to r/o an OD, there are other ways to accomplish this. And is their level of responsiveness truly that important when considering the degree of drug/alcohol intoxication? I don't believe it is. There are significant physiological markers in this population of patients that should steer you down the correct path without resorting to ammonia. Is it a terrible option? Not if used by an honest to God adult for the purposes of patient treatment. I just think that most often that is not the case. And I think it's lazy assessment. You sound like a smart man. Can you truly tell me that you don't know what response you'll get before you apply that particular intervention? Do you not have a really good idea what your pulse ox will say before you apply it? If not, then I'd argue that you have no right to be using it. Don't you most often know what your monitor is going to tell you before you read it? As before. And if your assessment skills are weak, or tired, or just simply not worth applying in the 'possibly drunk, possibly OD'd, possibly faking' crowd? Then I think that is a separate issue all together. Of course I don't know you, and have only a few posts to judge you by, so I'll ask that you believe that my comments are meant for the purpose of debate and not to slander you personally. I'm grateful for your thoughts, and for the fact that you're brave enough to share them. Dwayne

You have to decide on your priorities babe... I don't see any way to do both well. Which is more important? Dwayne

Then you treat appropriately, right? What is the down side if you're wrong? I see increading numbers of people thinking that they're cool for 'catchin' those that are faking, but what's the upside if you're right? What's the downside if you're wrong? The upside is minor, bragging rights at best, the downside is a bruise to your paramedic soul, so do you find that to be a worthwhile cost/benefit? If so, then I think that you're shameful. Care for patients, care for people, but let the wankers brag about withholding care. Just my thoughts.. Dwayne

Hey Nik, welcome! You'll find that we bag on Fire pretty hard here sometimes, but if it doesn't make you so mad that you run away, I think that you'll find that there are valid reasons for it. Though what we don't bag on, at least not normally, is anyone that is committed to learning and doing good medicine, Fire or not. I think that you're right about a forum being helpful. This forum changed many ideas I had going into EMS and I am a much stronger, smarter provider because of it. A word of advice. Many here read the forums, as you might a textbook, and take away what they gleen from other's opinions. I believe that that is a mistake for the serious student. If you really want to harvest all that is growing here then you really have to pick up a hoe. Post your questions, answer other peoples' questions, take chances, be brave, be involved. I think you will find that it will give you a major leg up over your classmates. See one, do one, teach one. Again, welcome to the City! I look forward to your thoughts. Dwayne

I assume you mean a full length, college level A&P course, right? Not one of the short classes that they often offer to medics and hosemonkeys? What other college level courses do you have? Does your course require A&P or is that something that you did on your own? Hard to tell you brother what would be a good fit to begin studying without having some idea where you're at now..see? Welcome to the City! We're glad to have you! Dwayne

I got into it because I heard that all the chicks on ambulances were sluts, and would even sleep with ol' fat homely paramedics...THAT is what I was counting on to get me through... That plan turned out to have several significant problems with it, so now I use exotic locations to get me through...Not exactly the same, well, ok, not in any way the same, but it aint bad! As you've seen said here, it can be a livable wage depending on where you live and what you consider 'livable.' Dwayne

WARNING WARNING WARNING I'm sure that most of us that have been here for a while realize that ak has asked many of the most hotly debated questions on the City. Though I know the temptation is going to be strong to romp and stomp on each response that many of us have come to believe are incorrect, though counter intuitive to those that have not been in the field for a while, perhaps we can use this opportunity to learn about the view from those that are taking the path of this poster and avoid insults, etc. Thank your for your time and attention... :-) Dwayne

A couple of things... First, if I knew of a medic that intubated a drunk pt for punishment I would take every step possible to burn him/her down. There is no room in professional medicine for that type of idiotic, unprofessional behavior. I'd burn them down not only for being unprofessional and unkind, but for being ignorant enough to consider intubation a benign procedure. To risk permanent throat injury/pneumonia to a pt to 'teach them' for being drunk is not only unprofessional but morally bankrupt. Second, Doc says he should have had anti-emetics (in a perfect world) so that seals it for me. But I'll tell you one of the many things that I'm coming to like a lot about you, is that in many medics minds, vomit = antiemetic, who can fault me for that? But instead of taking the obvious, easy way out, you chose instead to say, "What is best for my pt? Not just now, but throughout his recovery?" And that is friggin' awesome! The upside? Thinking like that will always get you respect from silly medics like me, as well as many that are much better than myself. The down side? Sometimes when you think through your problems, instead of simply following protocol, you're going to screw the pooch. You will make some mistakes, but I truly believe that a well educated, pt focused process will almost always keep them from being giant mistakes. A well balanced approach is what seems to work for me. I very much respect my protocols, but question whether they are right, or all that is needed for each pt. That seems to keep my wee wee out of the wringer while providing the very best care that I can at the same time. It's good to have you here. Dwayne

Welcome man! I was impressed that you jumped right in with responses not long after becoming a member...good for you brother. I'm a true believe in see one, do one, teach one. So while it is certainly important for you to make your original posts, it is also very productive for you to respond to others as you've already done. I have a feeling you're going to be a really good medic. Ask, explain, argue, teach, learn, but never, ever sit on your hands... It's good to have you Beiber. (Do you have like, some weird 12 year old's haircut or something?) Dwayne

Emtcutie, welcome to the City! A few words of advice, and please believe that they are meant in kindness. You should pay attention to your capitalization. When presenting yourself on the forum, where you're main impression will not just be the validity of your thoughts, but your ability to present them clearly and in a professional manner, spelling, grammar, punctuation and capitalization can certainly be the difference between getting quality responses and simply being ignored. Just a thought It sounds as if you're off to a great start in class! Each of those subjects can be a little nerve wracking and stressful, but none, as you seem to see already, so much as internship. The biggest regret that I have from my time in clinicals is that I wasted so much time being insecure. I had a really shitty first phase clinical experience, in fact I almost quit my medic program before graduation because of it, but then when I got amazing preceptors, (all the rest), I wasted a ton of time being timid. And not just mine, but the preceptors that were kind enough to take me seriously, even though at first I didn't deserve it. Don't forget that the clinicals are for you to FINISH your classroom education with. It meant for you to get a safe place to practice your skills, but much more importantly, a safe place to practice being the medic in charge. Take your time, but don't waste your time. Do you see? I love your enthusiasm, and the bravery that you've already shown by being smart enough and brave enough to post. Study hard, practice hard, put yourself in every shitty/scary position you can during your clinicals, and you'll do fine. Dwayne

My opologies for the appearance of my post. I hit enter and walked away. I really, really hate what this editor does to my posts sometimes... I'll try and fix it.. Dwayne

I'm not terribly clear on just how responsive he was, but it sounds as if he was 'spitting.' Was this because he wanted to clear crap out of his mouth, or just sort of altered gagging, spitting? It sounds like you did real well. I would have made the decision this way, for what that's worth. I would have strapped him down LLR (left lateral recumbent) and let him puke off of the side of the cot into a bunch of towels. If this allowed him to keep his airway clear, then I would have done as you did..run a bunch of fluid if there was no reason to believe it contraindicated and transported like that. On the other hand, if there was a reason that I couldn't lay him LLR, or after doing so found that he wasn't vomiting strongly enough to force the emesis from his mouth, causing a risk to his airway, then I would have nasally intubated him. I had a Doc tell me once what the mortality rate was for people aspirating on stomach contents, and though I don't remember the number, I remember that it freaked me out, so I'm maybe a little over cautious of that. Bottom line is that we need to keep what's coming out of his stomach from going into his lungs. If you can do that by saying, "Hold this bag and don't puke all over my ambulance!", or by positioning, or by close monitoring with suction, so be it. But if you have any reasonable question regarding that, and your intubation skills are strong, then a nasal intubation seems to be a reasonable choice to me. Of course all opinions are subject to change after input by my betters. I can tell you that the few pts I've nasally intubated secondary to drug/ETOH issues in my small rural town either freaked out or pissed off the nurses when I brought them in. But in each case the physician seemed to feel that it was a prudent intervention. A question for our Docs and nurses. Do nurses not train in intubation and/or nasal intubation? I actually had one nurse point to my nasal tube and ask the Doc, "What do you want us to do with...whatever that its?!" He said, "It's a patent tube, just leave it where it is." I'm not poking fun at nurses, I've just wondered since then if they were stating it in that way because they didn't recognize it, or being sarcastic because they thought that it was a poor choice. And Lifetaker...Kudos to you for having the balls (or ovaries) to post your call, with possible errors included. It can sometimes be tough to ask for constructive criticism...I'm grateful that you were brave enough to do so and allow us all to learn from you. Welcome to the City. Dwayne Edited to repair editor molestation.

I like your attitude, I really do. It would be nice to be presented more in a more professional light. I'll even go you one better. I think that not only should they pull that commercial but they should remove all programs that show firemen doing all sorts of heroic nonsense. I know you're likely to be offended, but lets be honest. If it's good for EMS to be shown in a more accurate professional light, then certainly the same is good for Fire, right? Unfortunately, neither is likely to happen in our lifetimes... Welcome to the City man. Thanks for posting, and don't take the ribbing to seriously. Dwayne

Yikes. I posted at the same time as Matty....There was no collusion there. It was my desire to give you a frank and honest opinion, to to support a mugging here spenac. But perhaps is you decide to continue the conversation there is useful information in these posts. Dwayne

Of course it was me that gave you the negative. Normally you're whining and whatever nonsense you spout in the chat room keeps others feeling sorry for you and prevents them from doing so. But why do you assume that I'm a jerk for giving you a negative? Why can't you, like an adult, assume that I thought that your arguments were shallow, one dimensional, self serving, cookbook Basic level medicine and simply not good educational material on the board? Isn't that what the votes are for? To show others my opinion of your thoughts, either exceptionally good, or exceptionally bad? You continue to espouse 'proper' exam. And I couldn't agree with you more. You simply go so far out into left field that your opinion loses my support. Wasn't it you, months back, that said that if we let a speeding car pass, or one drive through a yellow light without calling the police that we may have just allowed a kidnapper to escape with his victim and that we should be ashamed? That's what I'm talking about. Your thinking is so one dimensional. It's too shallow. You sound as if you're constantly doing scared medicine. "What will the ER complain about? What can I claim that I do that everyone with think is very unusual and heroic?" I'm hoping that I misunderstood you when you asked why we take blood pressures when it won't change my treatment as I can't raise or lower blood pressure? I can do both...did I misunderstand? If so, then I apologize, if not, then they should shred your medic ticket today, right now. I hope that you're a good provider, but I don't believe that you are, and I'll tell you why. You are too inflexible. You take the first thing that pokes itself in front of your nose and makes sense to you and you commit to it, fully unwilling to change your mind. The very best educational moments in my short career have come from exposing my own process to others, having them say, "But what about X?" At which point I often said, "Holy shit...I don't know how I missed that..I screwed the pooch on that one." Also, your skin is so thin as to be near transparent. No one simply disagrees with you because they don't respect your opinion. They "don't like you" or "have it out for you" or some other such nonsense. I've been watching for the shout out, if we still have them, saying something that resolves in, "Oh poor me, everyone is so mean!" Ive not known a provider, and I've known a few really good ones now, that are so easily offended, nor so quick to discount a valid opinion as simply mean spirited harassment. I've gone to the friggin' mat with Dust, ak, an many others here much smarter than myself and at times left feeling pretty good, at other times bloody and beaten, but still I count each here that has intellectually bashed my head in amongst some of my closest friends. When Wendy used to correct my grammar and spelling I wanted to choke the shit out of her! But I know present myself, though not as well as I'd like, much, much better than I did before she took me to task. (Watch, now she's going to shred this post...and I'll say thank you, though perhaps it will be hard to understand through my gritted teeth.) Do I like you? No idea. I've not given you enough thought to develop an opinion. Why do I care then if you give opinions that I disagree with? For two reasons. First, I believe that there is great power in strong debate. If I confront your best argument with my very best argument, perhaps we'll both leave with some wholly unexpected piece of knowledge that neither of us would have gleaned on our own. Secondly, and much more importantly, there are many, many young, and/or new providers here that come with the belief that we are here to help them, as well as learn from them. You are willing to take an argument that you believe Dustdevil would have made, only he was most often right, and present it simply to feed your ego, to have the young/new come to you and say, "My God! You are so brave!! I would never ask a woman to expose her vagina and use her hands to spread her labia! You're a rockstar!" You plant the seeds that will send them into the ER glowing only to have the ER physician say, "What were you thinking? Where did you go to school? Are you an idiot!?!" Do I believe that you would always employ those interventions? I don't. I believe that often you simply present them, and then swear by them, for effect. What is a proper exam? Initial impression, good sets of serial vitals, an in depth current/past history to include current medications whether compliant or not, an attempt to get a decent feel for my pts frame of mind, and depending on their chief complaint exposure up to the point that I believe it is necessary to support or retard my working diagnosis. SPO2, monitor, etc? Sure, if indicated, but they are mostly toys and I can't really think of a time that I couldn't guess what they were going to say before I read their fancy little screens. And as expected, you ignored my questions, which I'd presented carefully to make them relatively easy. Do you spread the cheeks of your 70 y/o hemorrhoid pt? Palpate? Do you expose your kidney stone pt that has radiating pain into her groin? Ask her to spread her labia for a peek inside just in case your working diagnosis is incorrect? I worked with a new medic that wanted to put 15L NRB on every pt that she believed needed O2. I suggested that she use more appropriate amounts when required. She said, "Why? It's not going to hurt them, and it's better too much than too little." I told her that in the vast majority of cases that she was right, the pt was not going to be hurt, but she was. That the people that view her treatments, or take transfer of care of her pts are going to expect her to know how to determine, and then use, appropriate interventions. She thought I was silly and is now little respected around her peers, and worse, her betters. That seems to be what you're suggesting here. I will expose the genitals and ask an already damaged pt to spread her labia so that I can best examine her whether or not my thorough exam reveals that this is a prudent step. A vagina is an amazing and wondrous thing, but I promise you this. No matter how macho you think you are, how many "babes you've bagged", nor how many books you've read or videos you've watched, you will never know more about the inner workings of that freaky little machine than it's owner. Peds and trauma excluded of course. Is it leaking icky stuff? Sure, and it smells nasty! I can't justify being down there under the guise of alerting the ER to this fact. Is it swollen? Yeppers! How come? Beats me, and I can't justify collecting that information under the guise of alerting the ER. Is she tachy, diaphoretic, appearing to be trying to smuggle a giant watermelon under her shirt while she screams "I think it's coming!!!" Ah, see, this might dictate not only a peek, but a good hard look. But my physical exam already told me what to expect before I dropped her drawers, right? I once exposed a rape victim and examined her genitals because she claimed that her attackers had stabbed her multiple times in the rectum and vagina with an ice pick. And the area was a mess. It was ugly, disturbing, but it turned out that she had inflicted the wounds herself. Did I need to expose her? I believe that I did, as I could see blood through her clothing at the vagina and rectum and believed that bleeding control might be necessary. Would I have exposed her if I hadn't seen blood? Absolutely, as she told me that she had been stabbed in that manner and I'd want to look for signs that she had compartmentalized bleeding or that it had perhaps been tamponaded (? Not sure that that is a proper word) in some way. I also checked femoral/pedal pulses, checked cap refill, and did a lower extremity neuro exam on the way to the ER (as well as prudent, associated interventions) in case there was hidden vascular/nerve damage. Those are things that I believe the ER might benefit from knowing at, or prior to my arrival. A lot of people here have tried to express their views of your opinions and you've narrowed it down to "everyone thinks I'm right except those that don't like me" again. You need to let that go brother. Many here, such as Wendy, Matty, Dust, akflightmedic, Kaisu, etc, etc, have told me that at times I'm an arrogant, ignorant asshole. And you know what? In each case I went back, reread the posts that caused them to draw those conclusions, and I can't think of a time that they were wrong. Despite my best efforts, sometimes I simply go off into the ditch. And I thank the powers that be that there are people here willing to say, "I know you think that you're right here, but you need to trust me when I tell you that you are thinking and behaving in a way that you wouldn't like if you could see it from the outside looking in." Step back from the self pity man. Stop making an argument simply because you believe you will look ignorant if you reverse your position once chosen. There is not a single person here that I respect that doesn't say, on a regular basis, "I don't know" or "ooops, I see your point." It won't kill you...trust me. Dwayne

So following your logic then spenac, when the 70 y/o male calls with bleeding hemorhoids then you must bend him over, ask him to spread his cheeks widely apart and examin his ass? I mean you must, as he called 911 which in your mind seems to imply that he is incapable of any type of reasonable thought without your intervention. Of course his 20 year history, list of meds and cases of Tucks pads is irrelevant? Do we expose a trauma pt? Of course? Do I expose the vaginal area of the female that claims to have fallen off of a ladder and landed spread eagle on the edge of her wheelbarrow causing blood to soak through her pants and undergarments? (real pt) No question. In both of those cases there is the near certainty that I will have some knowledge and expertise that can be of benefit to my patient, warranting the exposure. Do I expose the female that complains of spotting and some vaginal burning x 5 days? Of course not. She is the expert in that case. Good vitals, (And come on, you're not talking to children here when you describe compesated shock, as much as you'd like to believe that you are), good history is all that I'm likely to need to properly care for this pt. The female pt that complains of lower flank pain radiating to her pelvis and groin...Do you truly expose the genitalia of all of your kidney stone pts as they writh on the bed puking? I have to assign a meat gazer label if that were the case. I have examined many penis', vaginas and rectums overseas where longer term pain management, wound care and antibiotic therapy was within my scope of practice. In the U.S? Only if my intelligence, history, and index of suspicion would lead me to believe that it was a prudent medical intervention. How do you know if she's lying when she says she's spotting but is actually flowing heavily? You, as a medical professional should not only notice the change in vitals, but the giant blood stain at her crotch should cause some suspicion. As Matty said, your entire argument was predicted by the way you phrased the question. I've not been around much for a bit, but I'm guessing that the City has a bunch of new, eager, curious young minds, as that seems to be the time that you throw this type of silliness out there. Always properly assess your pts kids. We don't put a splint on for chest pain, we don't use CPAP for a twisted ankle, and we don't put pts in compromising, possibly humiliating situations without first developing an index of suspicion. Besides, if a good set of vitals, good physical exam (non traumatic, clothes on), and a rockstar history isn't enough to tell you that you're pt isn't bleeding to death through her vagina, than it's back to Basic class for you.... Of course, having said that, there are more than a few providers at the City that I would gladly allow to do a genital exam, regardless of my physical complaints... :-) Just sayin'... Dwayne

I've not been participating much for a few months, so perhaps we've gone back to the touchy, feely EMT City, but I didn't really see any significant issue with mfprincess' post. The OP, who I applaud for having the courage to search for answers as well as post an experience that she's not very proud of. To say that she is not emotionally equipped to deal with these kind of situations seem self evident to me. The cknowledge that she is not currently equipped certainly doesn't imply that she's to weak, or stupid to become equipped, in fact instructions for doing so followed the comment. Perhaps msprincess pissed someone off in other threads...don't know. The OP presented her story clearly, and honestly, I didn't get the feeling that she came here to be coddled, but to become educated with a decent dose of empathy thrown in to boot. But the fact is, you are not currently emotionally equipped to deal with such a situation. Non of us was the first time we saw an emergency, but you can become equipped. What worries me more than the emotional aspect of your response, as you will react completely differently next time, is the fact that you state that you've taken a CPR class times three yet don't seem to understand that a breathing person does not require compressions (in the BLS environment.) If you were confident that he was breathing there was nothing medically that you could do for this guy. Physically you certainly could have as explained before, but even then, unless you allowed him to flop off of a balcony or some such thing, you shouldn't feel responsible for his condition or the outcome. I found my grandmother dead in her bed when I was 16, long before becoming involved in EMS. I couldn't touch her. I said, very quietly a few times as if speaking aloud might bring out the ghosts, "Gram, are you ok?" and then went and called 911. Did I act that way because I'm some idiotic emotionally unstable pussy? Idiotic, often, emotionally immature perhaps but not unstable, and I doubt anyone that knows me would define me as a pussy. I simply had no tools for that situation. My brain tried to lock into my past experience for finding dead people, found nothing in the toolbox, so I acted silly, random, and called for help. There is no need to be ashamed of that, and I'm not. I mentioned that I was worried that you didn't seem to understand that a breathing person doesn't need compression, but I'll tell you what wipes that worry clean off of the plate for me. The fact that you were brave enough to tell your story and actively seek constructive criticism and advice. That is friggin' awesome! Cast iron reproductive organs are often necessary in these situations, and you seem to have that in spades. Retake your CPR class, perhaps see if there is the possibility to ride along with a local ambulance, stop using the language "I didn't want to kill him." as that is mentally damaging as well as being completely inaccurate. You didn't put him in this situation, (Or if you did, ignore the rest of this post and go and turn yourself into the police.) you couldn't have prevented it from happening, it was not of your doing. You have to eliminate that "stinking thinking" that says, "If I help him, and he dies, then I killed him." If that is the case then I've killed dozens of people. Do you see? I am going to criticize your inability to afford an AED. You have chosen a profession that puts you in regular contact with high risk patients. You've chosen to try and help them physically, yet have also chosen to allow them to die needlessly while in your care by not preparing to save them. In a new business I can almost guarantee that you have spent more on carpeting, curtains, electronic equipment individually than the cost of an AED, yet you've found those things more valuable to your patients than a simple, proved, life saving tool. That doesn't seem responsible to me. Most importantly? YOU WILL NOT ACT THE SAME WAY IN THE NEXT EMERGENCY. I guarantee it. Your toolbox was empty last time, you had no experience to draw from. That is no longer the case. Do you want to add more tools? Absolutely, in fact you may find that you want to install some mental pegboard to keep expanding once your toolbox is full, but you have a significant advantage next time you're exposed to this situation that you didn't have last time. Also you'll take your next CPR class in a completely different context. Things will stick now, where they didn't before. Cut yourself a bit of slack. You were a victim at this emergency, yet you have the ability to prepare not to be victimized next time. Good luck. Dwayne