DwayneEMTP

Sounds like an oxymoron to me, but perhaps I'm misunderstanding the terms 'clot' or 'non occlusive. Dwayne fuck it. Tired of trying to figure out the formatting. I've bolded 'clot' and 'non occlusive' but the editor has buggered it up. No other changes made.

I'm guessing that the answer to your question is in my response to the thread. In a full arrest my partner is as qualified, or more so, than any advanced provider. He's not a 120hr wonder, he's a basic with 16yrs experience, and that seems to make a difference, at least to me. What is the down side to him pushing meds while I manage the parts of the call that have been more scientifically proved to be effective? All of this assumes of course that i've verified my partners competency to push the meds mentioned. It really is not rocket science to pull a med, verify it, draw it up or prep it, verify it again, prepare to push it, verify it, and then push it in the manner most appropriate. (IVP, IVSP etc) Right? I ran a COR (full arrest) with a brand new basic on our team. After I'd intubated I told him, "Your job now is to ventilate this pt. What that means is that you give a breath on every count of '6' and make sure that that tube doesn't shift from 23cm. Do you understand?" He bagged as asked, exactly, and I watched him as the pt regained pulses and everyone got excited, yet he never looked away from his tube, the duty I'd given him. Given another dozen or so experiences like that and I've no issues allowing him to push my drugs. See? Dwayne

Wow...Google really is your friend. Care to expound instead of just queering this interesting thread? Dwayne

I guess I'm not completely clear on what's BLS vs ALS either. Though, thank goodness my partner understands his role down to the letter. If pushing ALS drugs is ALS then my BLS partner does it all the time. I believe, though have never researched it, that my partner can push any ALS drugs as long as it's supervised by a medic. He can not tech those pts to the hospital, but he can push the drugs. Common COR scenario for us. My partner begins CPR while I attach the monitor, or vice verse, CPR is continued (we have QRT, Quick Response Teams that are trained to the first responder or basic level) by QRTs, my partner grabs the drug box while I set up for intubation, while I intubate he gets vascular access, (unless in the rare case that that requires I/O and then I gain access, though he preps it for me.) normally intubation and access happen near the same time, he runs the ACLS protocols, as he knows them as well as any medic at our service, I monitor the monitor, CPR, affirm the meds he calls before he pushes them and acknowledge that they have been pushed, rotate everyone in and out on ventilation and compressions and adjust where necessary, and then make the decision to move, stay on site, or call the arrest in place. If that is what you mean, then yeah, my BLS partner does ALS procedures regularly. He doesn't intubate, though he's got more than 10 live intubations, he doesn't tech pts with anything more than BLS interventions on board, but other than that he's at least as smart as I am and participates in every other way. I don't consider him an 'average' BLS partner, but these are the things he does. Is that what you were looking for? Dwayne

I had the privilege of meeting this extreme athlete tonight, as well as his wife, and what an amazing, inspiring experience... http://www.facebook.com/group.php?gid=85090489887&v=wall In the Race Across America the riders ride approx 3200 miles on a bicycle and finish in anywhere from 6-12 days, with most that complete it finishing on or before the 10th day. It's a 24hr race, no mandatory rest or sleep breaks. All riders start on one end of the country and the first on to the other side of North America wins..It's friggin' insane!! Ian is riding to raise money for MS research, which has afflicted his drop dead gorgeous wife. Anyway, I won't soon forget our visit and thought some of you might be interested in his story, and the race, and might even donate a few bucks if you have them laying around. Have a great day all! Dwayne

That link is cool as hell! I'm looking forward to seeing the documentary. Dwayne

I think that perhaps you misunderstood, (and I'm going to speak for both of us, though of course that may be in error) when you take our comments to believe that there is no such thing as a difference in situations, that all is neutral if we eliminate 'good' and 'bad.' I proposed that the words themselves have gained a power that is unproductive. About a gazillion years ago B. F. Skinner proposed that we would never come to a point where we would blame environmental factors for an entities behavior instead of an inherent quality. He believed that to solve our crime/prison issues we'd have to come to understand that 'bad' people weren't born bad, but were made bad. We would never do so because then the inverse is obviously true, that 'good' people are not inherently good, but also created by their environment and no 'good' people were ever going to admit that there is not something mentally, spiritually, biologically better about them, thus explaining their success and giving them the right to be scornful of those in the opposite group. I believe that it's it's more productive to label behaviors, not people, but behaviors as productive or not. When a kid steals a candy bar at the local gas station, that behavior is not only labeled bad, but also the child, as only a 'bad' child would even consider stealing, right? That bad label now needs to be punished if the 'good' people are to feel satisfied that justice is to be done. During that punishment we've not only punished the behavior, but as only bad people are punished now explained to this child that he's been moved from the 'good' category to the 'bad' category, and the new label will shadow much of how he feels about himself in the future as well as likely tarnish much of his future behaviors secondary to a self fulfilled prophecy that he's been taught, against his will. See? If we instead look at this behavior as unproductive, and understand that all kids are going to steal at some point (at least the vast majority) and attempt to educate this problem away, then we end up with non of the above negative fallout. Does that make sense? Yes, it's neither good, not bad. It depends on perspective. Not bad, but certainly undesirable, and punishing to the parent, which is a good thing as it predicts less chance of this behavior happening again in the future. I think we can all agree that this is desirable. Again, I think we probably agree more than disagree, but look at the power of words differently in this instance. I would replace 'good' with reinforcing or desirable, and 'bad' with punishing or undesirable as these label behaviors and not people. And I think that that is much more productive. As well, I do believe that my way of thinking fits more into the evolution mold then the religious, as becoming more kind, intuitive, insightful, and 'aware' would seem to be a likely evolutionary step. But how then to explain akflightmedic? He's one of the kindest, progressive thinking people I know, yet lives in the body of an ape? Some thing we may just never understand... Dwayne

In the end, in any way that my little pea brain can see, it makes no difference if the heart is beating because of electronic support, some device that creates circulation via some mechanical manner, or if he's been infected by some body snatching alien kinda thing that makes the heart beat with mind waves. If this pt had a perfusing pulse then none of the rest of the story makes sense. An ER staff, even a very, very poor one should be able to determine that something very strange is going on with a pt that has fixed/dilated pupils, no cardiac electrical activity, a pulse, yet still manages to sit up and look around during a resusce attempt, right? And yet they were unable to find a way to discontinue attempts nor define where the pulse is coming from? If there is a pulse there truly are a very, very finite number of places to look when trying to figure out how that is possible. See what I mean? Worst case someone should have said, at some point during the resusce attempt, "Can someone figure out where that God damned pulse is coming from!!??" I hope your instructor is top notch, but he's either simply screwing with you guys to get you to think outside of the box, hoping that someone is going to stand up and yell, "Bullshit!" or he's talking out of his ass... Dwayne Edited to reformat

When did you become such a crybaby?? I most often believe that I am wrong, or at least partially wrong, but am not sure how to discuss things from that perspective. I argue from the point of view of being right until one of my betters shows me the errors of my thinking, logic, etc. That's the problem, next time think about the information instead of posting irrelevant shit and pretending that it supports your argument. Don't blame the SHP for the fact that you failed to think through the information you posted. I might expect such nonsense from a new poster, but you? Pretty surprising. Trying to muddy the waters with the Wiccans/Pegans bullshit isn't going to fly brother. There are few here foolish enough to consider that a valid argument. Easily the most idiotic thing I've seen posted on the forums in a long time. The make-up of the population that the statistics are drawn from are vital if you are going to attempt to show that there is no profiling occurring, or as it appears you attempted to show, reverse profiling. I made the comment that I believed that you are plenty smart to get that, though unfortunately your comment above shows that I was mistaken. Of course you can, as can anyone else that debates on this forum. Simply don't try and present bullshit as a valid argument. See? Easy. I'm not sure how we do that exactly? I'm not going to stop commenting on posts that catch my attention and that I find interesting. Unless you are suggesting that you are no longer going to post then I suggest we simply continue to debate until we come to a better solution. Dwayne

As a big fan of your posts, intelligence and logic, I have to say I'm disappointed by this one. This isn't about whether you were right or wrong, it's about our civil liberties and the right in our country not to be detained without probable cause. If the officer was there to help your sister, Kudos to him, helping her would not involve a drivers license, insurance card, nor running her plates to see if she had priors. It would simply involve asking what her need was, and then helping to fulfill it, though I'm guessing that that is not the only thing that occurred. We have a right, and an obligation, in my opinion, to ensure that our police forces do not become an armed extension of the government. We have an obligation to ensure that law enforcement is fair, equal, just, and unbiased. I will not be punished for visiting my friend in the inner city, and if we have to let some folks get past that are buying weed instead of actually visiting anyone, well, in my world, that is a small price to pay for our liberties. The same liberties that are being whittled away at year by year. Case in point. http://video.google....2117793977759# I can't remember the last time I broke a law other than speeding, but I'll tell you this. If I get stopped, the officer, whom I respect greatly en-masse, and less so sometimes on an individual basis, will need to explain to me why I was detained before I provide any type of documentation. Each time we say something to the effect of, "take away my rights and liberties as long as it will help you catch some bad guys." we choose to pee on our flag, we degrade our constitution, and we sacrifice some, perhaps a lot, of what it means to be American. No disrespect meant to your opinion brother. I've only meant to offer my passionate, and contrary point of view. Dwayne Edited again for formatting, no contextual changes made.

C'mon Ruffers, you have to know that these numbers mean nothing without knowing the percentage of black people in these environments. I agree, if the percentage of blacks/whites is 50/50 then there is certainly no profiling going on here, but if the percentage is 90/10 then yeah, the black folks should be screaming their heads off..and I'll stand with them as they do it. You know better than this brother, you can figure this shit out...lets not spew statistics that seem to make your point but we all know don't actually do so.

Yeah girl, there is truly nothing about that story that makes any sense.. From the story there was never any indication for CPR, regardless of how many monitors showed asystole, the patient was not asystolic with a pulse and b/p. If 'each time', implying multiple times, that they attempted to discontinue resuscitation attempts the pt sat up and looked around then the treating facility needs to stop treating pts as it sounds as if this patient was doing much better when they stopped treating him than when they were. Either you got the story wrong, or someone is bullshitting you babe... Dwayne

Bars and restaurants that serve alcohol have made it clear for decades that uniformed officers are unwelcome, why is this different? The owner states that she caters to clientele that have had specific issues with the police of late. And even if they hadn't, they tend to consider themselves rebels and all that bullshit. She wasn't shitty, the cop wasn't offended, I'm not really sure why it's an issue? Secondary to my job I no longer enjoy any illegal substances, but it's possible that any any party at my house there may be several folks that may have trouble passing a drug screen. When I refuse to invite a police officer into my house, is it then implied that I am anti police? I am not, I simply don't agree with each and every law that they are morally/ethically obligated to enforce, and respect the fact that they will do so should I put them in a place to be forced to observe them. (For the record. No one does anything illegal in my home, on my property, or near me or my family. In fact other than a pleasant smell that they may have picked up accidently, I have no proof that anything illegal happens at all. They simply 'go for a walk' and come back a little more chipper than when they left and I have no moral issues with what I presume to be their choice of party favor. Just sayin'...) If my business revolved around the same theory, I'm afraid I would feel the same. Dwayne

I had an 86y/o woman roll her mini van 40 mins out on a country road. Despite the fact that she was calm, color appeared good, mentating normally, I chose to begin my transport emergently. After about 5-8 mins I downgraded to non emergent as the time to do a more thorough assessment revealed that despite mechanism I couldn't really find anything wrong with her. Our protocols state specifically that mechanism alone is not justification to run emergent. I disagree with Phil that mechanism alone is indication for emergent transport. A pt might fool me for a few minutes by compensating, but if it last longer than that, shame on me. Use your judgement, intuition, full skill set, and then make an intelligent decision that weighs the time saved, the effect of coming in emergent on the hospital, against the danger of running lights and sirens. Dwayne

I'm calling bullshit for a couple of reasons.. First, I believe that they should have to publicly justify their already boated budget before being considered for more money... Second, who is to represent the drivers in this scenario? This is a bullshit idea as it allows the FD to hold out of state drivers hostage... Added charge for controlling a fuel spill? Who's to say if it was necessary? We know that soon the argument will be, "Any fuel powered vehicle that has been in a collision has the likelihood of fuel cell compromise making it prudent to place control measures to mitigate the danger to Rescuers, other motorists on the highway, woman and children nationwide, and higher functioning DNA specimens around the world. That seems self evident." Extra fee for extrication? Define that for me? When Bubba the knuckle dragger jerks my door open with his hands, how much is that extrication going to cost me? And when the door flies open and he falls on his ass, of course requiring him to retire on a medical due to traumatic/emotional damage, how much do I then become responsible for? If a tax is prudent, it is only prudent if those that will not benefit from the tax are in charge of assessing it. Not only does attacking only out of state drivers keep them from having to put up with a bunch of shit in their own back yard, but it allows them to hold those drivers hostage for the fee regardless of it's validity. Should these charges be appointed unfairly, how many people will be able to afford to hire a lawyer and travel back to Denver to defend themselves? How long do we really believe before there is a good, solid number that says, "Assess all you want, but not more than X, as we've found that people don't kick and scream below X." And doesn't the City and/or the fire dept already receive stat/federal funds for the service that they provide on those highways? I'll tell you what though. I might actually vote for this thing if I never have to see another "I run in where other people run out screaming!" Or "I fight what you fear!" Bullshit tshirt on some fat shithead at Walmart. I probably wouldn't, but it would be a close thing. My apologies for bagging on fire to our members here that actually think that serving the public as a fireman/woman is an honorable thing and that those being served shouldn't be abused secondary to that service... And, as always, the comments above are meant in the most biblical, heartfelt spirit possible.. Dwayne (Dang it. Created this yesterday, got toned out and forgot it. My apologies for redundancies to posts since then.) Edited for formatting bullshit. No contextual changes.

Yeah 4c6, I took it that you were being an asshole to this kid too, and was surprised by it. I'm guessing when you reread your topic, description and post that you can easily see where people got that idea. I do believe your posts show you not to be that asshole though...just sayin'. What I do have issue with is those that have stated, "If it compromises pt care, I'm cutting it off." as if cutting or not are the only options available. In my experience people often cut off clothes for the same reason they can't wait to get to c-spinin', because it makes them feel very heroic. All of my trauma pts get near naked before going on a board, but rarely do I cut more than tshirts. You know who I love to cut the clothes off of? Those people that explain to me how bad they are going to kick my ass if I do. You know who I really, really, hate to cut the clothes off of? Homeless people. My basic partner, who teaches me something new just about every day, and I had a homeless man that had been attacked and stomped to whale shit. He was wearing a nice warm leather winter jacket and I friggin' hated the thought of cutting it off, though there was no question that in needed to come off. I finally made up my mind to do so, shears in hand, when my partner simply reached over his head, grabbed the back of his coat and the collar and pulled it over his head without moving him an inch. He got a thorough assessment and got to keep his much needed coat. Things rarely, if ever, are black and white. Protecting peoples lives is important, but so is protecting their property, and the trust that showing that respect exemplifies. Let's try and think outside of the box when we can... Dwayne

There is very little doubt that he was a monumental shithead, but man, he and I smoked a lot of weed together, I 'll tell you that! :-) (Of course I was baked with a bunch of friends and he was riding his chopper on TV, but still, I feel we had a bond... ) Prayers for him, and those who loved him from my little family in Colorado. Dwayne

I Don't know what's best for you to do, but I can tell you with confidence the way the conversation would go with my partner and I.... "Did you get a manual pressure on this pt, or did you just trust the monitor cuff the whole way?" "No man, I got some manuals, but the monitor cuff is good enough." "I was watching and didn't see you get out or the intubation seat the entire transfer, when did you do your manuals? "How about if you don't worry about it??" "You should plan a meeting with the District Manager in the morning. I'm going to take it to him and allow him to sort it out." At which point he would go to bed and in the morning he would burn my ass down for being a dipshit, pretend medical provider. And I couldn't respect that more. The reason I'm saying that I can't tell you what to do is that, though I love his attitude, and his willingness to question me on anything and everything, not all services value that. If yours does, you should throw this lazy prick to the dogs. If they don't, then you need to balance your need to feed your family against a complaint that is likely to do nothing more than make you feel better, yet not change anything. Decide now what type of provider you're going to be. I've known since treating my first patient that sooner or later I am going to be fired for defending my morals or ethics. I'm fortunate that my wife has made it clear that should I ever decide to injure my spirit to maintain my paycheck that it's best that I keep that to myself as I will not be considered a hero at home, but not all families are like that. You must decide now, and every day, what you're willing to forfeit morally and ethically to maintain your job. If the answer is very little, to nothing, then create some paper on this shithead and help management begin the task of putting him in the unemployment line. Not sure if this helps, but I find that the moral/ethical challenges of EMS make the medicine pale in comparison. Dwayne

I'm so proud of you girl! Good for you for taking the hard road, but you will be so glad that you did... Take a break now. Relax. Allow yourself a reward for your job well done now, so that you're rested and fired up when it's time to start again! Good job. Dwayne Edited to correct a spelling error.

I'm all for bagging on fire fighters, as they're full grown and can bag on me back. Imply that they have to many fire tattoos, wear too many hero shirts or drive giant 4x4 penis extenders, but to imply that they watch Dancing With The Stars?? Well, that's just low...you should be ashamed of yourself... Of course, to our brothers and sisters in the fire services, that is meant tongue in cheek. Dwayne

Heh, and I disagree with you! I think Herbie was suggesting that she try and get ahead of the pain. It takes way, way less medication to control pain if you know it's coming and premedicate somewhat instead of trying to beat it into submission later. And once medicated, don't wait for it to get severe again before taking it seriously. Other than forcing rest, I'm not aware of a single positive physiological effect that pain has on the body. And people in pain don't become addicted to pain medication. It's the continued use after the pain is eliminated that causes the problem. Just sayin'... Dwayne Hit edit on accident. No changes made.

That was a helpful, and really cool link man, thanks for posting it. And, in a peripheral way, I do believe it belongs in this conversation. As seen by my post above, I don't believe Matty disallowed religion, only asked for an intelligent discussion surrounding it when used. Obviously my comments regarding it are far from intelligent, but they are what I have, and part of the attitude and thoughts I use on those rare occasions that I ponder such things. Dwayne