DwayneEMTP

Why we're here, as humans, seems to be tied, for me at least to how we got here. As the universe is 'something' then it seems logical to assume that it came from something else. But my little pea brain insists that if there is something, then there must have been a time 'before something', which would seem to be nothing. How does something come to be from nothing? The religious folks often say that you can make something from nothing if God does it. I get that, and am not making fun of it, but again there seems like there should have been a time before God, which should preclude the possibility of a God, or a universe, but yet the first is arguably here, and the second provably so. So what the hell? (Heh..Sort of a religious funny right there.) Why do we do what we do? Why do many of us take our moral and ethical responsibilities so seriously? My behavioral science bent would argue that our behavior today is the sum of our lifelong reinforced and punished behaviors. Yet still I 'feel' that there is something more than that. Something bigger, though a single behavior being performed as the sum of a lifetime of behaviors is pretty huge to me. Again, some would say that we do those things based on an innate understanding of right and wrong bestowed upon us by a Creator, but that doesn't work for me because as we all know some of the most morally horrendous things have been done by religious leaders and their followers. What I do know is that doing what I consider to be morally sound things washes me a a 'good' feeling. For example when treating the drunk kindly on the third time I've treated him in one night, when I really want to poke him in the eye with a 10g catheter. I feel good when it's done, and right. Yet when I tell the same drunk what a waste of resources he is and explain that grandma may be dying because I'm wasting my time on him, I feel like a shithead. What I don't know, is why I feel either of these things. I love the idea that 'good' and 'bad' most often should be used to describe the status of milk and not people. God is good, yet for many he also created a hell, one of the most sinister, evil fucking ideas ever conceived. So should I ever commit myself to a religion, it certainly won't be to a God that could create a hell. Volcanos are bad, yet every now and then they resupply the world with the micro-substance necessary to sustain life on earth. And as ak stated somewhere, though I don't pledge my allegiance to any particular religion, I still feel the desire to be morally and ethical sound. I don't do that for a promise of glory, nor to avoid the torment of eternal punishment, so why then do I do it? I'm not sure. Was I born biologically superior to the person that doesn't share these desires? Was my moral cortex somehow more defined simply by an abnormal cell devision at just the right moment? Nah, I don't think so, as I've done some pretty shitty things... But then again, in the Beginning...No, not that Beginning, I mean the BEGINNING Beginning, there was nothing, and from nothing comes nothing, so we can't possibly be here at all making this whole exercise ridiculous. (Damn it! I can't believe I just wasted an hour of my non existence creating a moot post...) No answers here Matty, but I hope this was in keeping with the spirit of your thread. Dwayne

Sending kisses for your owie girl... :-) You needed a little time anyhow. You push too hard. Get some rest, follow the docs orders, whether you want to or not, and you'll be back at it before you know it! Dwayne

Yeah, very few of these folks, and non of the firemen, are going to get fired. The fire unions will simply run some full page ads in any area where this actually becomes news explaining how people are going to die because our heroic men and women of the fire services were tricked into receiving fake certificates. Get stoned at a concert and pop hot on a drug screen for doing a little harmless weed and you will be fired and possibly lose your cert. Show that you're ignorant, lazy and morally bankrupt and you get retrained. It's a crazy world kids... Dwayne

For the life of me I can't figure out how you've managed to turn my comments into an assault on your religion?? I've never judged your religion other than to say that I don't share your Christian beliefs. I don't really see that as an attack. If I say that I love to have sex hanging from the rafters while while being spanked with a goth Barbie and pelted with eggs from the local midget wrestling club, and you reply that you don't, does that then imply that you don't share any other principles that I might have, and that you devalue me as a human? We can't then talk about evolution, cellular biology, our hopes and dreams for the future? (I hope not. Because midgets don't come cheap man....) Step back from the pulpit brother, no one is attacking you here. I was simply commenting on the way you chose to approach your love of your religion in this topic. I think it was a bit sideways. And I'd be more than happy to share my theories on life. Belief is too strong a word as I don't have a concrete belief system. I can't point to a book, or group of books and claim that they represent my thoughts, but have just a bunch of thoughts and feelings. I didn't believe that that type of exploration was what Matty was looking for in his thread. I'm not afraid to share them with you, there is nothing sacred or holy in my beliefs, nothing special about them at all likely, but they're certainly not secret. Dwayne

Evidently not, as one of the manufacturers interview said that they understood that this is a significant problem, but they are willing to sell you the solution for a mere $500. I'm not sure if that's blackmail or extortion, but it pisses me off that they are going to, against my will, store up to 30,000 documents and then charge me for the privledge of deleting them. Also, I noticed that it's 'leased' copiers that they had purchased for the story. I think that a huge percentage of security sensitive agencies lease their copiers. Police, EMS, hospitals, etc. It gives them a maintenance and trade in option. Can anyone think of why a copier/printer/fax machine would need such a large hard drive in able to do it's job? Dwayne

Let me start with a half apology. The first have being that you implied that global warming was as much a scientifically established fact as gravity. I believe that most would agree that this statement is so patently incorrect that I allowed it to shadow the rest of my statements on your opinions. The half that I'm not apologizing for is that you chose that statement, and I'm allowing you to be responsible for it. And I'm glad you found items in the links I posted worth discussing. That was my intention, and why I stated "start here" as opposed to "Ka Pow! Take that!" :-) I found them to be elegant counter points to what you have claimed to be a foregone conclusion. I in no way intended them as scientific evidence to support my point. I'm confident you get this, as, though I absolutely see where I'd implied you are an idiot, I certainly don't believe this to be so. I'm going to give you the benefit of the doubt in hoping that you understand that there is more bullshit in scientific journals than you can shake a stick at. And I'm disappointed that you believed that being published in a newspaper gives their opinions any validity at all. Which journals specifically have their peer reviewed opinions, specifically, been published in? That makes a difference, and I believe that you're smart enough to know that. You're too smart to try and shore up your perfectly good ideas with a bunch of grandiose sounding nonsense. I am sure not, and I'm sorry that I made implications to the contrary. That was a lazy, petty thing for me to do. Agreed. As above. Fair request of course. Again, the links I posted I felt were fairly elegant presentations of my point of view. I took this subject on as a hobby about 5 years ago but was not so passionate that I retained the information I'd gathered. As time permits I'll see if I can't present a more scientifically sound/intelligent debate from my end. Fair enough. But should those trends be occurring, and again I've not seen convincing evidence that it is, though I have made no attempt on my own to find it, the ability to link that effect to a human cause has got to be staggering. 1+1+1+1= doesn't always equal 4. And in science, perhaps it most often doesn't. I love the discussion, but it seems that it's becoming almost impossible to detach the data from the media machine. Thanks for you reply and for not following my poor example in doing so. I look forward to your thought, though perhaps we should begin another thread as we've derailed Matty's, and I think is idea was awesome! Dwayne

Ok, so this is driving me batshit. I find it very, very difficult to have an intelligent (if you can call what I post intelligent) without using them, but they have become so troublesome that I'm considering just simply not posting any more. I have very few opinions that can be expressed in a few lines, but beyond that the editor seems to become hinky. But I'm not sure how to have a multi-poster discussion that's even halfway clear without it. Anyone else having this problem? It sometimes takes me 15-20 tries to get one small post posted by the time I've reedited it over, and over, and I'm just not willing to do so any more I think.. I've tried using IE, Firefox, and my favorite, Safari, all on different posts with the same results. Admin, any chance you're going to take this seriously or is it time to find a new place for me to post my silly ideas?? Dwayne

<div><br></div><div>Hell...you've just proved that you don't know the difference between popular hysteria and proof. I'm taking away your science card brother.</div><div><br></div><div>Global worming is without question the most highly publicized, least support theory in human history. Just because you see a bunch of shows on tv about it doesn't make it scientifically sound.</div><div><br></div><div>Step away from your tv, and your liberal arts teacher, and look at the science, and then you can come back and say, 'ooops!</div><div><br></div><div>Start here:&nbsp;<span class="Apple-style-span" style="font-family: Tahoma; white-space: pre; ">http://www.telegraph.co.uk/comment/columnists/christopherbooker/3982101/2008-was-the-year-man-made-global-warming-was-disproved.html</span></div><div><font'>http://www.telegraph.co.uk/comment/columnists/christopherbooker/3982101/2008-was-the-year-man-made-global-warming-was-disproved.html</span></div><div><font class="Apple-style-span" face="Tahoma, arial, sans-serif"><span class="Apple-style-span" style="white-space: pre;"><br></span></font></div><div><font class="Apple-style-span" face="Tahoma, arial, sans-serif"><span class="Apple-style-span" style="white-space: pre;">Then try here: <span class="Apple-style-span" style="font-family: Tahoma; ">http://www.heartland.org/policybot/results/22866/New_York_Global_Warming_Conference_Considers_Manhattan_Declaration.html</span></span></font></div><div><font'>http://www.heartland.org/policybot/results/22866/New_York_Global_Warming_Conference_Considers_Manhattan_Declaration.html</span></span></font></div><div><font class="Apple-style-span" face="Tahoma, arial, sans-serif"><span class="Apple-style-span" style="white-space: pre;"><br></span></font></div><div><font class="Apple-style-span" face="Tahoma, arial, sans-serif"><span class="Apple-style-span" style="white-space: pre;"><span class="Apple-style-span" style="font-family: Tahoma; "></span>And then, if you really wish to stop looking silly, take a look at some of the actual 'science' supporting your dearly held ideal...I'd love to talk to you about it after.</span></font></div><div><font class="Apple-style-span" face="Tahoma, arial, sans-serif"><span class="Apple-style-span" style="white-space: pre;"><br></span></font></div><div><font class="Apple-style-span" face="Tahoma, arial, sans-serif"><span class="Apple-style-span" style="white-space: pre;">Dwayne<br></span></font><br><br> </div> Hell...you've just proved that you don't know the difference between popular hysteria and proof. I'm taking away your science card brother. Global worming is without question the most highly publicized, least support theory in human history. Just because you see a bunch of shows on tv about it doesn't make it scientifically sound. Step away from your tv, and your liberal arts teacher, and look at the science, and then you can come back and say, 'ooops! Start here: http://www.telegraph.co.uk/comment/columnists/christopherbooker/3982101/2008-was-the-year-man-made-global-warming-was-disproved.html Then try here: http://www.heartland.org/policybot/results/22866/New_York_Global_Warming_Conference_Considers_Manhattan_Declaration.html And then, if you really wish to stop looking silly, take a look at some of the actual 'science' supporting your dearly held ideal...I'd love to talk to you about it after. Dwayne Edited, once again, to re-fucking-format. Not sure how many tries it will take, but no contextual changes made. Admin, are you hearing us about the formatting issues? I've talked to many that say using multi-quotes in a monster, so I know it's not just me. Hell...you've just proved that you don't know the difference between popular hysteria and proof. I'm taking away your science card brother. Global worming is without question the most highly publicized, least support theory in human history. Just because you see a bunch of shows on tv about it doesn't make it scientifically sound. Step away from your tv, and your liberal arts teacher, and look at the science, and then you can come back and say, 'ooops! Start here: http://www.telegraph.co.uk/comment/columnists/christopherbooker/3982101/2008-was-the-year-man-made-global-warming-was-disproved.html Then try here: http://www.heartland.org/policybot/results/22866/New_York_Global_Warming_Conference_Considers_Manhattan_Declaration.html And then, if you really wish to stop looking silly, take a look at some of the actual 'science' supporting your dearly held ideal...I'd love to talk to you about it after. Dwayne Edited, once again, to re-fucking-format. Not sure how many tries it will take, but no contextual changes made. Admin, are you hearing us about the formatting issues? I've talked to many that say using multi-quotes in a monster, so I know it's not just me. Hell...you've just proved that you don't know the difference between popular hysteria and proof. I'm taking away your science card brother. Global worming is without question the most highly publicized, least support theory in human history. Just because you see a bunch of shows on tv about it doesn't make it scientifically sound. Step away from your tv, and your liberal arts teacher, and look at the science, and then you can come back and say, 'ooops! Start here: http://www.telegraph.co.uk/comment/columnists/christopherbooker/3982101/2008-was-the-year-man-made-global-warming-was-disproved.html Then try here: http://www.heartland.org/policybot/results/22866/New_York_Global_Warming_Conference_Considers_Manhattan_Declaration.html And then, if you really wish to stop looking silly, take a look at some of the actual 'science' supporting your dearly held ideal...I'd love to talk to you about it after. Dwayne Edited, once again, to re-fucking-format. Not sure how many tries it will take, but no contextual changes made. Admin, are you hearing us about the formatting issues? I've talked to many that say using multi-quotes in a monster, so I know it's not just me. Hell...you've just proved that you don't know the difference between popular hysteria and proof. I'm taking away your science card brother. Global worming is without question the most highly publicized, least support theory in human history. Just because you see a bunch of shows on tv about it doesn't make it scientifically sound. Step away from your tv, and your liberal arts teacher, and look at the science, and then you can come back and say, 'ooops! Start here: http://www.telegraph.co.uk/comment/columnists/christopherbooker/3982101/2008-was-the-year-man-made-global-warming-was-disproved.html Then try here: http://www.heartland.org/policybot/results/22866/New_York_Global_Warming_Conference_Considers_Manhattan_Declaration.html And then, if you really wish to stop looking silly, take a look at some of the actual 'science' supporting your dearly held ideal...I'd love to talk to you about it after. Dwayne Edited, once again, to re-fucking-format. Not sure how many tries it will take, but no contextual changes made. Admin, are you hearing us about the formatting issues? I've talked to many that say using multi-quotes in a monster, so I know it's not just me. Hell...you've just proved that you don't know the difference between popular hysteria and proof. I'm taking away your science card brother. Global worming is without question the most highly publicized, least support theory in human history. Just because you see a bunch of shows on tv about it doesn't make it scientifically sound. Step away from your tv, and your liberal arts teacher, and look at the science, and then you can come back and say, 'ooops! Start here: http://www.telegraph...-disproved.html Then try here: http://www.heartland...eclaration.html And then, if you really wish to stop looking silly, take a look at some of the actual 'science' supporting your dearly held ideal...I'd love to talk to you about it after. Dwayne Edited, once again, to re-fucking-format. Not sure how many tries it will take, but no contextual changes made. Admin, are you hearing us about the formatting issues? I've talked to many that say using multi-quotes in a monster, so I know it's not just me.

I find your thoughts interesting, but also contradictory. If we're to follow the 'laws of nature' which I read to mean our biological programming, then certainly we've failed when men stopped humping every female in his general vicinity and we devalued anarchy, right? Our biological programming says that we should spread our seed, and physicall/mentally dominate every individual we encounter, yet as a civilization we've chosen to believe that those things are not in our best interest. (Though I'm a little disappointed in the humping the females part. They're WAY harder to get naked if they don't feel biologically obligated to do so. Just sayin') Perhaps I'm missing your point. Are you saying that because we believe that we can reproduce without repercussions that we're different than other animals? Are you aware of a Lions and Tigers and Bears family planning clinic somewhere that I've not heard of? Population control for hamsters or some such things? Is there some type of Urban Planning Commission for the foxes and eagles that hasn't made itself known in Colorado yet? Those species are following the laws of survival of the fittest, simple as that. Yeah, as with others here, I disagree. Is our management intelligent? Nah. But are we destroying the planet? No man, it doesn't even know we're here. And if it does begin to get cranky, it'll just smite us like so many pesky mosquitos. If you were here I'd kiss you right on the mouth. This is one of my favorite lines of thought. When we define good or bad, we don't only define thoughts and behaviors, but people. We begin to define people by these terms. And that is pathologic. Maybe we could replace these things with desirable or undesirable? Dwayne Edited X number of times to correct formatting only.

Agreed, but the symptoms he expressed do not follow any of the disorders that you've posted here. Obviously not a petite mal, certainly not focal, as the symptoms was global, etc. I tried to make it clear that I'd considered those disorders, but I'm also sure that there are many that I didn't. Despite that, sometimes, if it looks like bullshit, smells like bullshit, etc... :-) Dwayne

I fail to see where he disallowed dieties in the discussion, he simply asked that you back it up with a rational argument that didn't include 'because it just is.' Which you've failed to do. Then you should have shown him the respect to have played by his rules, right? And you rarely pass up an opportunity to make that point. I don't follow your beliefs brother, but I have respect for them. Unfortunately those that follow your beliefs, as here, often fail to show respect to those of other opinions. He didn't disallow your point of view, simply asked that you back it with logical, intelligent discussion as well. I for one would love to see you attempt to do so. Interesting discussion so far, by a bunch of interesting people. Thanks for the idea Matty! I'm still trying to find a point of view to argue... :-) Dwayne

The pts behavior changes dramatically about 15 mins after. You can't really comment on her LOC is she was bullshitting you to begin with. Know what I mean? And she claims no memory, not the same as having no memory. This was certainly non a Grand Mal seizure, there's very little question about that. S/s here: http://www.mayoclini...ection=symptoms A person having a true, 'brain storm' seizure is not conscious. So responding to the sternal rub and withdrawing from the lancet is just not going to happen. I'm not saying nothing is happening here, but it doesn't sound like a Grand/Petit Mal seizure. Though I'd imagine there are a bazillion other types I'm not familiar with. Seizure? Not going to happen during a true 'brain storm' seizure, but have seen it happen during a pseudo seizure. Unfortunately brother the diagnosis will almost certainly be something husband related. This woman, though you don't want to hear this, almost certainly bullshitted you. Fake seizure pts can be amazingly convincing at times, but this one wasn't terribly close. She was unwilling to go the extra mile necessary to pee her pants and bite her tongue. Why did it all suddenly resolve at the ER? Because she got what she wanted, to freak out her husband, and/or kids, all of the attention that comes with an ambulance ride, and a trip to the ER. I'm willing to bet her husband isn't in back with you at this point. He might be, but probably not. It's uncommon in someone with a true seizure, in my experience to be conversing normally in such a short period of time after being effect for such a long time. And even removing the postictal phase of the seizure, seizures are a lot of work. Even if she was completely resolved mentally at 15mins, she would be significantly tired. No man, you didn't. A 10 minutes seizure, of which I'm willing to bet no one her has ever run and ended up with a live pt, doesn't present as you say. A pt with tonic/clonic seizure, as it appears that this woman was trying to appear, is unconscious, not breathing during the clonic phase, and burning a lot of calories. You would have found her extremely diaphoretic and hypoxic long before the 10 minute mark. In fact an actual uninterrupted tonic/clonic episode would almost certainly have left her dead long before 10 mins. And if she had been seizing, what is your cert level, what would you have liked to have done differently? Lets assume that I'm completely right, which assumes I'm batting about 75% above my normal average. What will you do differently next time? Nothing man, you'll assume it's a seizure and treat it to the best of your ability and be a little bit embarrassed, and a little bit pissed that she screwed around with you like this. You know how I know? Because until I'd seen maybe 50-100 fake seizures and a dozen or two real ones, I was fooled and freaked out every friggin' time. Good question. I'm confident my betters will have better input than mine, but this is how I see it.. Thanks for having the courage to participate here. Dwayne Edited (however many times it says, as I'm never sure how many it will take) to correct formatting. No significant contextual changes made unless noted.

And I thank you for your disagreement. Thanks for playing brother. These threads tend to die quickly when a halfway coherent contrary opinion is posted, and that's too bad. But see, this is where I believe that we split the sheets. From my personal experience I can tell you that though I've run on skads of 'attempted suicides', I'm confident that I've never truly run on one where the intent was death instead of attention. Scratches across the wrist, drinking a quart of tequila 'to end it all', taking a few of moms Viccodin, does not to me constitute and aggressive, honest attempt to take ones life. Are these cries for help? Sure, I believe that they are in many cases, simply grande standing in others. But either way I don't believe that it constitutes signs and symptoms of a person that has become acutely altered beyond the point of self advocation. As above. I would argue here that the person refusing care from a trauma or acute onset pathology is much less able to advocate for themselves due to the emotional, physiological changes that take place along with such an event. If we're going to force anyone against their will, and I know that that line is very fuzzy, it should be these folks, not the coherent 'suicide' attempt. Now, I'm not exactly sure how to make my point while also making it clear that I'm not advocating, 'There's no need to transport 100 bullshit pretend suicides just to save the one person actually in danger!' My argument hinges not on the amount of work involved, but on the rights of those people that are able, to the best of our ability to detect such a thing, to advocate for themselves. I agree completely. But I would again state that it is my belief that the vast majority of my 'suicide' attempts were lucid, without an acute event causing the behavior. I know I'm going to take a beating on this, and I look forward to it, but with the information that I have now, that is my belief. Again, completely agreed. And in a perfect world we would have a, hell, I don't know, one of those StarTrek thingies that would allow us to discover such things. But as it stands now, most of our protocols, and I believe the law, only allows us to force transport when that type of pathology is identifiable by us. In some cases they will be, but I don't believe that that appears to be the case in the OP. Again, certainly agreed. And in a perfect world I would again be able to treat this pt against their will. But if I see the s/s of hypoglycemia, yet the pt refuses to allow me to test and treat for it, then I am unable to develop the evidence necessary for me to treat this pt against their will. I will want to, and will exhaust every trick and trap at my disposal to do so, but if the pt is still mentating at the level that you mention, then I have no legal right to treat them. Though I know that they are physiologically altered, and I believe that that altered state is causing them to make poor decisions, unless the police decide to step in, then I have no legal right to treat this pt. I'm going to hope that you were simply making your point and that I haven't presented my arguments so poorly that it's believed that I feel that AAOx4 is adequate information for the judging of reliable mental capacity. Unfortunately, in most cases it will be adequate for the necessary legal capacity to refuse. I've only two or three times had someone that I've truly wanted to transport refuse. One one of those I involved law enforcement and have regretted it every day since. An older woman with a hugely swollen leg secondary to cellulitis. She refused to take her antibiotics because they made her sick to her stomach. Her PCP had been consulted about this but she didn't like her options. Circulation was compromised distal to her knee and I knew that she was going to die from this infection if left untreated. She had multisystem issues, was tired, hated the hospital and truly believed that resting would cure her, and if not, then she was ready to die. I forced her to go despite, in my opinion, her being very capable of understanding her predicament, including the high risk of death, and accepted them. I involved the police, who refused to intervene, then I involved Social Services who declared her unfit to care for herself, giving me the right to force her to the hospital. To this day I believe that that is THE most morally/ethically bankrupt thing I've done as a medic. Is my decision going to be popular here? Sure. Would that be a feel good story to tell at parties? You bet. But I took away the rights of an old woman, mentating perfectly to every way that I could find to test her, except that she made a decision that I disagreed with, and forced her from her home so that she could die in a place that she hated. And we should all call bullshit on that. But again, I pose the question. If a clinically obscure mental alteration is all that is necessary to force transport, then aren't we then obligated to force the obese, the tobacco user, the chronic alcoholic? Each of these as well has been well proved I believe to involve mental/physiological aspects that are beyond the individuals ability to control with the available tools in their current toolbox. The only difference I see between them and the attempted suicide is the timeframe. One is simply going to die sooner than the other, but all will ultimately die secondary to their pathologies, right? Do they all then lose the right to refuse? Thanks for you post man. I look forward to your thoughts. Dwayne

I tend to stay out of the pranking circle as I have a real issue with people touching 'my' things, whether it be personal or the things I'm responsible for on shift, though the pranking spirit is alive and well where I work. It seems that I remember billygoatpete coming back to quarters once and finding that someone had put his Oakley sunglasses into a quart jar of water and froze them solid. The jar broke, so there was just a giant ice cube with the fuzzy image of some sunglasses inside. Fair warning. Pranking billygoatpete is a really bad idea. I once tried putting a rubber band on the handle of the dish sprayer on the sink, so that when the water is turned on it would spray whoever is in front of it. But I kept forgetting, and I drink a lot of water, so after I'd sprayed myself about 6 times while waiting for the chance to laugh at someone for getting wet I took it off and admitted that practical jokes just aren't my thing... :-) The powder sounds funny, but would generate a report if it happened in my truck. I'm not a prude, but can't really get onboard with anything that might damage property, hinder a response, or send a crew on a call looking like slobs. Just me... Dwayne

Ahhh....got it. I'll try it your way after I get a bit of sleep. I am truly interested in this conversation and excited to have some intelligent folks to poke holes in my thoughts... Dwayne

Yeah, in fact it sounds like they've taken the spirit of implied consent and simply made up a new definition out of whole cloth. Unless I've forgotten how this went, it sounds to me like this pt is AAOx 4. How does implied consent come into play concerning a pt that is able to continue to coherently advocate for themselves? Do I WANT to transport this patient? Of course. Do I have the right to take an alert and oriented pt against their will? Absolutely not. I would get the pd involved, if that didn't work I'd request a pd supervisor while I contacted medical control, and do what I could to bring the entire world raining down on his head. But, you know what? If all of that fails to put this pt in pd custody, he's staying home. It really is as simple as that. I'll run on him again when he's less responsive or dead. It's a shame, but it's also his right at this point. I ran on an 86 y/o woman tonight after a fall. Large abrasion center of her forehead, nose obviously fractured with anatomy pushed a few mm to the R, mushy to palp, significant swelling at apex and continuing up into medial/superior orbits bilat, slight drips of clear fluid from R nare, airway patent, including nasal passage, AAO x 4, PERRL at 3mm, eyes tracking properly to all fields, yadda, yadda. She refuses transport, no way to shake her. I even bring a mirror from her bedroom so she can see how screwed up her face is. I finally call her son, a priest, to help convince her. His response is, "A broken nose isn't the end of the world, she's had one before, she falls almost every week." Pt lives alone. Police called, ER physician notified. Police refuse to place her in custody, physician states that pt is able to refuse though explains to pt and son that he and I both believe that there is a significant chance of a cranial vault fracture currently and many possible current/future occult live/limb threatening pathologies possible if not likely. Son refuses. She is home now, asleep, or dead, and I await my call back to either treat or pronounce her. Does it suck? Oh yeah, I was fucking livid! But you know what? She has the right to determine the course of her own life, either safely, or not. Tonight she believed she did right, I believe she made a terribly foolish and dangerous decision. So, it sounds to me that what about 90% of these posts are saying is that I should have followed a logic tree similar to, "I've told her that this injury can, and may, kill her. She has decided that she finds that risk acceptable. Therefore she is purposely endangering her life. Purposely doing so is akin to suicide, so this woman is suicidal. Because she's now suicidal I have the right to throw her on my cot, tie her down and force her to the hospital for evaluation based on the fact that a suicidal pt must be altered and altered people can't advocate for themselves.' Etc, etc, etc. Doesn't this seem like long, long, long bullshit path to follow to attempt to treat someone against their will? I transported 99.1% of my patients this year, so it's not about wanting to dump anyone. It's simply a strongly held belief in a persons right not to have medical/psychological treatments physically forced upon them if they are able to show that they understand their situation and are biologically sound/mentally able to advocate for themselves. Do I think that true suicide attempts fit into that category? I do not. Do I believe that 95% of reported suicide attempts do? I do. Can I tell the difference? Fuck no, mistakes are going to be made. But that sometimes is going to happen in a free society. Or so I believe. So, in case I got to wandering, it's late at the end of a long week, NO, if the police would not put this pt in custody, after my righteously aggressive, very best attempts to convince them to do otherwise, I would not have taken this pt against his will. Dwayne

Man Croaker, great replies! I think I get what you're saying, though you're certainly debating at a level well above my ability to participate with my scant knowledge of the subject. But, as mentioned before, is poor EMS better than no EMS in these areas? Are people better off believing that when they call 911 that someone is coming that is going to add more benefit to their morbidity/mortality than if they'd simply just had a friend drive them to the hospital without a wait? I'm not sure really... Dwayne

Damn it...they cancelled it due to weather.... Thanks for the help all, I was really convinced I could generate some serious bank for the charity... :-) Maybe next year. Dwayne

You know what I drives me crazy about these conversations is that people have a hard time understanding that we can not like a system, but not dislike ALL of the people in it. I'm not a fan of volly system, and very much not of fire fighters, yet my partner and friend is a basic, medical responder volunteer and chief of his volly fire dept. And I couldn't like or respect anyone more than I do him. He's smart, really smart, dedicated, is working, as he has been for several years, to turn his dept paid, and is willing to admit to all of his personal failings as well as those of the paid and volly systems he works within. Yet, some people are still sometimes shocked when I throw him the drug bag when we go on an arrest and simply acknowledge as he calls out the drugs he's about to push while I spend my time doing other things...(I rarely transport CORs unless we get ROSC.) Should I not allow him those responsibilities because he's a basic and a volly and, God forbid, a hosemonkey? People hate some medics because they're ignorant, lazy, and arrogant. I'm not, so I'm not offended by those comments for the most part. Many vollies are lazy, idiotic, hero seeking idgits...if you're not, then let that pass and continue the discussion of the systems without personal offense. There are many, many really, really good people inside of bad systems, but those people, no matter how good, don't make the SYSTEM good, See?? Take a breath folks, separate individuals from groups, and don't take offense. We're all part good, part idiot, part competent, part asshole...if you're not being singled out as a majority of one or another, then take a pill...OK? Dwayne

Have you ever seen him do either? His ability to contribute ends with idiotic quips and self-righteous bitching. No worries girl. Those that have no education believe that the the rest of us should simply allow the uneducated to flow into our field as they see EMS as a club and not a profession...I can't find way to discuss these things intelligently with the ignorant. Send firemedic and capfiremedic a Tshirt with a fireman carrying a baby from a burning building, or an angel crying over a helmet, and they'll go away happy. Dwayne

Sorry JP. I've spent a few hours replying to your post and each time the fucking editor ate it, so I'm giving up. I'll have to continue this with you when I see you next as I don't know how to formatt a reply in small enough chunks to make this editor happy yet not sound as if I'm missed most of your points... Thanks for your response, it did not go unnoticed... Dwayne

You're my hero. Finally, a progressive idea in EMS that someone just ran with!! Dwayne

Good questions, but I believe you will come to understand that you misunderstand some things about many volly systems. I work closely with out volly system here, and where you make your first mistake is believing that the majority of them are there to 'help their community' instead of simply trying to find the cheapest, laziest way to appear heroic. It's rare for me to come into contact with a volunteer that isn't wearing a 'Hardcore Firefighter!" T-shirt or some other such crap. They are, in my experience, for the most part, volunteering for perfectly selfish reasons and seem to have no regrets at all when they show up on scene with nothing to offer. And that's sad. I can show you why I have a lot of confidence that that is the case where this add is run by the words they chose to use in the ad... Why, if what these people want to do is serve their community in the best, most productive way possible, do even the people looking for volunteers know that they need to make it clear that all you need to do is run around your community with lights and sirens, and no worries! there's none of that silly 'learnin' involved. When someday I see a volly system that express their disappointmet over the fact that they don't get enough education, and have no requirements to learn unless the knowledge is hand fed to them, when we see some threads on the City of vollies asking how they can become more competent on their own, then I'll change my opinion. Not to mention, there is absolutely no way that I would ride with someone encouraged and then trained in this manner. They would gain a 'driver' but lose a medic on their calls. Not a great trade in most emergencies I think. Dwayne

What is with this new trend of telling folks, 'specially our new members, not to ask questions here? That is what the City is for, isn't it? This is making me batshit. Answer the question, don't answer the question, ignore the entire thread if you want, but who are you exactly to be telling folks which questions are allowed here? When did we decide that some questions were just so beneath us that we needed to explain to folks how dumb they are? How about we stop that habit now and replace it, say, with pics of boobs. Anytime you feel the need to tell someone not to post you post a pic of boobs instead? I believe the world, and certainly the City, will be the better for it. OP, you didn't mention when you are using these new found skills. Is it at work? Or from your private vehicle? Are you being paid to provide them, or doing them as a volly? I think all of these things make a difference, but I'm not exactly sure. Also, take a look at the Good Sam laws and see if you fit... Dwayne