DwayneEMTP

Most of our societal laws revolve around intent. Does my belief that at times I may lie secondary to my intent to be my patient's advocate make me right? Heh...not by a long shot. But when you're as dense as I am there are many times that situations were not covered in class, nor by previous experience, so I then have to do what I believe I'll be able to live with tomorrow. Bad answer I know, but it seems that very often, in my most critical patients, that I don't always have all that I need in my 'good answer toolbox.' :-) It wasn't necessarily my moral ethic. It was that of EMS, in that I believe that becoming a medic bound me morally and ethically to do all within my power to care for those that are put into my hands. I gained nothing personally by this lie. I believed that his anxiety was helping to retard his condition and gave an answer that I believed would a) perhaps help him relax and therefore respond better to treatment, or at least not make him worse. In fact, I'll take it one step further. What I really wanted to do was to hit this guy with about 8mg of Valium to calm him down, out of kindness, but also in the hopes of making him more compliant to me managing his respirations, but my protocols don't specifically allow for this use, nor is it listed as an option for DOB. (If you remember, or maybe I didn't state it, he'd made it clear that he didn't want a tube if at all possible.) So I chose to allow him to suffer more than was necessary. By following my protocols I may be shown to be ethically sound, but I would say morally bankrupt as I allowed my pt to suffer in order to cover my ass. I ran this scenario by my medical director the next day and he was in fact disappointed in my decison as I have a guideline that allows for chemical restraint of combative patients, or those suffering from severe anxiety. But I pictued myself in front of a jury being asked, by a whole room of non medical people, "So you gave a person that was soffocating a drug that's known to hinder their respriatory drive?? What kind of bullshit is that!?!?" I was such a pussy. We have very liberal protocols, with almost nothing spelled out as a certainty. Lots of 'might' or 'may' or 'should' language. But I followed my protocols, so does this make me morally and ethically sound? Or would doing what I was certain was right despite being a 'cowboy' perhaps have been the better choice? That is the first time that I can remember that I made a medical decision based on what I believed others might think, and I sure as hell hope it's the last. And I agree. Though sometimes I want to simply beat patients onto my cot for their own good, I'm a true blue believer in a patient's right to decide their own fate if able. I believe that he took it at face value. He did seem to relax a bit and breath a little bit easier when he believed we were winning instead of losing. (Really? Or did I simply see what I'd hoped to see? Not sure.) I'm confident that it was a question, though could certainly be wrong. I'd say that finding the exceptions, at times, is my obligation if the rule is bullshit, or simply to far off of the mark to be useful. I disagree completely here. In moments of severe terror I need to know that the person caring for me is ONLY caring for me, not playing word games. As soon as I would have heard a politically correct answer where a straight forward answer was expected I would lose faith and that would add to my terror and in this case likely degrade my already hinky status. In this case if he died he'll remember nothing, and if he lives will remember that I was right. Seems win/win. Now, I was discussing this with Wendy and she made a great point that this might have been ok while we're alone in the ambulance, but certainly wrong if there were family or friends present, to which I wholy agree. I'm counting on it. Thanks for your thoughts Matty. On a different topic. LoneStar your posts, both the quality of thought and the presentation have increased dramatically in the last year!! Good to see brother. I don't have time to respond to your post line by line right now, but it was certainly worth reading. Thanks for taking the time to post. Dwayne

The name of the thread is, "Non-english EMT test in USA?" Why are you having so much trouble with that? And yes, I lived in Afg for many months, and the base environment was my community. Had I lived outside of the wire I would have been near impotent as a provider on the level we understand in the United States. Could I have done the medicine presented in front of me at my current level of education as it relates to treating the signs presented? Sure, but I could not have participated in at the historical/ongoing level, and that is a big part of my job. Dwayne

Holy shit Vent. I'm with JP, I give. You win. You've decided to only participate in this thread if you can be belittling and shitty. I'm not sure what's going on with you. And for the record? My little mind has worked in KAF Afghanistan. That would happen to be a NATO base with about a gazillion nationalities involved. So my guess is that I've been exposed to doing medicine with many, many more different kinds of people than you have. I'm not sure what's going on with you right now...But I'm sorry to see it. Dwayne

Yes Not illogical at all. But as morals and ethics are something that for many of us are complex and confusing concepts, in those unusual moments when decisions have to be made using their application I'll not have time to explore those of my patient. I must use those that I've developed for myself and try to apply them in the best interest of my patient. I believe that in this instance that I've then covered my ass, but haven't advocated for my patient. In my opinion my moral and ethical obligation here is to make him better. I'm willing to bet that had I given the patient in my example this answer I would have caused his bullshit detector to redline. He knew his condition was serious, he knew he was in big trouble, and knowing how big exactly was going to effect his physiological response to treatment in some regards I believe. I could have given a more politically correct answer perhaps, but being politically correct was not my intention, getting him to the hospital alive was. I don't advocate lying as a general medical tool, but more so was attempting to debunk the idea of 'always' and 'never' as intelligent, useful language when discussing many things EMS related. Here again I'm not saying that this is a wrong answer in general, just wrong for me in the given situation. I could never ignore such a question and expect my patient to continue to trust me. Also, I believed these to likely be that last moments of his life...I didn't want them to be any more horrifying than they already were. The standard party line says I should have found a way to be honest. The human being in me felt that it was more important to be kind and productive. That was my moral/ethical intent when I lied to him. See? Perhaps this is off in the ditch, I'm not sure, that's why I love these debates. And your thoughts are always worth hearing and considering...thanks for sharing them Matty. Dwayne

As someone who relishes your posts, I'm truly confused by your inability, or unwillingness to address the replies given to you in this thread as they stand as opposed to attempting to give them a political/moral twist to the negative. I've just not seen this approach by you before. I've not claimed that they are less intelligent, and in fact attempted to make the point that just the oposite is likely true. Disabled, yes, in their inability to communicate in the majority of their chosen country in a profession where communication is a fundamental skill. Also, and perhaps you're just skimming posts and not reading them entirely, I mentioned their retarded communication ability. The term was not presented as a medical diagnosis for all of those without competent English skills. Fair enough. It would seem that what you're saying here is that if a program is not housed within an accredited college system that there should then be no standards for it? You could be right...Intuitively that doesn't feel right, but I'll have to give it some thought. I see that, but again am unable to grasp its relevance. IFTs sometimes transport very sick pts so the communication requirements stand. Of course not. But I'm also not going to put them with a provider, and again here we're speaking of the majority of the country, that can't get them the care that they need, should they need it. Is this a problem in China Town if the dominant population, the transfer service and the hospitals all speak a Chinese language? Of course not. But that situation does not describe the majority of the country. I don't completely understand this statement, but if it's asking if I'd do those things to show my superiority, then I'm not sure how I've earned it. In this thread, as in the vast majority of those I've posted before I believe you'll have difficulty finding anywhere where I've implied that I'm superior to anyone. I would in fact apply at an SF Chinese hospital for the amazing medical/cultural educational opportunity it would almost certainly provide, though I wouldn't expect to be hired based on my bilingual language deficit. In the U.S., which is where we now reside, bilingual education is not the norm in most places. Kudos to the businesses that cater to the non English speaking populations. I had no idea that the non English speaking populations had a legal right to medical care in their own language, though as we actively pursue and welcome those from other countries I would hope that the medical services would consider this a moral obligation at least. Unfortunately though I do believe that bilingual skills have incredible value in these populations, other than where described, I believe adding care providers with one language that only supports a finite need is much less so. I'd rarely agree to any statement that uses the terms always or never. And I believe that I'd tried to make it clear in my post that certifications to fulfill certain needs and specific populations should be exempt. Do I believe that a non English speaking Haitian should be able to force the powers that be to allow him to test for EMT in whatever his/her dominant language is in Minn? (Assuming there is not a huge Haitian population in Minn) I don't. Do I believe that a Chinese speaking EMT should be denied the ability to test for EMT in SF in Chinese if his/her primary function will be to service the Chinese population in a system supported by a medical community that speaks primarily that language? I don't. Though it's likely my ignorance is monumental in this instance, this makes sense to me. I can see that this is an issue very near and dear to your heart, and as always I love your passion for all things medical/patient based. But you seem hell bent on making this about 'us v them' with 'us' being the superior English speaking population and 'them' being the lowly non English speaking population. I've not see anyone here putting forth that attitude though you seem to feel the need to attempt to force all arguments into that pigeon hole. For me this is as simple as not using pliers to loosen a tight bolt. Pliers are not an inferior tool, they are simply not the best tool for the majority of these applications, but for those applications where they are useful, they're superior to nearly all others. Medical practice at all levels has communication as it's foundation, from communicating with patients, other care providers, to documentation. If you're unable to communicate well when interacting with the majority of the people you come in contact with it in no way makes you an inferior human being, but does in fact, despite your possibly superior medical ability, make you an inferior provider. As always, I'm grateful for your thoughts. Dwayne

But I didn't see where the OP was referencing bilingual skills, but Spanish only. I guess I don't see the positive in this unless its a limited license to resolve a specific issue in a specific area. In most areas communication with partners, patients, hospitals, will all be severely retarded. Vent described how to do a work-around to this, but why? Unless you're telling me that those that speak Spanish only are so much more intelligent and valuable than the average English speaker then I don't really see why this should move forward. I don't want a partner with no arms, one that is blind, one that is wheelchair bound, despite that fact that I may not only love and respect each of these people and be trumped by their intelligence, but it's not about my feelings, or their desires, it's about providing the best possible patient care while attempting to elevate EMS as well. I may have missed some posts that make my opinion moot...but I looked pretty close... Dwayne

I hate absolutes, and have in fact found that any time that I try and construct one the EMS Gods swoop down and make me look like a bigger shithead than usual. Never palm the breast in a 12 lead, never lie...never, never, always, always, yadda, yadda. I believe it all resolves around your moral and ethical intent. Tonight I had a breathing difficulty patient. Long time COPD, lung sounds silent in all fields, resps of 36 and shallow. Despite all of my best efforts, BVM through my CPAP and emptying my med bag into him via one route or another he was crumping very, very fast. He asked, "goin'........................to............die?" I said, "No worries brother, we're pushing it back. Can't you feel it?" But yeah, there was almost no doubt in my mind that he was going to die before I got him to the hospital. He didn't, thanks in almost no part to me, but what I really didn't want to do was tell the truth, add to his axiety and increase my already shitty position. So those that believe that lying is 'always' bad...was the better answer then, "Yeah man, I'm afraid you're going to die, I just can't get ahead of this thing.'? Whatcha think? Dwayne

Sorry man, you lost me when you talked about abandoning the fire station and 'getting separated from the truck.' We have no such protocols here. Once in a blue moon dispatch will check if we haven't checked in...but not often enough to matter. Rural though, likely a different threat potential here... Dwayne

Heh..I hear you. Here we'll normally run a core with 4 people, and that's more than enough. So are you saying Kiwi that you bag during compressions? Without filling the belly with air? I've not heard of anyone doing this. The main reason that a tube is a relatively (Key word being 'relatively') early intervention is so that I can ventilate during compressions without creating abdominal distention and the issues that that involves. I don't believe that this is possible with a BVM/OPA while compressing...though I could be wrong... Dwayne

No worries. There's no reason you should know the prices of any of this crap. One thing that you'll find as you begin your journey into EMS is that you start out so excited! But with many of us this new knowledge soon breeds insecurity such as, 'Holy shit! I NEED to intubate to save lives?? What if I miss?? Perhaps there is something I can do/buy/barrow/learn to make sure this never happens!!' (Yet, it will still) Of course you soon get over that (At least most do) and learn that, as Dust said a million years ago, that "EMS is assessment.' And he's right as rain. Most of the rest is just a dog and pony show. Besides, despite the most bestest toys..sometimes you're going to land on your ass..guaranteed. Trust me when I tell you that if you completely ignore skills (You won't, but you could...grin) and focused on anatomy, physiology, patho, etc..learn how the body works and why then you will give barely a hoot for all of the gadgets when you hit the streets... These tools are neat for difficult airways perhaps, but trust the basics first. You'll see what I mean later... Dwayne

I have little issue with him taking a minute to intubate, but I have serious issues with interrupting compressions so often and for so long. I'm not a big fan of using an OPA/Bag in place of an ETT for any extended period. It seems that he science is pretty convincing that compressions are the ticket to saving the tiny percentage of these folks that we're actually going to save. OPA/bag means interrupted compressions every 30 seconds (or as close as many come to that) and that is just unacceptable I think, 'specially when it seems that that only gives you 10-20 seconds of actual halfassed blood flow/minute. Once you get the blood flowing, don't screw with your interthoracic pressures if you can help it. Of course electricity is one of the obvious exceptions to this rule. Do an external exam to estimate your chances of success, prepare your pts placement and your equipment for best chances of success, visualize as much as possible with compressions continuing and shoot your tube. Of course it's not always so easy, but compressions are king in CPR. Allow the minimum interruption possible. Dwayne

Yeah. The company you ultimately work for will determine the standard equipment for you unit. You're own equipment will likely, at least after a year or so to give you a chance to get over the noobi bat-belt syndrome, consist of a stethoscope, a watch, some trauma shears, perhaps a field manual or two, and a flashlight. So no worries girl...grin. No need to budget extra 10's of thousands of dollars for spiffy gadgets. Good question though. Dwayne

Hmmm....Seems like another new way to do the same ol' thing. The few times I've been challenged while intubating, the issues have been anatomical not due to inferior illumination. Perhaps this will help, but I don't really see it. Are there really so many people that are able to locate the vocal cords but unable to see them clearly enough to pass a tube? Not sniping, I just haven't had that issue to date. If I can clear and identify the anatomy I can't think of a time that an alternate source of illumination might have helped. I'll be interested to hear what my betters have to say... Thanks for the post. Dwayne

Colorado does recognize Intermediates, but I do believe the I/85 will be a basic as well. I'm afraid I don't have any more info that than.... Good luck! Dwayne

Yeah, I'm with the likelihood of the pt not being properly restrained. We had an ambulance rollover here not too long ago. Not our service but one transporting through. The ambulance was destroyed, literally, but the cot was still hooked securely in the antlers and the pt fared much better than the crew. I'm going to put my money on this being a sleep related accident. God's speed to the crew, the family of the pt, and all of those that love them. Dwayne

I had Babs make me a tshirt and send it to me in Afg. It said, "Be kind, spay and neuter your hose monkeys." I only wore it one day before enough people got mad that I had to take it off... :-) Dwayne

Speaking of misinformation and confusion. You feel free to continue to PERSONAL ATTACK REMOVED -ADMIN, and continue to use the term "us", though doesn't it say student under your name? What part of "us" don't you understand? You agree that 'we' crawl into cars and do all sorts of other bullshit heroic stuff...when did you do those things exactly? Before you send hateful, ignorant, vulgar emails to our new members perhaps you need to take a reality check babe. Lisa, I recommend you forward those emails to Admin....He won't be pleased with the language, nor the threatening tone. As well, any more shit she sends secondary to this post, forward them as well... PERSONAL ATTACK REMOVED -ADMIN At least have the ovaries to do it in public with those of us that have been here a few weeks... Dwayne

Hey Girl... I'm shocked, and really, really sorry to hear about your troubles. I know you were very proud of finally fitting in there and doing good work. What's the update? Anything you can share? I like your partner (ex?) a lot! She can be a pain in the ass, but holy shit, she has fire!! That's cool as hell. Not sure if you still have my number, but I'll shoot it to you in email. If you need to chat so some old dumb guy...you know... Love you girl. Be strong. Take a few days and come ride with me in Trinidad!! :-) Dwayne

Holy shit...He only has two posts, took the time to get involved, and Really? The only thing the next page of posters could think to comment on is his caps lock and formatting? C'mon folk. Some of us have done way more foolish things, I do them on a regular basis, perhaps we could show a new poster the courtesy of at least commenting on his content at the same time as bitching about his presentation?? Capt Stern, a few things, as I'm going to assume you might be new to forums. First and foremost, welcome to the City!! Thanks for taking the time to participate. Presentation sucked..But that's not terminal, as I think your post content was really good! All caps is bad form. We're strong believers here, many of us anyway, that the way you present your ideas in text tells much about your intelligence and personality. Spelling, punctuation, capitalization, and paragraphs go a long way towards making your post easier to read and respond to. Also any 'lingo' that may be specific to your location, cert levels/radio codes, etc should be defined when used so that others are not confused by them. Not sniping brother, just trying to give you a heads up. I absolutely agree that much more information was necessary, including your ideas on confirming that this was actually a CVA, is necessary before being able to determine whether or not fluid was appropriate. Though it's not uncommon here for folks to create a 'what if' scenario off of an actual call to help them ask a specidic question. I found a lot of food for thought in your post, I'm grateful you took the time to create and it and had the courage to post it. I'm also confident given the information you need, if you haven't been discouraged by your first time out, that your presentation will be much different in the future. And last, and possibly least, if most or all of that information came out of your head as opposed to being Googled, as I have a feeling it did, I have much to learn from you...I hope you'll stick around. Have a great day all... Dwayne

Yeah girl...you rock! I get frustrated sometimes with the 'I don't need to be smart to ride in an ambulance!" crowd. But every time I'm about to throw in the towel someone comes along that I know will be so good, so smart, so dedicated....it just makes all the rest of the nonsense worth the effort. Without many of these people in my corner (Dust and ak held my hand through the whole ride as they continue to do now) I would be 1/3 the medic I am now, though what I am now isn't necessarily anything to brag about. :-) Every time I got exhausted, felt that I was simply too stupid to make the grade, wanted to quit, I came here and was gifted with a second wind...and a third if that's what I needed. Use these guys and you will be a rock star! Good luck Lisa... Dwayne

Your spelling, grammar, and attitude regarding each is why so many here have a severe dislike for fire based EMS. Congratulations on shooting for the very lowest level of achievements possible. Yeah you! Be glad that you've found yourself a fire based program that will baby you through, as you would be removed from any reputable educational institution in short order. If you look back through the history of the City you'll see that every now and then we have a rush of idiots that come trumpeting the idea that, "i ain't able to spell or talk good but that don't meen I cant be a really grate Heero!!" They all fall by the wayside, as will you if you should choose to continue to be proud your ignorance. I hope better for you.... Dwayne

I think what Dust was implying is that whoever makes the boot buying decisions is likely to be spending some quality family time on some pretty amazing 'sponsored' vacations for some time to come... Dwayne

Hey Tyson, welcome to the City. I'm going to take the less politically correct road here, as I have a feeling that's what you're really asking. How big is this guy? How big are you? This is what this situation says to me, that he started out being just sort of an ass, yet during transport this turned into an 'Oh Shit!' moment and you asking how to deal with it on your own? I get that... First off, for me, once he began to spit, all bets are off. Now he's gone from being an asshole to creating a significant bio hazard for me, and that just simply is not going to continue. Where I work it's pretty rural and PD is rarely on scene, often will not respond in a reasonable time if called, and when responding there are only a few officers that will be of any real help when they get there, so we tend to always think of resolving these types of problems without outside help. We have pretty progressive protocols so I'm allowed options for sedation, though if this isn't in my opinion a true psych, meaning that this is some spoiled kid acting like a weenie because it gets him attention, I may choose not to use them. I'm happy to use them to ease the situation for the truly mentally damaged, but not so quick for the spoiled idiot. Moot here I know as you don't have a chemical option. This just happened a few nights ago. I dropped the head of the cot, pt didn't have a shirt on or I would have pulled it up over his head, pushed his head to the side with my knee and put my full weight on that knee, mashing his head down into the cot. At this point I had complete control over him, not to mention eliminated the possibility for spitting and biting. I had my partner pull over, come to the back. While I kept his head mashed, all the while he's screaming about abuse and law suites, my partner pulled all of the straps as tight as they would go, tied each hand with Curlex to the Pt's thighs, pulled the chest and shoulder straps as tight as possible, to the point of restricting breathing even. This ended his options for any significant struggle. I put a surgical mask over his face, (this pt was a muscly 250 or so) and taped it in place with medical tape wrapped all the way around this head. None of this was done in anger, which I believe is a significant point. This guys was not happy, but he also understood that his dangerous behavior was not a game to me and was going to be neutralized. I'm not his mother or father, to be held hostage by such behavior, but I am a husband and a father who is going home without spreading disease to my family. Once he calmed a bit I loosened the chest strap so he could breath freely, chose a vein on the outside of his bicep and got an IV in case something else was going on here that I hadn't discovered yet, and we rode into the hospital. By the time we arrived he was calm and assisting me with his assessment like an honest to God human being. Now, you're probably going to see me get a beating for this answer, and my rating is likely to drop significantly, but that's OK, I'm wearing my big boy pants. And I do certainly see the need for this type of pt handling as a failure on my part. as there are many here that may be able to talk this pt into behaving without needing to resort to the above tactics as I most often can, but in my experience sometimes EMS simply becomes a contact sport. Now understand, had this been someone truly in mental pain I would have mashed his head into the mattress as described above but would have kept it there only so long as it would have taken for my partner to get me a line and some Versed from the lock box and life would have been peachy just the same. I simply don't like to be bullied or threatened into giving drugs by chronic assholes as opposed to those seriously ill. Bottom line is that you stay safe. If something like this works for you, go for it. If not, as mentioned above, get your ass out of the truck, call in PD, and get ready to eat some crow. :-) Dwayne

Hey Lisa. I'm not sure how old you are, but the only time I hear how valuable 'time in cert' as a basic is is when I'm talking to the part time firemen/medics and basics, at my service. They love the whole, 'whoever last that longest wins' concept. Most of the rest of us think it's utter bullshit. I like to believe that I am considered a competent medic where I work/have worked, both here and in Afghanistan, yet I've never worked a paid day as a basic. I truly believe that the most valuable things I use in paramedicine I brought with me. Kindness, attention to detail, a solid work ethic, a half decent ability to problem solve, a hunger to be a better medic tomorrow than I am today, the maturity necessary to talk with patients, make mature decisions, and the life experience to understand the pain of my patients and those that love them. Oh yeah, and an almost unlimited ability to haul the same drunks/drug addicts/psych patients over and over week after week without choking anyone. :-) In fact it's been my experience that the vast majority of the terribly difficult decisions I've made have been moral/ethical, not medical. I chose to go straight to medic school from basic based on the opinions mainly of Dust, chbare and akflightmedic, though many others were influential as well. I earned my AAS in Emergency Medicine and have never, ever regretted it. As chbare mentioned, EMS is the only medical field where many believe it is best to gain experience before knowledge. All others do it the other, and seemingly more logical, way around. If you choose to go straight to medic you WILL catch some shit from those that don't have a significant education (which is why they need the 'experience' scaffold to support their self esteem)...but f*ck em...this is about you, not them, right? Best of luck to you in whatever you decide. Dwayne

Why 'duh?' Do you then feel that the poking, prodding and percussing have an intrinsic value, even when done by those that gain little if any clinical information from it? I didn't get the feeling that the OP, though he seems to have chosen to no longer participate in his own conversation, felt that these were worthless skill on all levels, only those at the basic cert. Why then are they valuable? Should the hospital give me all lab values of the pt I'm helping to resuscitate after transfer of care because it's a standard of care, despite the fact that I have almost no knowledge of their significance? What is gained by that? Dwayne