DwayneEMTP

In one of his books, at the time I read them he'd written three, John Douglas claims that staking should be one of the police's highest priorities as very often it concludes in murder. (I shouldn't have offered Journey Into Darkness as the source as I don't really remember which one these thoughts came from. Sorry about that.) So it follows, according to him, that if you terminate the stalking, then very often you will prevent a murder. Again, he claims the stats to make such a claim and it seems if anyone would know, he would, so I simply accepted his statement at face value. I found all three of his books riveting, for what that's worth, should you ever want to take a look at them. Dwayne

Not sure what policies are, but I have too many years of farm experience to move without checking...It's just second nature. I do think the odds are poor that they were dispatched to the firehouse, yet failed to recognize it. I mean, who's better with directions and addresses than Fire? So, doubting that this man used his personal cell phone to call 911, my money would be on the likelihood that they were responding to whichever pay phone is located closest to the station. My guess is that he believed he'd get the brush off is he knocked on the door, but the 'calvary' by dialing the phone. This guy obviously needed serious psychiatric/medical attention. They dispatched Fire and for once that actually ended in the best medical attention money can buy...sometimes things do work out. Dwayne

I wonder if they couldn't pursue, or at least closely monitor him based on his psychological proclivities associated with serial murder? Imagine, investigate, accomplish, practice, improve (something like that). When reading "Journey into Darkness" I think it was (A book written by the man that imagined and then developed the behavioral science unit for the FBI) he states that stalking should be one of our highest priority crimes, as "Stalking is a proved preventable murder." Perhaps there's available fodder there, related to how committed he was to making contact with the same individuals on different occasions? Not sure, but I wonder how far the leap is from fantasizing over these things, to trolling these sites, to encouraging these suicides, to possibly forcefully hanging the less than willing? Of course, I'm making many assumptions based of a few lines in a newspaper mixed with some years old psychology classes, and it is 0400, so that might all just be crap... :-) Either way, should it be Dylan found hanging, I can guarantee that the end of his life would make an interesting M&M. (No, not candy, Morbidity and Mortality review) Dwayne

Wow! Usually the only time we get this many responses to a 'meet and greet' is when a new member has a sexy name and her avatar is way hot and has that 'I just might talk dirty to you in chat' affect... Welcome to the site man! You're off to a good start! Dwayne

As this is an educational paper, on an educational topic, posted on an educational forum, I'm confused why you insist on doing it all in private? Why not simply post your questions so that all can learn from the answers and debate? It seems that that would give you at minimum the same information, plus you benefit from the conversation concerning thoughts and questions that haven't occurred to you, right? What's up? Dwayne

My first inclination was to say, "Hmmm...possible he got fooled by some of the hinkiness that may have followed the head wound." But seeing that it's a firemedic, that actually got suspended for doing something wrong? Man, I have to think that he really, really mussed this one up. Now, before you chastise me for a hosemonkey hater, be prepared to compare stories of firemedics that have boneheaded calls and walked away to those that haven't...just sayin'... Dwayne

Welcome! Man, I can't remember that last time we had any type of virgin here! Dive in, participate, have a good time, learn, teach, explore. Good luck. Dwayne

Lids in the partially 'open' position if their natural relaxed position. Closure requires flexion, so in most cases, consciousness. For some reason the dead have never bothered me. Babies, adults, for the majority, no problem. What grosses me out is the living left to suffer. Dwayne

Yeah man, you make a great point. I love the scoop. Way more comfortable for people, they stay more easily in the center, less movement on our freaky country roads...much better option I think, though again, I can't prove it. All geriatrics, if I absolutely can't clear them, go on the scoop. And I agree completely with the rest of your post as well. Dwayne

Agreed. But the collar was the point of the discussion put forth by the OP. And I agree, if a large percentage of your patients aren't fighting the collar, then we do in fact live in different worlds. In the subdued pt, I agree with all of your arguments. Man, many of mine are not subdued or in a state of mind to become so. See what I mean? Dwayne

Yeah, but your word's good enough for me. And I agree at that point that things might possibly be improved for a cervical spine injury. But what has come before that? In the group of patients we're talking about, look at the manipulation that's taken place. And now, not just against the weight of the head, but against the force of another person attempting to hold it still. So after all of that manipulation, unless you have a way to from combative to immobilized without movement, by the time we've immobilized are we still really doing any good? I'm not so sure... Anyone have that study that compared New Zealand, with almost no immobilization of any kind, to a New Mexico service that immobilized nearly everyone, that showed the NZ system showing significantly reduced morbidity where spinal injury is concerned? (Again, taken from my head, I could be misremembering) I was just talking to our medical director the other day about this, but I can't remember where I saw it, though he was familiar with it. Though my thoughts are not likely to change anything, I sure find the discussion interesting... Dwayne

What!? Are you kidding me? At my service, working with me is considered akin to, say, spending your day basking in the sun while being bathed in a cool breeze... Just sayin'... Dwayne

Can't really help there as a quick Googling turned up nothing. But in science based medicine it's important to remember that a lack of evidence against should not necessarily be considered evidence for, and of course the opposite is also true. I'm afraid we're both stuck with intuitive and anecdotal reasoning on this one. (which makes for some gnarly good debates I might add!) Fair question. And perhaps I've simply been misapplying them all this time, but I've never really seen them prevent an uncooperative pt from doing anything except perhaps touch their chin to their chest. Other than that, without additional support pts have near full range of motion. Actually, WinterMedic and I were talking about this earlier today, that sometimes there can actually be several right answers to a question. I'm not sure this is one of those times, but I think that it might be.. The contrary ass in me wants to say, "Bullshit, it makes people uncomfortable and seems, intuitively,, to be useless, plus there's no science to prove that it's useful! So I don't want to use it" And then, everyone around me WANTS to use them, which makes me REALLY not want to use them...grin. So perhaps I've gotten a little off in the ditch here simply for the opportunity to be stubborn. I can see where perhaps they help to mitigate the force of compression on the c-spine...not sure though. I truly believe, at least in part, that we still consider long boards and c-collars 'vitally' important because it's the main, and sometimes only, skill of some providers. We can't logically devalue the equipment without also devaluing the people that consider them their only example of being important. See? In the short game, I'm ok with that, as long as the rest of us don't forget that we need to determine an actual applied value for everything that we do, and let the publics/Ricky Rescues perceived value be damned. Thanks for you thoughts! Dwayne Hell, I took so long to post I guess BDS really said the same thing in way fewer words. Welcome to the site man!

But can you show me where there is any evidence that the collar is valuable? As I said before, in my experience often a patient that was calm and still with manual stabilization becomes much less 'safe' once the collar is applied due to pain from injury, fear of the collar for multiple reasons, or simply because they're drunk and pissed off that anything is happening. I've found the c-collar to operate much more often as a pacifier for the provider than a benefit for the patient. Another thing I hate about c-collars is that more often than not, whoever is providing c-spine suddenly feels free to talk to their buddies, or check out the chicks instead of paying attention to in line immobilization. And I'm willing to bet that I'm not the only one that notices this phenomenon. No reason really, it's just kind of how the flow of my calls has come to be. More habit than anything else I think. Exactly. And again, in my experience the collar seems to have the potential to cause harm, and has no scientifically proven benefit, so does that change your argument at all? Thanks for your thoughts. Dwayne

Hey all, Just a quick introduction for my partner for this week, Eric, known here as WinterMedic. He's a new paramedic out of Florida that works at my service. Smart, wicked funny, kind, and as dedicated as anyone I've ever seen. I hope you'll all make him welcome. Thanks all... Dwayne

Exactly! Yours is a failure of the precepting process Timmy, not of your education. People need time to learn, and an environment conducive to learning. I don't know if you have the option there, but you should seek a different preceptor. Not an easier one, but simply one that doesn't have her head buried firmly in her ass. Don't let her shake you brother..Just keep on keeping on. Dwayne

Hey Angie! Welcome to the City! What level certification are you currently, or trying to achieve? Remember, to really get your moneys worth here, you have to participate. The lurkers take very little from here. Express your opinion, judge other peoples opinions, share your ideas, admit when you're wrong. See? Easy! :-) Good luck. Good to have you on board. Dwayne

I was under the impression that an intelligent clinical program was designed to give students those exact skills, right? Surly I don't have to explain to you that no amount of 'pretend pt assessment' in school prepares them to do well upon entering the clinical setting? Do you mean to imply that you came out of medic school a seasoned paramedic? I have to doubt that. Or perhaps you are of the school that believes that only those that have been Basics for so many years should be allowed into paramedic school? What did you believe that clinical time was for?? Dwayne Firefly, I was under the impression that he was referring to clinical time, yet it appears you're referring to FI (Field instruction, Field Internship, etc) of a newhire. Those would be two different areas of education as well as separate conversations I think... Dwayne

Also have 'no idea what a 'sticky test' is... A couple of things. I agree that assessment is the major component here, and that the legalities of of varying from your protocols should be considered. Having said that, I can tell you that often this is what happens. I show up on scene, fire is holding manual c-spine, I take the cot while my partner gathers spinal precaution equipment, by the time he's ready I have log rolled the pt with manual c-spine in place, assuming your standard 'test like' supine position, and simply roll him back onto the LB, apply collar, etc, etc. Now, the argument can certainly be made that the collar should have already been in place before I arrived...but then you'd have no understanding of small town, rural EMS. I've got next to no faith in c-collars being of more value than competent manual stabilization alone, in fact in my limited experience the majority of significant manipulation of c-spine comes from fighting against the collar, so this gives me no great crisis of conscience, but others will likely feel differently. But the science isn't there for any hardcore faith in c-collars. Also, based simply on what you stated above, assuming you're using intelligent assessment skills, I see no problem with your logic. And I absolutely respect your desire to think around the corners of something that so many consider just a 'silly skill.' Good for you for asking questions, for questioning the status quo, for being brave enough to put your thoughts out for scrutiny. All of those are wicked strong EMS traits. Good question! Dwayne

If I remember correctly, and I'm not sure that I do, I believe this was part of a test to determine the age at which children come to understand the concept of delayed gratification. It spawned from an idea of B. F. Skinners based on more intelligent, productive ways to teach children to control stress as opposed to allowing the 'world' to do it randomly. Cute video either way... :-) Dwayne

Oh, My, God. That was friggin hilarious... Dwayne

But then again, the IAFF supported Obama for president... Perhaps if firemen get to be called heros simply because they 'say so', then perhaps Obama gets to be the 'deliverer of peace' simply because he says so as well..? I think I see a pattern here... Dwayne

No idea, but I'll tell you one thing, I'll be getting THAT vaccine! Dwayne

Interesting debate I think... Based on this from Wiki, the award should go "to the person who shall have done the most or the best work for fraternity between nations, for the abolition or reduction of standing armies and for the holding and promotion of peace congresses." http://en.wikipedia.org/wiki/Nobel_Peace_Prize Based on this description, can anyone name a possible list of accomplishments that would have made him worthy? To those that believe it's a sham...What do you believe would be the motivation for these countries to embarrass themselves in front of the world and cheapen the perceived value of the award? Why would they do it? Could they have been coerced? How and by whom? I truly have no opinion on the award, as I'm not very political. On it's face it looks like bullshit, but sometimes things are not as they appear on their face..book by it's cover and all that. Pretty cool to see this debate, on such an inflammatory subject continue with good manners. have a great day all. Dwayne

Hey Jonathan! Welcome to the City! I'm afraid I couldn't read the first line of your post because of that stupid box thingy, but the rest sounds good! There is much to learn here, and always something to teach, but neither occurs unless you participate, OK? Go out on a limb, visit, challenge people's ideas and put yours out there for scrutiny! It's really the best way to learn. Good luck man. Glad to have you here. Dwayne