DwayneEMTP

Right you are. I remembered typing it and thought to catch it when I ran the spell checker, which missed it. Good on you for presenting yourself more intelligently, and then taking the time to correct my post as well. We are all better for the exchange. It's not the occasional error that is offending but the purposeful ignorance that causes people to believe that you may not be worth the time to answer, though I'm grateful for the correction in any case. Welcome to the City. You are off to a great start! Dwayne

Speak to a councilor at your community college. They can give you all of the information that you need to move forward. A word of friendly advice. People judge you here, as they should, on the way you present yourself in your posts. Reread your posts and make corrections for spelling and grammar as necessary and you will be much more well received. Good luck to you. Dwayne

Kaisu, what is your motivation for staying here? I know you're not a quitter, that you have issues with allowing them to chase you off, but this place, from your description, sounds ridiculous. I know you killed in school, you've been successful in most everything you've tried in the past, I know you have other options....So what keeps you jumping through hoops to earn the right to work in a system you won't be proud of? I know you're smart, beautiful, strong and have other options...Tell them to go pound sand and work for a place that has some self respect. Dwayne

It’s simple. No matter how smart someone thinks they are, they can’t get a comprehensive read on a person in one shift, ruling out the extremes of course. Any new person is going to attempt to fit into the ‘team’ dynamic, something that is impossible to do when you have to read, then get to get to know, and then succeed with, a different preceptor each day. They have a system designed to cause people to fail, and that shouldn’t be acceptable in any training/mentoring situation. To tell the truth, this comment surprises me coming from you, as you very often have some of the most intelligent comments in a thread. The least value she brings to the job is what she learned in medic school. She is a mature woman of 29++ years or so, had been successful not only in business, but in life in general (The reason I know this is that we’re friends outside of the City, though don’t blame her if she denies it). For her to be subservient to a bunch of medics that can’t even succeed at the much simpler task of being a successful preceptor is ridiculous to me. Based on what? They may have been medics before her, but so far they suck as preceptors, a very important part of being a medic. Again, I can’t imagine what has caused you to think this based on what has been written here. Which they’ve obviously failed at terribly, right? I guess I’m missing the positive that comes from giving them this benefit. They haven’t earned it. I have trained thousands of people of all ages, sexes, and socioeconomic backgrounds, and on not one single occasion did I need to make them feel small to help them succeed. What about the things that she has written has lead you to believe that they are more than they appear to be? Can you do me the favor of quoting from her previous passages the parts that make you believe that this is what is actually happening? I think we have been reading very different things. Thanks for taking the time to post, I look forward to your thoughts. Dwayne

Hey Girl, First, I've found that things are rarely different than they were in school. The anatomy is exactly where I was taught to expect it. The physiology and pharmacology do what they were designed to do the vast majority of the time. I don't like it when you sound like you have to explain that you were just a student a few months ago. You've lived a few years, been a professional, killed em in medic school (No pun). You're full grown now, no apologizing for not having done this since you were a kitten. I'm going to take a leap here, but it sounds to me like you're still, at least partly, in student mode. You don't owe any of these people anything. Your life experience alone poots you miles ahead of most of them. Write my PCRs twice? Aint gonna happen. That may be fine for students, but it's bullshit hazing for a paramedic unless you've done something dangersous, or been cought lieing, which I know beyond a doubt has not happened. You know as well as I do that you teach people how to treat you, so stop allowing them to treat you poorly. I know you're not starving, so this is my advice. Go to work tomorrow and be a paramedic, completely remove all subserviant student parts of you. Allow them to respect you as a medic, and if they are unable to do so then take one of the other job you were offered. Stand up, do good medicine, be confident. The good medics will respect that, the bad medics won't be able to tolorate it, and in a few days you will know if this is a good place for you to work or not. Besides, anyone that is attempting to evaluate without one consitent, educated opinion as opposed to a bunch of ecclectic uneducated opinions probably isn't going to make you happy anyway.... Or....Takes names and I'll fly over and kick the snot out of them for you....Though the first option is probably better... Keep your chin up Lady. You've worked hard, you've earned your knowledge and this job, and the respect that comes with it. stop letting them treat you like a second class citizen. Dwayne

Good question letmesleep, I don't think it's harsh at all, it's very appropriate. I guess where I'm getting lost is in the name of the thread, which I also believed to be the focus of the thread most times. Would you work outside your scope of practice to save a life? Doesn't the question itself demand that the pt is going to die if I don't choose to work outside of my scope of practice? If it's assumed by the question that that is a fact, then why would the pt need protection? I'm assuming this is an acute case, or there is no reason for me to make this decision as a medic in almost all instances. So the pt is certainly going to die if I don't act. If I act poorly, perhaps the pt will die sooner. If I act appropriately, then the pt will possibly survive at least a little longer, right? So why does the pt need protection from my good intentions? Has everyone simply forgotten what the question was? And if so, why do we continue to go back to the "you're a menace" point of view? In the general order of things, IF WE STAY ON TOPIC, it's seems simple to me. We have an acute pt that is near death. If we act outside of our scope, he lives (Implied by the question I think) If we don't, he dies (Dito). The vast majority have chosen to sit by and allow him/her to die, neutered by the fact that acting in the PT's best interest could possibly cause them issues in the future. So perhaps we're all just seeing the question differently. Let me ask... You are on scene of a critical, acute pt that you've determined after a thorough assessment is CTD. All SOP interventions have been exhausted, medical control can not be reached. Using your education and experience you KNOW that you have an intervention that will in all likelihood reverse this person's fortune and allow then to live without deficits to the natural ending of their lives. Of course fire is there, along with the family, so there is no possibility that your intervention will go unnoticed, you will have to pay the price for saving this life.... What will you do? Dwayne

Why do you ask? I don't see how that relates to our conversation. Dwayne

Gotcha Doc. I didn't make the distinction, though I understand it, because it didn't seem to matter. It seems to me from this discussion that a person's life should be forefieit if there is any possibility that a rule exists prohibiting your action. In fact, the best I can see here, if a medical director that failed to make a rule concerning a particular issue then you should no longer be responsible for that procedure either. I'm off in the ditch on this one I guess...But I'm used to it... :-) Dwayne

For a couple of reasons. I was taught, and very much believe that the heart of paramedic medicine is pt advocacy. I am morally and ethically tasked with knowing as much medicine as possible, being physically fit, etc to protect my pts from illness and injury. I am also tasked with being mentally fit to protect them from poor advice that may be given by other medics, nurses, or even the medical director. That if, after bringing my education, training and experience to bear on a problem, I'm asked to provide or withhold an intervention that I believe to be in error, I'm morally and ethically obligated to refuse to follow through with it. So far the only arguments that I've seen against my doing so go back to "You shouldn't because you don't understand it." Not the case, the argument assumes I understand the indications, contraindications and believe a life to be in the balance. "If you need to do so then get a job where that skill is allowed." This is silly, as the entire thread assumes we are in this position now, not at some later date. I'm obligated to this pt, not to some future hypothetical pt. "If you don't like your system, change it." Again, has no place in this conversation as we're talking about an emergent, unforseen occurance. I'm not sure how to predict the unpredictable to make those changes. "Work somewhere else." Not even slightly interested in responding to this foolishness. "Your intervention may cause more harm than good." Once again, it's been assumed in the argument that I have a fair understanding of the cost/benefit. Could I be wrong? Sure. But to do nothing, when I believe I can help increase the odds of a positive outcome, has a 100% chance of failure. Vs-eh?, as you've shown time and again that you simply wanted your little moment to take a shot at U.S. EMS education I won't waste time on you. But I'm curious, if your education is so superior why is it that you're unable to hold your own in debate even with American basics? Shoot...I'll have to think about it. The silly ones for sure. Pt trapped in a burning car by his mostly amputated leg. Amputate or let him burn? I'll try to come up with some decent examples, though as I've stated about a gazillion times, I'm not looking to work outside of my scope of practice, nor even outside of my protocols, so if I could predict them then they would likely be a non issue. Dwayne

Couple of things...First, I agree with this of course. But I get confused...with me the only one on the other side of the fence, do I assume that this is a rebuttel to my arguments? Can't you also think of a gazillion instances Doc where the protocols don't specifically relate to a life ending/altering situation yet a medic would be perfectly qualified to intervene? I'm guessing you can, 'specially if all of the horseshit protocols country wide are considered. Also, I've tried to make it clear this isn't about heroism for me, yet for some reason we keep returning to that topic. Why can't someone simply choose to do the right thing, a thing they are confident that they are qualified to do, simply because they believe it to be right? Why does there have to be fantasies of heroism? Are many of you so far removed from simply trying to be a good neighbor and a good human being that you can't imagine taking a beating for what you believe in without first verifying that it will make the paper? I'm completely off in the ditch as to why it must be heroic simply because it's not common practice. Again, isn't this the whole point of the question? If you performed it daily, then it'd likely have a protocol, then it wouldn't and shouldn't be part of this discussion. Someone claimed once that there are systems where a medic needs permission from medical control to start an IV. So if I start an IV on a trauma, or OD, or preeclamptic woman, or an anaphylaxic (sp) pt....then I have only done so to be a hero? When I'm sitting next to those supplies, and drugs, yet the tired, bitchy medical control doc who believes I have time to make it to the hospital denies my orders, do I then watch little Suzie suffocate? I mean, starting an IV is outside of my protocols. Do I then watch her die because I'm unwilling to break a rule? I know that everyone here can think up at least a dozen more realistic scenarios where this might apply and be desireable...but only one or two are even able to consider it without going into near seizures at the thought of breaking a rule? I thought for sure that once I clarified that we were talking about, not common practice, but that once in a career decision that most would say, "Oh well, yeah! If I know the implications for and against and am comfortable and qualified, of course I would choose to save a life." I'm truly a little weirded out that it didn't happen. Rules before life? Where did my education and life experience go so far off into the ditch that I thought it was supposed to be the other way around? Dwayne

I think it's a great example. Protocols say you shouldn't, but in my world you should. Should I cut the last thread of tissue holding a pt in the car, preventing transport? I'm not trained for it, but my education tells that this is not going to add significanlty to his injury, but that it will allow me to transport, which will create significant possibilities for a positive outcome. So am I not obligated to make the cut? I think I am. Do I refuse the assistance of the surgeon on scene so that I can do it myself instead and be a hero? Of course not. I simply think that if I have the CLEAR ability and knoweledge, and there are no reasonable, realistic better options, then I'm obligated to act. This is just right for me obviously, as I can't sustain the argument if I am limitted to using the SOPs and protocols. I think this has been a great discussion. Thanks for taking the time to participate. Dwayne

Absolutely. Completely disagree. Even if we don't resolve the problem, we come to know each other better, getting a better feel for tone, sarcasm, etc. Exaclty what I was trying to say, only you said it much better. For some reason I still see, "Continually operate outside your scope", and "If you want to operate outside of your scope" etc. I had assumed we were speaking of the incredibly rare instance where this would be beneficial, perhaps I was the only one with that understanding. Awsome point. It's just that I often don't know what's right or wrong, or what I may find acceptable in the future until I'm able to bounce it around in here for a bit. I'm grateful for everyone's opinions and for you taking the time to do these mental gymnastics. I think it's important to explore and make decisions on these principals before the time comes when you need them, but don't have the time to think around all the corners. One last time...Not an advocate for creating your own scope of practice daily...I believed us to be arguing the rare, once in a career decision to act or not. Have a great day all! Dwayne

That's it exaclty...Thanks Jake....

So it sounds to me as if you're a good company/corporate man Timmy. Let the problem go now and do the correct paperwork later. Good for you. Doesn’t work for me. If making excuses for a lack of action after it's too late to create a positive outcome for that pt is acceptable to you, then good on you man. But don't attempt to put if off as being morally superior because you were afraid to act but are willing to "do the paperwork" afterwards. Deciding now that you will allow those in your charge to be victims, while in your charge, victims of shallow protocols, of medical direction, of circumstances, makes you a pretender as a medic. I realize you are not practicing at the medic level now, so I make this as a general statement and not one aimed at you. As a medic you are ethically charged with fending for your patients. As a human you are morally charged with defending those that can't defend themselves. You can wrap your decision not to do so until it's to late any way you want, file all the post incident reports, do any amount of finger pointing, but that pt will never care, right? Cause they’re dead now, right? Also, if you weren't responding to me, who were you responding to? I seem to be the only one at the moment with this opinion, right? Dwayne

"...the San Antonio Fire Department permanently barred Gardner from working as a paramedic in the city and transferred him to the firefighting division. It also temporarily deauthorized Huntsman, Bullock and Collins as San Antonio paramedics and transferred them to the firefighting division" Standard fire punishment. Can't hang as a medic? Then let's punish you by allowing you to sit and do nothing at full salary. What? You meant that's what you wanted all along? Amazing..... Dwayne

That's what makes it an interesting question. It is a hollow argument to withhold treatment for THIS pt for the sake of future pts. I hope if this is truly your opinion that you never treat my family. What happens if you decide saving my son is not as important as saving your hypothetical future pts? You have stopped being a paramedic when you choose to stop doing everything in your power to advocate for my son. This is a silly scenario and I think you're plenty smart to see that. If you think operating outside your scope of practice has a weak argument, try telling your medical director you made a decision for your current pts care based on how you think a future pt would have responded to it.... I have many options. I don't need to be a medic to avoid a dead end job. If you don't believe me ask the scores of medics that leave the field every week for better jobs if that was their only option. Fair enough. Nor do I. I never said that doing what I believe is right would have no consequences; I simply said that I would do what I believe to be right despite those consequences. Agreed. But evidently we see the base issues differently. If you see the Dr. doing something that you KNOW is detrimental, yet say nothing, than you can no longer pretend to be a paramedic. You may be called a paramedic, but when you've chosen to allow your pt to be damaged in your presence then you've failed to be your pt's advocate. Simple to me. Please explain this statement. Grabbing some random issue and stating that is shows that I have no self respect doesn't fly...You're going to need to flesh this statement out a bit...But if you're going to claim that I have no self respect then you need to be prepared to back it up and then go to the mat. Respect, for myself and for others is something I take very seriously. Dwayne

Shoot letmesleep, I don't think you're off base at all, I just think we're still looking at the question differently. I would absolutely provide supportive care until the surgeon arrived. Again, I'm not looking for a reason to breach scope of practice. I'm assuming the surgeon is not available. There is no issue that I can see if obvious solutions exist within your scope. I thought that the interesting question was "what if you had no choice but to sacrafice a life or breach your protocols?" If I can resolve the issue within my protocols then I will do so. I have no need to show I'm above the protocols. It's simply that if my protocols are not adiquate to save this life, then I will choose to save it if it's within my power, and deal with the fallout later. Cut off a limb to remove a pt from a burning vehicle? To me that's not even a close call. use a scalpel, my Gerber tool or gnaw it off with my teeth...he's coming out of the vehicle and all that believe that to be outside of my skill level, or outside of my area of responsibility can be damned. There is no one on this planet that has the power to tell me that I may not use my hard earned skills to save the life of someone that wants to live. I can find a new job... but my morals, ethics and humanity are not so easily replaced. Dwayne

fire_911medic, I'm not sure if you keep twisting things to look better of if I am, but here is what I've seen the argument become.... You are on scene with an acutely unstable pt. To survive the pt needs an intervention that you can provide but that falls outside of your scope of practice. Do you provide that intervention? It seems to me that the question implies that you understand the intervention, are capable of providing it, and do so to the pt's betterment. I guess I keep wondering why you continue to try to make it appear that I'm advocating for everyone simply doing whatever they want? When was that ever part of the discussion? Obviously rules are good. Rules are particularly good for weak medics. I am not advocating a life of crime, simply answering the simple question above. If you have the opportunity to save a life by stepping outside the protocols, and again, I'm assuming it's an intelligent, logical, productive intervention, yet medical control has ordered you not to do so, what would you do? Would you ‘be stupid’ and advocate for your pt, providing the intervention allowing them to live? Or would you follow medical direction, allow them to die, and follow the rules? I believe the “what about your future patients?” argument is ludicrous. I can’t imagine causing suffering to ‘this’ pt for the betterment of hypothetical future pts. So maybe we can agree that that’s a non issue? Hopefully this puts us back on the same page. Dwayne

That is an oxymoron. If you will do everything in your power, then the only 'point' is when it becomes beyond your power, right? Not when someone you disagree with tell you to stop. Nor would I. There are places that insist that you call before initiating an IV. If my pt needs and IV yet medical control refuses, then I will start the IV. I have gone against medical orders in Afg, and will do so again when someone not on scene refuses to give me permission to do what my eyes, and education, show to be necessary. I have known several good medics that refused orders from medical control, or provided interventions that they were specifically ordered not to. Each is still practicing medicine, happily providing for their family. Their defense was that medical control was wrong. They made decisions from afar that were incorrect for the situation on the ground. When the medics explained their reasoning all went away happy. I promise you this. If you work in CO Springs and follow medical control to the detriment of your pt, medical control will pull your right to work under his lisence the moment you step through the hospital doors. He expects you to know how to do medicine, and to do medicine even if it means going against orders. I am tasked to protect my pts, not cover my ass by claiming, "But MC told me too!!!" If you are not confident in your medicine then covering your ass is an outstanding career move. If you have confidence in your medicine, and have committed yourself to advocating for your pts. then you don't assume that MC is the final word. Dwayne

I think you and I interpreted this question differently. I didn't read it to say "Are you looking for a reason to exceed your scope of practice?" But "If a life was salvageable if you would step outside your scope of practice, would you do so?" I have no desire to step outside my scope of practice, but will do so if a life is at stake. Perhaps that would play a role for you, but I believe that those that know me here will tell you that it is not a part of who I am. Perhaps you see anything that causes one pain while doing the right thing as heroic. I don't. I will try to do what I feel is morally and ethically right because that's what being a paramedic means to me. I was taught by those better than me that I am obligated to protect my pts from all comers. Police, nurses, Dr.s and yes, even my medical director. I must have been asleep the day they taught "Protect your pt unless it's likely to get you jammed up, then allowing them to die needlessly is acceptable." I'm not selling this to you. This is how I choose to live my life. I've attempted to help people when doing so put my life at risk. Do you think I can somehow choose not to do so simply because my medic ticket is at risk? Not likely. It's unfortunate you spend your time around such weak medics. But again, the age old bullshit of BLS before ALS isn't really what this thread it about unless I've misunderstood something. I was trained to do monkey skills. I was educated to know how the body works, what it needs to survive, how my actions and medications affect those needs, and to use that education to create possibly life saving interventions on the spot. If after bringing my training and education to bear I find that my pt needs don't fit into the protocol, or their chances for survival will be lessened by strict adherence to the protocols than I will do what I think it right and take my beating afterwards. If you can only see stupidity here then you very much should stick to your protocols. It's not time, nor may it ever be, for you to think on this level that demands you may make a sacrifice for your art. For me, the very soul of paramedic medicine is pt advocacy. If I remember that, that I must defend them from sickness, from trauma, from insufficient care, and yes, also from possibly poorly written protocols, then I stay on track. I think the view you have is a smart one. I think it will guarantee you a career much longer than mine, but when you choose to forfeit a life to follow a rule then you are no longer fulfilling your obligation as a paramedic. You may do complex medicine, but it is soulless, and I'm willing to bet your practice suffers for it. Thanks for sharing your thoughts.... Dwayne

Understanding that in my very short career I've rarely had the necessity to do so... I've sometimes operated outside of my scope here, and the scope is broad, and had to take my beatings afterwards. I was able to justify my decisions each time and came out ok...and that works in this life. I'm thinking it'll get my ass kicked stateside. But I've made my decision, and I think it's right for me. When time is an issue..I'm going to do the very best medicine I can.. I'll try to do what is smart, efficient, moral and ethical to the best of my ability and then let the chips fall where they may. If my job demands that I allow lives to be lost simply to prove that I'm a team player then I'm not interested in playing any more... It seems to me that I'm obligated to advocate for my pts, all of them, even those that are so rude as to fall outside of my protocols, or fall across multiple protocols. Nowhere did I learn, or come to believe on my own, that I should protect my patients unless it gives me a pain in the ass from my medical director. My obligation is to THIS patient, not hypothetical future patients. Besides, like I said, I don't have the mental muscle to figure out the medical, social and political consequences all in that moment. I'll stick to the medical and worry about all else later. Dwayne

Another shining example of why EMS is, and probably will remain, a Good Ol Boys club for yahoos and wackers. If you see nothing but a 'skell', and no options other than 'getting pissed off' or 'chasing him around the bus' then you are part of the problem, not part of the solution. Time to grow up a bit. And if that's the attitude you leaned from your recently graduated medic school you need to demand a refund...you got screwed. Dwayne

Hell letmesleep, not only do I expect you to attack my opinion but I can't think if a single good reason to come here if you're unwilling to do so. I can see you were stirred up by my post. Good on you. It was my intention to be clear about how I felt, and I was pissed, but if those feelings are in error for some reason you do me no favors by allowing me to continue to be wrong. Though I can see your points, sort of, my question for you is this; Do you find it acceptable that a medical professional stands by while an altered, non violent pt wanders/falls around unaided? If that had been you in the video, is that a call you would be proud to show to your family? Your teachers? Your medical director? Speaking for myself...If I ever get to the point where I am comfortable watching a damaged person run into the street and/or fall multiple times on their face, I hope the EMS Gods fly down from the heavens, tear up my medic ticket and spit it back into my face. We are tasked, within certain limits, with caring for those that can't care for themselves. Many of those people will need to be saved from situations that they created on their own. That's the gig man...If you don't do it because it's the right thing to do, then do it simply because it's what you get paid for... I think, though I don't have time right now to reread the thread, that my comment was addressing the idea that this video didn't belong in an ethics discussion. It seems I was clear on that, but if you still don't know where I'm coming from I'll readdress it... These providers chose to be on the scene that involved an altered pt. Do you feel that there is a moral obligation to protect that pt? Do you feel that there is an ethical obligation to be this pt's advocate? I look forward to your thoughts.... Dwayne

348 posts as of this writing and not a single intelligent entry to date. This is not a dead issue, or it wouldn't still be going. It is only dead to you because you're too ignorant to see the issues involved. And too ignorant to contribute, thus the textual diarrhea you continue to fling at us. Think Don! Come up with something that you can share, something that you want to know, something that contributes, and then hopefully you will find that you don't have to continually sit in the back of the class making fart noises to get people to notice you. I think you'll like being noticed for intelligence instead of ignorance if you'll just once give it a try. Dwayne

Man...I'm so disappointed by this thread, and even more pissed than disappointed. Dirtbag? Scumbag? Drunk? How do you know? You should all go and visit the thread at JEMS on the seizing baby. Dust took on all comers for making such foolish assumptions. Do you automatically assume that a warm baby is a febrile seizure? Only if you’re an idiot. Is every altered black man in your poor neighborhoods a drunk? What about a diabetic emergency? Stroke? Trauma? OD? And you consider it acceptable behavior to allow an altered pt in your care (And yeah, if you’re not tending a pt nor fearing harm to yourself I consider this your pt) to run into traffic? To fall on their face multiple times before finally declaring “Aha! He’s now sufficiently injured to be worthy of my awesome talents!!” Horseshit. Every one of you that fails see the issue here needs not bother boring us with your bullshit about, “I just want to help people” anymore. It’s rare that I see someone needing care as badly as this man, yet you revel in his suffering and humiliation. And I'll guarantee that any of you that can't see the ethics lessons in this video have never had an ethics class. Ethics is all about "what if", "why?", "Why not?" etc....it certainly is a valuable video for that. It truly makes me sad that so many of you decided that this MAN was just a scumbag drunk without considering other options. And even more sad that once you'd decided that, you felt he was no longer worthy of your care. How the hell did you get so friggin high and mighty that you can no longer be bothered to dirty your delicate hands on a drunk? If you can't see that you're way off in the ditch here I pray you never work the streets of my town nor care for my family. Dwayne