DwayneEMTP

I'm not sure who you're responding to, someone in this thread? [edit: I see now where you're responding to Dustdevil] The paid v volunteer has been covered ad nauseam in multiple threads, you might find a better argument there... Though before you begin, it might benefit you to define 'career', 'profession' and 'professional' before wading into that pond...there are a lot of passionate, educated opinions on the subject. Dwayne

Hell, just when I'd gotten all excited about this thread it turns out fire doesn't want to play after all... My apologies Wayne, I didn't notice that this thread had replies. Though, because you still didn't address the most pertinent of the previous questions, I would just be restating the things I asked before if I replied to your latest post here... Have a great day all. Dwayne

Just a bump in this thread for the holidays.... :wink: http://www.caringbridge.org/visit/alyssageske I just got off the phone with my sister in law, Kati, and niece Alyssa. Kati was talking about what a blessing it is to hear from the people at the City...She couldn't really believe that these were people that I knew, that I shared time and opinions with, that had taken time to take an interest in their family. "Why do they spend their time with us? (Said humbly) There are times that I can't read more than an entry or two at a time, because the enormity of the the love from around the world simply overwhelms me..." She used to like to read through the many responses, but I've never talked to them about my City family...She had believed all this time that I'd taken out an ad in some lonely heart paper/magazine asking people to write and say hello (Ok, so perhaps I've given her reason to believe I might resort to unorthodox means to fill Alyssa's mailbox...Thank God I never needed to go past plan "A" in this case) When she found out these weren't simply lonely people answering an ad, but smart, kind, busy people that have full lives and other things to do...she was stunned. Kaisu, Wendy, Dust and all of you that have been posting regularly are truly a joy to this little girl and her family. I had hoped that she would get a kick out of getting notes from around the world. I'm ashamed to admit that it never occurred to me that each of you would bring so much more...that you'd leave part of your heart, soul and amazing strength with each visit. I underestimated you, even after knowing you all this time...I'll be much more careful in the future! Thank you for all you've done for my niece, my family, and myself. You've changed me for the better in many ways...I'll never again be the person I was before we met. From Dwayne, Barbara and Dylan in CO...We'll be sending you love and happy thoughts for the holidays! (Please ignore any naked people that might inadvertently slip into those happy thought...they're...err...probably coming from Barb!) Merry Christmas all! Dwayne

CPAPMedicCO, welcome to the City! That is a great scenario, and interesting question. Thanks for posting. Though to let you know, as I can see you're new, it's considered bad form to post the same content in two different forums (Though I can see the logic behind both choices). Also, if you'll break your long posts up into paragraphs (proper or not) it makes it much easier to read and more folks will take the time to do so, increasing your responses. Both pieces of advice meant in the Christmas spirit to a new poster! Not trying to disrespect your post, I'm glad you took the time to share it! I look forward to your posts in the future! Dwayne

Just out of my head (meaning without looking it up to help prevent myself from looking like a bonehead) I also thought the SPO2 didn't differentiate between CO and H2O, that it would read high. Though it sounds as if he was able to watch it trend to that point, which may have given him confidence, wouldn't 99%-100% sat on room air at 9400 ft. cause you to be suspicious of the reading secondary to CO poisoning? Just wondering... Dwayne

I too got caught up in the question and lost sight of the spirit of your posts. Behavioral psychology is a terribly strong tool for developing behaviors and attitudes. The problem is that while everyone claims they use it, it's rare to find anyone with even a rudimentary understanding of it's concepts, which are very, very specific. A couple of books that you might find useful. Don't Shoot the Dog, Karen Pryor. Don't Shoot the Dog at Amazon A terrible title, as it has little to nothing to do with dogs specifically. A great primer for behaviorism, written by a woman pretty good at getting the point across. A small paperback, quick, fun, valuable read. The Game of Work, Charles Coonradt. The Game of Work at Amazon This book caught my attention years ago, as the author asked this question, " Why are people willing to pay to work harder than they will work to get paid?" If I remember right, he worked in some type of cold storage facility. The employees constantly complained about the cold, the low pay, needing more breaks and chances to get warm coffee...but then on the weekends payed $100s of dollars to go skiing! They worked much harder skiing than driving their fork lifts, yet never complained, as well as paid a lot of money for the privilege! So he set out to define the difference between work and play and see if they could meet in the middle somewhere...He did a great job. Again, it's been a while, but I remember it as a powerful, logical, productive book. I think the common thread we see here is that randomly treating new people as if they represent the lowest common denominator, creates people that believe they ARE the lowest common denominator. Whatever else happens, you must not develop a system around the 5-10% of the losers (that should be fired anyway), because it punishes and retards the growth of those that had potential before they entered that system. Good luck to you! Dwayne

Yeah, I can't imagine having to spend time around anyone that believes treating new people with disrespect is a good thing. It's the tiny penis mentality passed down through the generations, that surprisingly, you don't see in many of the really macho professions. I spent my younger years on a working cattle ranch. Pretty macho environment, no hazing. People are expected to carry their weight, and if they don't, they're gone. Pretty simple system. This is not to be confused with not knowing their job. If they fall behind out of ignorance, that is seen as the crew's failure...Out of laziness?...Too much time to invest in creating character before you can instruct in duties. Same experience on livestock farms, cash crop farming, animal training. All pretty macho, yet none get their rocks off treating new folks badly. The feeling seems to be that if you're not qualified to integrate a new person into a productive position on your team, perhaps you're not qualified to be in that position. If 'hazing' (understanding that we all seem to be on the same page that violance or humiliation is not to be tolerated) is to work, it needs a well defined behavior plan. It needs a way to be ended based on merit. A one year time limit is just a bunch of idiots getting their jollies picking on the defenseless. That being said, vetting isn't always a bad thing. We see it here often. How often do we see Dust tell someone that seems to show promise something to the effect "What are you talking about? That is a ridiculous statement!?" (though said much more eloquently of course). Does that statement make them comfortable? Usually not. It rocks them back on their heels, forcing them to think, and then to make the decision to either step up to the plate and shine, or whine and fall on their face. When I see this happen I often want to send a PM saying something like "You may not see it now, but he's just given you a huge compliment. Dust doesn't push those he expects to fail. He sees something in you that made him believe you should be and are qualified to be operating at a higher, more intelligent level and is investing himself in guiding you there!" But of course that would defeat the purpose of the "nudge". Using pressure to guide is a good thing if that pressure is planned, and will show the character/weaknesses/strengths of a person so that those can be addressed in a logical, progressive manner. Making the new kid shine Bubba the 400# veteran's boots for a year doesn't seem to fit the bill. You know, there was a great article in JEMS (I think) describing one fire districts decisions to quit doing things the traditional way, which was failing, and use an approach that made more sense logically and intuitively, but much more important provided quantifiable results based on skills, intelligence and attitude, with attitude being the focus of the entire training/probation period. Private EMS should be very afraid of this type of attitude if they plan to continue to compete with fire for these services. (I wanted to say private EMS should feel challenged by this, but that doesn't seem to be a realistic expectation at this time.) Yikes, I guess I got to rambling... Anyway, unplanned/unmonitored hazing is bad. Planned/quantifiable vetting is good. That's my story and I'm sticking to it. Have a great day all. Dwayne

Thanks Dust. I really didn't think anyone would believe I was serious. An interesting story (to me at least), that generated this idea. I was reading the biography of Jack Welch, the CEO that turned GE around. (There's something interesting about reading about the lives of people that make billion dollar deals as part of their normal workday, and he was kind enough to stay focused on management instead of tooting his own horn.) The story below is relayed with honest intent, though the numbers may be off as I read the book a decade or more ago. Anyway, GE decided it needed to start marketing some of it's products via internet. Plastics and such. They looked first in house, but couldn't find anyone qualified. They wanted to gross $50,000 their first year, but didn't have anyone confident they could make that happen. So they hired some kid (30 or so I think) from Sun Microsystems to come in as a consultant and evaluated their needs and get them started on the right path. He spent about a month or so looking into it, then prepared his proposal for the Board. Now understand that everyone on the board earned a salary of $1 million/year plus. I believe this kid made $28,000/year or so at Sun. When he had the floor, he was asked, "How do we make this happen?" He replied, something to the effect, "You don't. You are too old and fat." As the story goes, with the exception of gasps, and red faces, (You didn't attack ideas in Jack's company), there was silence. When asked to explain, he told these older, richer men that it wasn't them personally, but the company. They had too much money, so there was no one in the company hungry enough to make it happen. And they were too old, they had been looking at things in their way, through the eyes of their generation too long. They simply couldn't get there from here. He suggested that they create a new company, which GE liked to do anyway, but with young, hip, internet generation kids, and tie their income to the success of the project. They did it immediately, and the first year, the new company grossed (I think) $55 million dollars. Anyway, I sometimes wonder if that's what's happening to EMS. For generations now it's been managed by doctors, medics, politicians, or some combination these. I think maybe it's time to bring in someone that knows how to run a business, at the fortune 500 level, but isn't blinded by three decades of looking through the same tired, dirty, cracked glasses. Completely off the subject I know, but as this thread seems to have fulfilled it's purpose I thought it might not be a terrible sin to throw this out there, for what it's worth... Have a great day all. Dwayne

The calcium made her blood hypertonic. That, combined with the several fluid boluses caused the rales. The calcium and albuterol might have been ok without the extra fluid, but with it I think it was asking for trouble. Assuming we've quieted her hinky rhythm, we'll now need to try and un-drown her... That's my story and I'm sticking to it...(Unless it's wrong, then I'm going to blame someone) Edit: Ooops...I missed the part where she's dead.

Yeah, the medic was certainly talking out his rear. There are many different kinds of pacemakers, but there must still be perfusion, acceptable electrolyte conditions, room for the heart to beat, and on and on. To say that you don't need to know (not you of course, but a general 'you') what the heart is doing because "if they have a pacemaker the heart must be working fine" is insane. If you're portraying this medics comments accurately, go to any beginner EKG site and within two hours you will be able to give him/her a clinic on cardiology. Great question. Dwayne

Of course Doc...I count on it! Also, I think we're going to add renal failure to this ladies list of ailments. I haven't worked out all the 'whys' yet, but I'm going to take a shot after work if someone else hasn't beat me to it. I want to try and figure out as many of the angles as I can, instead of simply the treatment...which I think (though am not sure) is pretty standard. Thanks for taking the time to do this for us Doc. Have a great day! Dwayne

I can't really explain how it works in the other medical fields. I know in my college the nursing students have a "professional" dress code, which they seem to enforce, as the nurses tend to look sharp and professional. I'm not even sure that the paramilitary style teaching is the best way. I do believe it is a good way. Assuming that we're often reminded that it's 'para'military, and not military. Whoever said it before me...they have different central goals, though many of the behaviors are in common. Professionalism is a partially a habit. Have you ever noticed that you can tell the kid that just got a new office job? You can spot him at the market, the post office, on the street. Even if his suit is well taylored and he's clean shaven. He the one that still looks like he's running around naked despite his great clothes. He hasn't had a chance to grow into them yet and feel comfortable. Dressing in a suit every day, pressed and clean, is a habit. It needs to be learned and practiced before one becomes comfortable with it. That is my point with many of these kids. Pressing your clothes, shaving daily, being prompt, being respectful. Some are things you can pull out of your butt when you need them, but mostly they are habitual. The students I've been exposed to, males more so than females, don't seem to have had a chance to model this behavior effectively, or if they have, have not become comfortable with it. Doing these things once or twice isn't enough. It must be reinforced (which it certainly will be in a professional environment) before it is something that they desire and seek to continue on their own. Giving them an environment where they are faced daily with that positive reinforcement seem like a good thing. If we were training young men, as was the case not so long ago, that were coming straight from military service, then perhaps these are wasted steps. The are proud of their appearance, their work ethic, and their committment to 'team'. (My experience again) When we have a generation of kids that didn't have that vehicle to help define their self respect/esteem and the behaviors that accompany that attitude, why would we choose not to supply it if we're able to? Dwayne

It seems simple and flexible enough, though I , in know way believe I'm smart enough to figure out every possible angle. 200# pt. 200 – right hand 0 = 20 20 – 2 = 18gtts/min at standard concentration/drip set for 5 mcg/kg/min So 3.5 gtts/min = 1mcg/kg/min (approx.), which makes the math easy for adjusting your dosage up or down in 1mcg/kg/min increments. Right? It seems like an acceptable level or error considering the lack of accuracy inherent to manually set drip rates to begin with...(guestimated weight + non perfect drip rate + plus moving ambulance). Understand, this is not meant to argue for this shortcut, but to show line of thought, in case I'm off in the ditch somewhere.... Jake, when I played with this, is seems that this gives you the same info as the clock, it's simply easier to remember, for me anyway. Do you not find this to be true? Thoughts? Dwayne

This is assuming you want to give 10mcg/kg/min from a concentration of 1600 mcg/ml using a microdrip chamber. The shortcut you listed is in our protocols though slightly different. Take weight in pounds, subtract 2 from the first two numbers, (100th and 10th places), and that will give you your drip rate for 5mcg/kg/min from a concentration of 1600 mcg/ml using a microdrip chamber. The the rate can then be easily/logically adjusted up or down for differing dosage ranges. It's easy to remember and I've worked a few dozen problems for comparison long hand and can't find any obvious holes in it. Good point to bring up though... Dwayne

I find this pretty interesting. I don't see where these classes can be a bad thing, and I'm not saying anyone is claiming that. Yet a common complaint on the forums about EMS is the poor expression of professionalism. Shirts untucked, slovenly appearance, lack of responsibility. Yet in the programs that don't allow that conduct, they seem to be viewed, nearly across the board as (my words of course), restrictive. You seem shocked that the door was locked 5 minutes prior to class. Isn't promptness a large part of professionalism? Is there some benefit that I'm missing to students being allowed to disrupt class with their tardiness? We had one lady in my medic class that came to class 20-30 minutes late every day. This frustrated the hell out of me! She would pretend to skulk into class, as if she didn't want to be a bother, all the time making sure to draw maximum attention to herself. I would have locked her out. Perhaps there's something about 'free' thinking, non conformity, that makes for better learning. I'm being serious, this topic is truly confusing to me. As well, you all seem to see a different version of 'student' than I've been exposed to. My experience is limited of course. Four campuses at two different community colleges, all in two towns of approx. 35-45,000 people. But it's uncommon for the kids (they are almost all kids) to come to class to learn. On my first day of physiology, after going over the class schedule, the teacher asked for questions. One cute little girl in the class asked “Why do women curl their toes when they have an orgasm?” (Not a bad question perhaps if asked in sincerity while studying the nervous system). Another asked, at a different time, “Is it true that if you put your finger up a man's butt and push on his prostate you can make him cum immediately?” Again, not a terrible question if asked appropriately, but not the kind of questions serious students ask for it's “shock” value. Also, and I'm guessing of course, but perhaps med students have more invested in their education, thus are more able to police their own behavior. My prerequisites seem to have been seen as classes needed to “get passed” instead of be immersed in, for many/most of the students. I was considered some kind or relic because I had to pay for my classes. I'm not sure I went to school with more than, say 5% of my classmates that had a financial commitment to their education. Could this be a difference in medic and pre-med students? The school from the above video, though showing much more PT than was required of us, was a pretty fair representation of my basic class. Again, I wouldn't take that route again at my age. But I didn't hate it. It was easily the most didactically focused class I've taken since returning to college. Isn't that a good thing? The flip side. Assuming that the class allows for free thinking, why would you not want to see the medic showing up in the ambulance called by your family to have been to such a program? What is it about the flip flops and hole filled jeans that would create a better educated, more professional medic. If you had no information about a person that was to care for your family other than the video shown above, or a premed class video(exaggerating to make the point) with unshaven, barefoot, wrinkled clothes students, and you had to choose simply from the videos, is there something about the med class that would cause you to choose them? I mean the above comments in all sincerity. I truly would have expected more “That is what EMS needs! Responsibility, discipline, and a commitment to professionalism.” comments. I'm curious as to what I'm missing? Dwayne

Great point...

Yeah, but I'm thinking we grew up in a different culture than these kids. As you've mentioned in another post (I think), it didn't even cause a blip on the radar to have my shotgun on the rack of my pickup at school. But I wouldn't be comfortable with that happening at my local schools now. Zero tolerance means exactly that. A felony for a ten year old? Of course that's ludicrous. Arrest? idiotic. I certainly think action should be taken, though, as she is ten. She needs to understand that some rules just need to be followed. I also think that a history of bringing a knife to school needs to be addressed. (I would love to see the knife. That would make a difference to me. Is it one of the round tipped, saw blade steak knifes? Or a 12 inch razor edged butcher knife.( I don't really expect the press to make the distinction) I would think there is a huge difference in the mind set of this child between the two). Also, how does this get by the parents? I know everything that's in my boy's backpack every day. (Though perhaps it's different with normally developing kids. I'm not sure at what level of autonomy they operate at at that age.) I saw an article (I can't remember where now) about one state having something like 2-3% of their kids,(Pulling the numbers out of the air) it seems like they were somewhere around 5-6 y/o, that had been suspended for sex crimes! This is that same type of simple minded, "I must be a very good person, because look how offended I am at such a small thing!", mentality that warps these children's sense of ralativity across different offenses/reactions. What I hate more than the ignorance of the adults in this scenario, is the effect this will have on the little girl. Tell kids they're bad, tell them that they're criminals or morally corrupt, and they'll believe you. We shouldn't then be surprised that they behave within the scope of the damaged persona we've provided for them. Have a great day all. Dwayne

I went to basic like this... Dress inspections at the beginning of every class, squads, squad leaders, pt, no facial hair, etc. If you showed up to class without a stethoscope, watch and BP cuff, you were sent home. If you got sent home twice, you were dropped. Doors locked 5 mins prior to class. If you weren't in your seat at that time you stayed outside until the break and met with the instructor to request permission to come back to class. You were expected to be a representative of your program and EMS in general, any time you could be identified as such. While in uniform, on or off campus, there was no alchohol or tabacco use of any kind. If you were seen to be smoking while in uniform, it cost you a day at home. As above, two days missed and you were dropped. It did much I think to instill pride and professionalism not only in appearance, but in attitude in all things concerning EMS. It all felt a little surreal to me though, as I was older. I wear clean cloths, shave and shower before each class...but much of the class was kids. The way they showed up for orientation was amazing. Dirty, noisy, laying on tables, wrestling and playing grab ass...Yet they didn't leave the class this way. The structure was very good for most I think, as well as creating a perfect environment for the serious students to learn in. I would have liked to have seen some components of this integrated into my medic class. Would I choose that type of environment again? No. Too much time spent on behavior modification (Which I felt was mostly wasted on me) that could have been spent on didactics. Do I think it's a great way to initiate 'most' younger people into the field? Definitely Dwayne (Sorry for the huge spacing in this post, it doesn't show up that way until I post...I'm not sure how to fix it)

You know, I knew I was leaving my pee pee out to get slapped with this question (Sorry, old Cheech and Chong reference), as it certainly doesn't appear indicated here. But with only 150 calls or so that I've teched, I've discovered that even perfectly logical people can make illogical choices when they start to feel hinky. We had a lady with uncontrollable n/v post knee replacement x 3 weeks. She had been doing fine on her pain meds (I can't remember now what flavor) initially, yet after about week two she started to feel sick when taking them. She decided that perhaps she was getting used to them, thus needed higher doses to overcome the n/v associated her new tolerance. So she started taking them more often, got sicker, took them more often still to overcome the increasing n/v, until she called EMS. A beautiful, smart, intelligent 65ish y/o lady...yet this made perfect sense to her. I'm just saying... :wink: I agree that 2L is ok here as well...It's for psychological comfort at this point anyway. And yes, I'd like to attach the monitor. (everyone's a comedian) Thanks for the scenario doc! Dwayne

General impression? (Sitting, laying, Skin condition, emotional state?) Mental status? Is she compliant with her meds? Has she taken any nitro? When, how many? Vitals, including lung sounds, SPO2, BGL? While that's working let's put her on O2 titrating SPO2 to mid-high 90s, and get the monitor set up and attached. I'll leave it at that for my turn... Dwayne

I'm not completly clear on your question... Are you asking if that is good advice? It is. Or are you asking why that advice is given? The glucose that you give will quickly be metabolized and they will be calling you back for the same issue soon. If the patient is not being transported, they should be advised to eat something with some protein, which takes the body longer to break down into glucose. You can think of the protein as 'time release' glucose. This is bad advice to give to someone that doesn't have anyone to care for them, or if that care is unreliable as not eating properly is what got them here in the first place. Assuming they will suddenly begin to do so when you're gone is not a good bet. Transport is much better. Advising them to eat protein is good. Waiting until you see them eat the protein will keep you from running on the same person again in a few hours. Others will most likely give more thorough answers, but that's it in a nutshell. Dwayne

Hey all, I'm months away from finishing my clinicals and being able to test for medic, but something occurred to me this morning in the shower. What drugs are covered on the NR written? I'm pretty comfortable with the 25-30 that are used locally, (I can list them if it will make things easier) but I see many from around the country posted on these forums that I don't recognize, or if I recognize the name, have encountered them in passing and certainly would not be prepared to test on them. Are drugs a significant part of the NR written? And if so, is there a list that I can access to let me know what to expect? The NR doesn't really concern me in general. I haven't found the testing at any point on the EMS path to be overly aggressive, I'm just attempting to avoid that "Oh Shit!" moment when I realize I neglected something that should have been obvious, while I still have a few months to prepare. Thanks to those of you that can help! Have a great day! Dwayne

http://www.nothingtoxic.com/media/11976005...njured_Patients I don't even want to think about it... Dwayne

I guess most of us know I don't have an EMS employer... But if I did! I'd pay (In all sincerity): $500,000.00 as a consulting fee to Jack Welch (former CEO of GE) to revamp the organization. $500,000.00 to spend in any way he chooses. Dwayne

As you asked before, I'll ask now, that you have faith my questions are genuine and not meant to be antagonistic. I don't see the underfunding in fire. I see fancy trucks, huge fire houses, new, first rate equipment, for a group of well paid men and women that are rarely (in most places, certainly not all) called on to perform the duties they are trained for. Where would I notice the underfunding for fire? None of these things have I regularly seen in EMS. How so? If six firement with basic training are good enough for my wife and child when they need ALS interventions, why is an ambulance with a fire extinguisher not good enough to save your house? After all, we're talking about my family's life, and just your house. Which is more important? I don't get it. Not exactly the same quote, but you have to admit more or less in the same dramatic vein? I don't really, I think I explained my experience with fire based EMS students, but I don't have the experience to pass judgement on the profession as a whole. Again, I've know perhaps...a dozen firemen personally. About half were truly inspiring, the other half just macho knuckle draggers. I'm neutral on firemen in general. What confuses me is this. The odds are overwhelming that if my family has an emergency it will be medical or trauma and not fire related. So when my son has a seizure, or my wife suffers from a tension pneumo or ecclampsia or I have an MI, why is it so hard to understand that I'd rather have two...or God forbid, four medics show up instead of six firemen trained to the BLS level? We can have the former for less money than the latter. We have I think...eight fire houses in my town, yet at any given time there are two medics on duty in two ambulances. How does that make sense? Wouldn't the money be better spent to add ambulances and medics, while subtracting firemen (that are rarely used for their stated purpose) assuming that the funding is unmovable, when we have the certain knowledge that medicals are going to outnumber fires approx. 10/1? How do we justify the latter, which mostly involves loss of property while allowing the former, when we know that it involves mostly loss of life/limb? Fair question. None really. Two years as a Hotshot when in my twenties, in Santa Barbara County in fact! That's where I got my first bad taste of engine crews...I can tell you why another time if you want(We called them 'engine slugs'), though I've grown up a bit since then and started thinking for myself. Now it's more a practical matter for me. What's best for my family, my community, and EMS as a profession. Also, I think you and I might have met. I went through the AHC basic program when it was still an academy. I'm not trying to put you on the spot if perhaps it was a differnt person, I just thought I'd mention it. (You'd remember...I was the only old, fat, dumb, homely guy within ahout a six year stretch I think!) Hopefully it's obvious now that I'm passionate about this subject, but ignorant in many ways as well. I've seen it from the outside looking in, so I know there is a lot I'm missing. That's why it's so cool to have you here. Thanks for taking the time to stay invested in this conversation! Pretty cool. Have a great day! Dwayne Edited for phrasing that might have been misunderstood to be insulting. No change in the message context. Ok, fine. Edited about 30 more times because I pasted in an old edit without noticing 'till later...Still nothing that should cause anyone issues if they posted after my original post. No major messege or context changes. To Whom It May Concern: Evidently brandy and 8,000 word posts don't mix. Please post responsibly.