DwayneEMTP

Ooops. Back on topic. Thank your all for your advice. I can't take the "looks" , criticisms, and personal uncertainties as long as I know I'm on the right track to doing good medicine. So I will continue to do what feels right for my assessments. And will continue to treat horses, yet watch closely for zebras while I wait for my own 'gut' instincts to develop and mature. Thanks again. Dwayne

What a gift you all are. I agree that if I fail, she fails as a teacher as well, though now that it's become obvious teaching is not her main motivation I'm committed to making the most out of the experience with the tools I have available. Being exposed to you guys, with your expectations, it just came as a shock to find that many of of the professionals I've been exposed to seem to fall short of a professional standard. I didn't expect that attempting to be an ambassador of your attitudes would put me in a minority. ER docs seem to be a glaring exception. They seem to love to teach, and truly seem to rejoice in the intelligence of those around them, be it nurses, other docs, or the lowly medic student. One of the high points of my rotation so far followed us bringing in a CHF pt having an MI (undiagnosed in the field) that they decided to RSI. While waiting the few seconds for the paralytics to take effect, with the RT standing by, the Dr. says “Hey, hotshot medic student, what does PEEP stand for?” Though it seemed a simple question, when given the correct answer he, the RT and several nurses started to laugh and applaud! It wasn't until that moment that I realize how much the constant nagging, insulting and effort to find error where it might or might not exist was taking a toll on my attitude and self confidence. It forced me to the conclusion that it was time to choose my own path on this clinical instead of continuing to hope that things would work out. In that one 'teaching moment' the Dr. reminded me that learning is about celebrating small successes and improvement, that learning is, or at least should be a positive, building endeavor, not one of fear. My reason for telling that story (obviously knowing what PEEP stands for is no great accomplishment) is to try and explain why you all are so important to those of us trying to find our way. I wonder sometimes if you know how important it is for us to have a place to come where it's understood that sometimes we just need the truth! Thank you for making me see that I'm being an idiot, or not. That things were unfair, or that I was simply whining. That I might be good, but I can be better, and this is how. That's such a gift. I know you have better things to do with your time, but this time WILL change the future of EMS...It changed my path, and continues to throw flares along my future path that I don't have the experience to see, but need to find, to end up where I'd like to be. A peer. I'm just an old, fat, not so bright medic student. Why do Dr.s and nurses and medics smarter than I ever hope to be take time to care about that? I don't know...but I'm grateful. Ok, I always feel like a dork when I write these things, and I know it has nothing to do with the topic, but I'd hate to go out today and get hit by a bus and have it left unsaid. Thanks for all that you do for us here. Dwayne

See, I knew you wouldn't answer my previous questions...they seem like such obvious questions to me, but no one ever answers them when involved in this debate. I'm afraid I can't offer scientific evidence in response to your question, only anecdotal, so you'll have to take it for what it's worth based on your impression of my honesty and ability to accurately report it. As an animal trainer for more than 20 years, I can tell you that I have seen what appears to be homosexual behavior in nearly all species I've been around. Mostly my experience has involved cows, horses, and dogs, but I've had contact with several dozen different species as a trainer. I say 'appears' as I'm not sure exactly how to define homosexual behavior, where it begins and where it ends. But speak with any professional involved with the animal husbandry program in high dollar livestock and they'll tell you (again, at least I've never spoken to one that hasn't) that dealing with sires that will only mount same sex animals is an issue. And in “most” cases, it is not simply sexual behavior, their pack and/or herd mentality 'seems' to be slanted that way as well. Same issue if you're dealing with horses, cows, dogs, pigs...you get my point I'm sure. Did these animals choose to only desire same sex partners, or was it hardwired into them? If you say they chose, you will be at odds with the vast majority of main stream behaviorists in believing that animals possess this type of abstract thought. I'm not claiming this as proof of course, simply evidence to be considered while pondering the issue. Also, training Arabian horses brings one into contact with many, many gays and lesbians, in fact, in the Arabian horse world I may have been the only straight trainer I knew of. Over the course of my career I've simply asked this question...of perhaps 30 people in the last 20 years and without exception the individuals asked did not believe that they had made an orientation choice. Many, if not most (I'm not pretending to remember each conversation) knew of lost souls that would spend time pretending to be gay, but claimed that they seldom stayed with the lifestyle as they were looking for something that couldn't be found by this means. And these are not the 'parade' gays. These were discrete professionals. Of course, most that I've met that believe that homosexual sex was “aberrant and sinful” seem to also believe that you can't possibly take a gay's word for how they feel or why they do what they do. Anyway, take it for what it's worth. I don't have a dog in the 'gay fight', I just like the argument. I was blessed to be born heterosexual, my lifestyle is accepted and easy...no one wants to beat me up, deny me work or housing, they don't believe I have a tendency to molest children, when I kiss my mate or hold her hand, no one (or at least most I'm hoping) don't find that disgusting, or jump to any other ignorant conclusions about what my sexuality says about my character. One more time, just so I can say I did...Did you choose to be heterosexual? And if you were convinced that being gay was hard wired, would it change your feelings about these issues? Have a great day Captain. Dwayne

Capisce.

Captain, I'd like to direct a couple of questions to you..for three reasons... One: You've proven yourself to be intelligent, and an asset to the City. Two: You have an avatar from one of the top couple of westerns ever made. Three: We're old enough to remember group showers...not Dustdevil old, thank goodness, but old enough. If gays, as a rule, chose to be gay, shouldn't there have been a time when we chose to be straight? I mean, was there a time after gym when you were younger, when showering with all the other boys, that you thought " WOW! Look at all those yummy penises! I'd sure like to have a go at one of them! But hell...I should probably go for a vagina instead...it just seems right." Did you hit a point where said "ok...boobs...penis...boobs...penis...How will I ever decide?!" And if you didn't have to decide, why do you believe others did? Second: If it was proven to you tomorrow, to your satisfaction, beyond any shadow of a doubt, that gays were born gay, would it change your feeling on this issue? No one has ever answered these questions...Though I'd love for them too...I don't know the right answers, only those that are right for me. But I am interested in your thoughts. Thanks for your contributions to the City, and I hope you'll take this post in the spirit intended, that of truly understanding another's point of view. Have a great day! Dwayne

Happy birthday old man...you're a gift to the City. I hope tonight finds you tipsy, naked, and feeling about 20 again! (you do remember 20 don't you? Oh hell, forget it then) Dwayne

Thanks Mike. Not an AMR school, it's a degree program. And I can ride with AMR or with fire, though rumor has it that fire doesn't care for ride alongs that aren't applying or currently employed with fire. I may ride one phase there, as they control the EMS in the Springs (fire controls the scene until released to the privates for transport, should they choose not to ride with the transport), where I'll likely be employed after graduation. I might as well see how they think. The ice queen is the only thing standing between me and my AAS in emergency medicine, so she's got to be dealt with. Like I said, I'm not intimidated by her, but by her motivation to help me fail, as it reinforces her opinion that 'people like me' don't belong as medics. By not having street experience I give her a lot of latitude to steer me wrong, or make me look foolish to my peers, so I'm ever vigilant for signs of that. I'm just not that good at it... For example, she claims that I gave her two different, incorrect, BPs on one patient (I'm convinced that I didn't) so on the next call she pushed fire aside and told them to let me take the BP as "He likes to make his vitals up! Anyone else need their BP taken?" Which of course caused a lot of laughter and scornful looks...She thinks that's pretty funny, I think it will take me a long, long time, with those guys seeing me do all the right things before they'll forget that. But having no street experience, I don't really know what plays, and what doesn't. I was afraid of being good at medicine, it appears I should have taken a few courses in politics as well. My ace in the hole? The same thing that convinced me to get a degree instead of a certificate...all of you guys. So for now, I'll ask your indulgence, and continue to bring my questions here. As silly as is sounds perhaps, it is truly huge to have access to a "no bullshit" zone. There is so much more to figure out than I'd ever imagined, pretty cool to have you guys to watch my back. I have no issues being wrong...I just hate staying wrong. That's where a good preceptor could help...I guess I'll ride this phase with you guys. Thanks again all. Dwayne

He's a she. Yeah, it's an ugly situation. And she just got a new basic partner, the only other person on the schools "don't precept with" list...lucky huh? This chick is AMR's Medic of The Year, she told them not to let me switch schedules, and they won't. I was amazed. She's already made it clear that she won't pass me through phase one if I don't complete phase three requirements, and she hates basic to medic students. When I called my school and said "When did she get put in charge of me clinical education?!" They said "Well, she's not. But if you choose not to ride with her AMR will not let you precept with them any longer." So, though it's far from optimal, it is what it is. It's just hard sometimes when I'm not sure what's best, to know that no matter what I choose, I'll never know if it was appropriate, efficient or correct, because each thing I do MUST become a lesson on "Why you should have never been allowed to become a paramedic." Anyway, it's wasn't my intention to cry about her...Hell, I'm 44 years old, have a 10 year old autistic son, and my favorite niece was recently diagnosed with a brain tumor with 80% mortality at two years...her being a bitch doesn't even cause a blip on the radar... Do I feel I have the mentality to be a good paramedic? Yes. Do I feel that I have the theoretic knowledge to become a good paramedic? Yes, if I can put it all together. Do I feel I can put it all together in the field by myself? Man...I'm not sure...but it seems like a mountain to climb... So for now I'll keep watching for zebras...and take your guy's word that little by little they will begin to look like horses... :wink: Thanks all. Dwayne

Deciding that a horse is just a horse... You know, I'm into my phase one clinicals and I think the most difficult thing for me is deciding that sometimes a horse is just a horse...when I've spent the last two years (nearly) learning to look for zebras. In medic school there were no horses. Every scenario (more or less) has someone looking pretty good that ends up dead, or looking pretty much dead and ending up smiling and happy. See...No horses, all zebras. Now that I've 80 or so patients on the streets, all I seem to see are horses, that I'm trying to turn into zebras. AHA! Gunshot victim! Horse. Chest pain! Horse. Two year old difficulty breathing! Horse. In each of these cases, I pulled out my paint can and tried everything I could to find the 'zebra within', but simply ended up looking like an ass to those around me. I did get some kudos from the ER doc for my reasoning a couple of times,...And was surprised how good that can feel.. I don't think I'm attempting brain surgery on hangnails. It just seems that everyone around me knows that there's 'nothing to see here', where I was taught there are possibilities for bad outcomes if not caught early, so I better watch for them! I'm hoping that seeing some more patients, and observing others will help find a happy medium...but man...at times I think it's time to head back and see if they have any room in the upcoming basic class. For instance...91 y/o female, confused, no s/s of acute neurologic event, got her car stuck on the median going the wrong direction, she believes it's 2230 and she just left a friend's house, it's actually 0240...I put on the pulse ox along with a full set of vitals. Afterwards was reprimanded by the medic “She's just a little confused, why do you want to cost her another $75.00 for the SPO2 when she didn't need it? All she needed was transport, if you weren't a student you would have cost her several hundred extra dollars with all your screwing around!” I guess I was looking for zebras. I'm not sure, though even now it seems logical...clinicals are making every thing much more murky instead of clearing them up...though perhaps that's how it's supposed to be. Did I just go off into the ditch somewhere? Is this mentally where I belong at this stage? I don't know. I believe much of this will resolve with experience, but I'm not sure that good medicine is what I'm being exposed to now...I don't want to 'experience' myself away from the education I've fought so hard for. Know what I mean? I don't want to mimic the experienced folks, only to find they really aren't that good... Well, I guess, after typing this, I'm not sure even what my question is. I'm just hoping someone will recognize this rambling as s/s of something more logical than how it feels at the moment. Have a great day all. Dwayne

Chbare and the two Docs make incredible scenarios, always difficult, but relevant but it's often for nothing as very few participate...Pretty cool chbare got so many people!!! Any chance to get you guys to post regular if we promise to come and play? I think this thread made me review about 6 months of A&P and 4 months of medic school in two days...Pretty cool...

Yikes. If you don't like the cartoon, don't read the disclaimer... Pretty bad taste all in all...

Looking through JEMS this month, which I'm coming to believe may be been one of the more obvious wastes of mony I've spent in EMS, and notice that it should make many basics very happy! (Yeah, I'm a basic as well, so don't get your panties in a bunch) Is it just me, or is the whole magazine this month (more or less) about 'advancing EMS' by giving basics more responsibility? More drugs, more skills...Man...Maybe I'm just tired...

You know what is completely stupid? I read that and thought "Hell, he usually has great posts, I'll bet he's right. It pisses me off that he cheated me out of tracking it down on my own!" My next thought...."Ok...syphillis...what is the physiology of syphillis getting to the lungs...??" Sorry akroeze...Lately I'm having trouble keeping all my plates spinning, and it's evidently got me a little grumpy, I should have thought it through before acting like an ass. Dwayne

If you're right, what's the point? If you're wrong, what's the point? See what I mean? We can use some good scenarios... If you're not in the mood to contribute, why the need to pollute it for the rest...? Be back in a bit chbare...thanks for taking the time to do this! Dwayne

LOC? General appearance? Breathing rate, quality? Quality of pain?

I don't believe he's saying that your're less that 'anyone' that went through, only that, point for point, when attempting to create a competent emergency diagnostician and care provider, the nine month graduate will consitently fall short of that goal when compared to the graduate with a 2 year degree. That seems logical doesn't it? (I hope to Christ he's right...I'll tell you that....) Dwayne

After all, we can see how well that worked for blacks and women... I can't reconcile this logic with most of the intellingent things that you post. Nothing significant changes without noise...and the pendulum always swings back to center..Way to the left perhaps, and then way to the right, but it eventually settles down to the middle. And for me, and the world I want my son to grow up in, I think that's a good thing. Do I like the parades? I hate them, I simply feel they're necessary. This too shall pass. Dwayne

I've thought through the A&P as well, and I guess I'm in the same boat as Captain...(if I understand him correctly) I can't see, even on a long transport, what information can be gleened from a digital inspection...but not a visual one..that is going to cause you to stop the ambulance and wait for an empending delivery. I'm not saying you couldn't gain anything...I just can't think of anything that tips the Cost/benefit scale in the 'digital' direction. As to the value in the hospital? I don't know, I'm sure there's plenty, but the only thing I've seen it used for? CYA when having to defend yourself against the Dr. who's pissed that you got him to the hospital before the head was crowning... I look forward to this discussion!! Have a great day all... Dwayne

Read the whole thing Hotshot... I still don't see the difference. I had to get a preceptor review for every patient contact, as well as create a PCR for each... I didn't say preceptorship was centered on skills, I was trying to say that not fulfilling the necessary skills could hold you in precptorship. Big difference. It seems to me...upon my SECOND reading..that you were saying the same thing.. My current preceptor is or seems to be the exception, though I've decided not to allow that track to continue so the point is moot. Perhaps you could do this simple, feeble minded old fool the favor of highlighting the part that I misunderstood? Have a good night sport... Dwayne NOTE: Yeppers, third time through. I usually respect your posts, yet can't find an inkling of what got your panties in a bunch...Point for point it sounds like my clinicals...You're going to have to help me out.

And lastly I would add... Go and stand on the very edge of the Grand Canyon... Notice how in one moment you can feel completely alive, in awe, totally fullfilled.....while suddenly realizing you are not the most important thing in the universe...and that makes you happy. That's what if feels like to share your life with a child, and why all that other stuff is unimportant...

UMSTUDENT, I think I'm missing the part that is different... Except for doing 'air' clinicals it sounds about the same as ours...We'll log a minimum of 800 clinical hours, or more depending on getting skills accomplished during preceptorship... Are other school's clinicals set up so much differently?

Yeah, I got you Jake. That's one of the reasons I avoid the springs. Fire controls the patients until released for transport to the private company.(We ride with AMR)..I guess it often gets very uncomfortable trying to get the private students skills, as they want the fire students to get theirs first... Yeah, only so many fish in the sea...I've heard horror stories about trying to complete clinicals...I'm keeping my fingers crossed.

Yeah, I was taught, I don't know about protocols, that nothing goes inside the vagina except to release tension on a prolapsed cord, or clear the front of the face of a baby born upside down. What would knowing dilation change about your prehospital care? Having delivered so many babies I'm guessing you know that 5cm in one woman might mean 6 hours where it could men 10 minutes in the next... I'm not criticizing your question, I just don't see where adding additional risk of infection to an already unsterile environment would pay any real dividends in this situation. It's just too unreliable an indicator where time is concerned.

Can you actually get into medic school with basic only? That would suck big time...A year, or perhaps at minimum, two semesters of A&P would be great.. Of course you'd have at least a year by the time you had the prereqs for those classes.... Well.... Ok...as becksdad once said...never mind. I'm not sure what my point was... Dwayne

I ride 3/12s per week, the maximum they'll allow if you have a job, so with drive time I have about 42-45 hours invested per week...and I'll tell you, it's tough! We have a 500 hr minimum, plus required skills, as spenac said. Ideally, the time is supposed to be done in four phases, with a different preceptor each phase, and as we have Pueblo and Colorado Springs to choose from, there are plenty of preceptors on varied schedules. I'm trying to do my early clinicals in Pueblo, as it's closer, about an hour as opposed to an hour-twenty. But also because fire controls the patients in the Springs...I want to get a few calls under my belt before I get involved in the whole Private v. Fire fiasco. I guess when I questioned the hours I was assuming the 500 hrs. are an NR requirement, instead of a school requirement. I think spenac has a good point, pass based on objective/subjective criteria as opposed to time...but then again, that would require educated, competent preceptors that are able to be fair and goal oriented. They would also need to be held accountable for their students, not just negatively, but positively as well. This seems like a no-brainer to me. Cull preceptors based on the quality of student they produce. Turning out high quality students, with a good attitude and work ethic isn't rocket science...though it certainly is science. Make substantial monetary rewards for objective criteria that would be within the scope of the preceptor to shape...Appearance, promptness, accuracy of reports, sick days taken in first 6 months (as it's based on attitude)...these are not difficult to track, they save the employer money, and has the effect of each generation of preceptor being stronger, more positive, and more fiscally productive than the one before...everyone moves forward. Still, I guess I won't hold my breath. Dwayne