DwayneEMTP

It's not your best goal, depending on where you are in your training maybe, to decide the best place to place your SAMPLE history in relation to your physical exam specifically. What was the scenario specifically? A hypoglycemic that was altered enough to crash his car, yet still lucid enough to give a relevant history? Pretty unlikely. Or an accident caused by other means where the patient just happened to be having a hypoglycemic episode? Something else? Diagnosis IS history taking. Truly. But what order that that history/assessment comes in depends on the the patient. Let's say that instead of this patient that you have an MVC, minor fender bender, pt unrestrained, complaining of crushing chest pain, diaphoretic, diff breathing. Would you want to extricate the patient and do a full physical examination before focusing on the chest pain and previous medical history, particualrly cardiac? No, right? I'm truly not trying to bust your chops, but instead warning of many if not most students desire to have a structure to follow for every/most patients, and that's not really a good idea in most cases, in my opinion. On every case you're trying to solve a puzzle. The puzzle involves the patient presentation, physiological/anatomical markers, previous pertinent medical history, history of current incident, etc. Which one of these things should be examined first? Would you choose to ignore the big sunflower in the middle, for which you can find all the pieces quickly, and instead build the edges of the puzzle because that's just the way that you always do it? Hopefully not in medicine... I certainly can't say that you're incorrect in your thinking, but I do worry that you force yourself down certain paths when you try and decide which thing is "right" to do first...Highest probability for mortality/morbidity first, then work your way down the list backwards...

Wait, the rest of us were talking about things possible within EMS, what the hell are YOU talking about?? :-) The majority of the shooting cases that they mention, (the ambulances being shot), I'm not sure why they would be examples of reasons to carry a weapon, but can certainly see why they are examples of not carrying them. Would those crews have been better served to stop and return fire in those situations, or continue on, assholes and elbows, and get out of that situation? There is not a single service that I've ever been exposed to, nor ever even heard of, where making this a policy accross the board would be realistic. And I'm confident that any service that tries will soon, within weeks, remove it as it will be misused...Craziness. Plus, what about split priorities? Why are you there? How about public trust? Many are opposed to badges and dark uniforms for this same reason, but guns will somehow be appropriate? Nah...this isn't going to happen in any way that I can see...and I'm glad for that..

I watched a friend, and City member do a field amputation under the eye of an Afganistan experienced Doc...if you can find that elsewhere...well, I'd still go to this one, but good on you. I/Os in every location as often as you want, brain discections, scenarios where you're truly tested and then mentored by a medical school doc, and you even get to see our very own City doc surrounded by amazingly beautiful ladies yet looking like he's not slept in a month...C'mon, just seeing him suffer has got to be worth the cost of admission? Truly, I've never, ever, in a paramedic environment been treated with such respect, and had such clear and vital goals laid out in front of me...I'd gladly pay $400 for this next time I'm available to go....no bullshit... If you can go, you should go. It truly is as simple as that. $40? Are you friggin' kidding me? I put my hands on, intubated, placed I/Os, and discected a ton of cadavers. This Lab is a gift. Dwayne

Yeah, I went from EMTB to ASA Paramedic. It was really tough, but I think it was good. At least if you don't listen to the whackers that tell you that "experience before education is best as it's Cowboy shit that gets you through!" I think I've become a decent medic without having a bunch of experience as a B, but you better have balls, because though you may make it through the didactic, the social pressure will be significant. Brains and then experience, or take the easy road....the choice is yours Brother...

Not sure if you're serious, but if your medic is trusting the "Doc in the box" then you need to run way...very far away. If I had a nickle for every time I've disagreed with the "Box" or the fewer times I've been humiliated for believing "Him/her", well, I'd still be poor, but am, hopefully much wiser...nickle speaking....

Dylan is nearly the largest single fund raiser in Colorado Springs....That is cool as hell. The vast majority of that money has come from just a few medics that I've never met face to face, but will never forget. But I will someday thank in person...I promise that. If you don't have a handicapped child then I have no idea if you can understand what it means for "the world" to speak to him and in essence say, "Don't worry little Brother. We've got you. Not matter what happens." It's life changing for me and my family. Thank you all...standing up for autism, and just as important, my little man...well, I'm not sure what to say about that...Thank you. ArticKat has been the largest single contributor. But the love felt in each contribution is not lost on my family....I'm not sure if I can convince you of the truth of that or not, but I hope that I can. Dwayne

A lot of the comments are asking why it's appropriate for this charge to be brought 13 months after the incident.... My guess would be that some pictures have unexpectedly turned up....

If you want, send me what you know in private, and I'll respond in kind if I can... It can be a complicated process to get through sometimes...though, the good news? It will be much easier when you've finished putting the M.D. behind your name... :-)

But Doc, can the time given to resuc efforts be considered seriously if the reason for the arrest isn't considered? For example, my intuition states, (solid evidence, right?) that many in hospital arrests will be to an end stage pathology, unless those were disallowed in the study. And an end stage pathologies will be all over the map in regards to resuc success or failure it seems? Just out of curiosity, what would your experience say is the the number 1, 2, and 3 reasons for in hospital, witnessed arrests?

I'm guessing that the train only runs once, maybe twice per day. They seemed to have the schedule handled...

Surely an oversight, but no a single mention of the Sherrifs dept threatening to sue the couple for the cost of their rescue. In reference to.. http://htl.li/dvCY6

No, no good energy in that.

That study, if only examining, generally, the parameters listed seems to be a near complete waste of time. What do they consider "survival?" The variables involved in that size of study group concerning terminal pathologies alone would be massive, but the data useless without attempting to identify them and then quantify their effect of the resusc process, right? Though it appears obvious what this study claims to show, I'd be curious if it really shows anything at all.

You know what P/E? It's cool as hell not only to see you as a new member jumping in all over the place, in different types of threads, but also already looking to contribute. It's really good to have you here...

What level of care will you be providing? And what country specifically? There are a ton of variables. The company, the risk factors (violence, malaria, etc), the type of project (mine, oil, gas, direct hire/subcontractor.) For instance I make approximately 20k/year more at my current gig than I did in Mongolia based on the tribal issues and malaria threat here that didn't exist there. And you'll need to decide how much risk you're willing to accept for the pay. The project that I'm going to this month was just shut down while an investigation is completed because an expat was attacked by some local nationals. I'm ok with that, as each time that I've seen this situation in the past it appeared to me that the expat called the ill will down upon himself and I don't seem to have such issues. In general you're likely looking at between 50k/80k per year, though of course, that's very general. I'm no expert by any means, but I'll try and help where I can.

Yeah, I'd seen that before, and though I have no idea why, I think it's really cool. Perhaps just respect of a certain kind of human spirit that can take such a thing in stride? Not sure... Why do you think that you like it?

Hey Andrew, welcome to the City!!

A new sound might cause more people to hear it, but would also come with a new, likely years long, learning curve as to what it is and what it means... There is not doubt that a new system is needed. Though I've gotten as frustrated as anyone by people's apparent unwillingness to give way, I'm also continuously shocked when in my POV at how long it takes me to figure out where the siren is coming from when I hear it. Often times I have no idea until I can see the emergency vehicle entering the intersection. But, for now, it's what we've got.

Yeah, unless you're running back to back calls you should have more than enough time and opportunity to pump. Throw a towel over your chest, do your business, and explain to anyone asking what you're doing, well, what you're doing. I'm unaware of any place that might have rules against it, no matter where you chose to pump in this manner. But it's way past time people were mature enough to stop thinking of it as an issue. Particularly in the EMS community, though you'll have requests to watch, it's difficult to imagine any complaints.