DwayneEMTP

I mean this in no way mean spirited, but I wouldn't likely hire you if you explained the above to me. EMS is kind of a sport for leaders, and from what you describe you want to be allowed to be a follower, taken by the hand and led to the place that you want to go. It's not going to work like that Brother. There are 8 million other EMTs looking for that same job, and they want to attack it, get involved, and be given responsibility. There is little hope for someone looking for the opposite to be 'helped' to become competent. You may get hired without experience, but there's very little chance that you will get hired while being timid. You need to get confident, whatever that takes for you, get much more aggressive, or possibly consider that EMS isn't really your deal. Again, all comments meant in the spirit of friendship....Welcome! Dwayne

Good to have you Brother... I'll be more than happy to answer any EMS related question that I can if you'll help out and answer my cooking questions! Welcome...

If you're basking in my jealousy of your chuckle meter then I'm confident that you got a sunburn. I want one so bad!!!

Actually, there is a well documented, huge study done by the United States military who, as you can imagine, was destroying millions of dollars of expired drugs each year. The study was done on 100 drugs that were neither light or temperature sensitive. After 15 years it was found that only a few of them had lost a tiny percentage of potency, and that none had been altered to become dangerous. Now, I'm going from memory and don't remember the source as I looked at skads of stuff, but I believe that the FDA concluded that the drugs from the study, I didn't find a list, should be considered acceptable for use 10 years after date of expiration. That just seems like a really powerful statement to me, coming from the FDA. (For non Americans the Food and Drug Administration is the God of all things that go into your body in the U.S.) Not sure if I've made my point to them or not. But for now a rule has been made for everyone to stay the hell out of my bags... Thanks everyone, for your help!

What the hell is everyone so excited about?? I knew it all along... Congrats man...

Yeah, I'm with Rock and others.... And even if it was inappropriate I'd have been saddened to think that those that loved me would have focused on what is and isn't sensitive and/or politically correct instead of love and laughter and hopefully the few good memories that I left behind.

Thanks guys. Jonas, I found that article, thanks. I pasted it as well as some others into my argument. Chris, yeah, it doesn't sound like an exceptionally safe drug. I've not used it as I only get involved with the most severe malaria cases, to try an verify it's not something else more dangerous that's being confused by local staff as malaria. Thanks Island. According to the above article, and others, the expiration dates are secondary to 'some' drugs losing their potency over time mandating expiration dates to ensure that consumers get 100% of what they purchased. But the length wasn't mandated, so the second reason, and the reason that they are allowed such a short shelf life, is marketing. To get you to destroy them so that you'll buy more.

A case recently came to the attention of, someone, not sure who, but it landed on my desk, where a heavy equipment operator was prescribed Fansidar for his malaria and then sent back to work. They want to know if this was a safe decision. Though it's prescribed here, it's prescribed by the local national staff. I've never prescribed it nor cared for a patient post delivery. Does anyone have any information that I can use to answer this questions? I've Googled, and gone to my fav Drugs.com, but though they explain that it can make you drowsy and/or dizzy, not how severe or common those issues are. I get the feeling that the person asking the question is looking to stomp his feet about it, so I want better information than I've found so far. (Note, he won't be stomping on me. Not my patient, nor my prescription.) Also, I'm currently in a knock down drag out over the use of expired drugs. I was told by my family doctor, who has a related news article hanging in her office, that the vast majority of prescription drugs are good up to 5 years after their expiration date. (expiry, for those on this side of the planet.) I've also been told by a drug rep that in most cases it's the packaging that expires, and not the drugs. Does anyone have sources for this, or arguments supporting this? They want me to remove my expired morphine and valium from my jump bag despite it's being terribly hard to replace here (as it sound is the case nearly everywhere.) I've refused so the Safety manager, who's in charge of the clinic, has told me to validate my position or destroy my drugs... So, as often happens, here I am... Thanks all...

I think that I know the contract that you're speaking of, 3mo/1mo? I'm sorry Brother, I just had a good friend offer me a contract close to that but I had to turn it down because of the schedule, but I really, really wanted to go. If you've got a family, especially kids, and your gig will be outside of the wire, you truly, truly need to consider the danger there. It sounds to me like it's becoming more real all the time, and it wasn't exactly 'touristy' when I was there several years ago. I hope that you'll report back with what you decide...Good luck. Dwayne Edit: It occurrs to me that we don't know each other very well yet so I don't want you to think that I meant to imply that you would be going over doe eyed and 'touristy', only that it wasn't friendly then, and I've heard that it's getting much worse now...

Actually, I've for a long time believed chronic asthma to be in the COPD family as well. But I only came to understand that after having nearly the same conversation with a nurse, only this one was in the ER. What does COPD stand for? What is asthma? Why does chronic asthma not fit?

Keep your chin up Brother, I don't think I've known anyone that was certain that they failed that actually did, especially in so few questions. As always, my money is on you....

It's kind of hard to explain...here is the biggest issue where this is concerned. Most times, based on their cultural difference and expected level of medicine things aren't deemed serious enough to need a medical evaluation. Fainting, car accidents where they 'just have neck and back pain' or an eye swollen closed, no need in the opinion of local staff. Though I have been able to educate a little bit of fear into them I believe. Any time someone calls in an emergency, like recently, a buss roll over, 7 patients, 30 minutes down the road. Security is sent to make sure that there is actually an emergency. Yeah, 30 minute delay before the possibility of my being dispatched. If they believe that there is an emergency, then they call in. To the Safety supervisor. On the rare occasions that they do call it in, they call into the Safety supervisor, who then decides if it needs medical attention. His answer is almost always no, as he's afraid that he's going to send me and my ambulance out to work on a local national at the exact moment that an expat (read 'white person.')might hit the ground. And he'd rather allow others to suffer than chance having to explain that. If he finds that the situation is emergent enough that he can't find a way to ignore it and cover his ass at the same time, then he gets the advice of a local national nurse. Their level of training is well below what you would normally expect of a competent EMTBasic. They will listen to the symptoms, but still without calling me most times, as calling me admits that they need my help and they are really opposed to doing that if they can help it. If they hear the s/s and can't ignore it and cover their ass at the same time, then they call me via pager, cell, or radio and tell me that "I'm needed at the clinic for a consult." Sometimes that means a very ill clinical patient, or other times it means a critically injured patient out on the road that they'd like me to speak to on the phone to determine whether or not I believe they need an ambulance or if Security can just drive them in. Yeah, see? It's a mess. But to fix it you have to find some way of doing so that allows each level of bullshit to pretend that they aren't adding bullshit to the mix, otherwise I just get shut out completely and they will 'forget' to call me even for emergencies, in fact refuse to work with me on anything. Yeah, I know from experience. So my goal is to create a protocol, that I'm going to do today, that will allow Security, with no medical training to make autonomous decisions on whether or not to call for a 'medical evaluation' (I started out with 'medical assist' but quickly found out that they won't use that as it, once again, implies that they need 'assistance.' As you can see, there is very little logic, and very little accountability in the system. I once stood up in a meeting of managers and yelled, "Ok, enough! Do you see that people are going to die because of this system? Do you see that our PNG brothers and sisters are going to be laying on the side of the road suffering while I sit in my office typing up another stupid report, because of this system???" The response, "This is how it's always been! It's fine! Do not ever mention that at this meeting again!" (You think that I'm aggressive? Papuans when they get all tribal are friggin' aggressive!) So I didn't bring it up at the meeting, but instead brought it up with the Security training coordinator/manager, Safety manager, and the ER coordinator, and came up with this idea. To allow Security to bypass them all together and just call for dispatch for a medical assessment based on certain criteria, which should make them look, and feel powerful (As they get to do so without supervisor approval) and more likely to use it, if I can make it simple enough and get it pushed through. (Yeah, I don't have real high hopes.) Unfortunately they can't call me directly because that will irritate those that have ranks above mine, which in medicine is none, but clerically is many, each demanding to be shown the proper respect by not being left out of the loop. Yeah, its going to create a shit storm, but if I can leave it in place then something good will have happened from my being here... And that's.....the rest of the story..... I'll post when I get something together...

But taking it on an individual basis isn't possible. And are you pretending that you'll be able to spot the more mature ones to hire? The problem that I have with the, "As long as they listen then they're old enough" argument is that it assumes that moving patients and giving the proper treatment is the biggest, most important part of what's done in EMS, and in my opinion it's not. Moral, emotional, psychiatric support is much more important, often creates more significant changes, and is/should be delivered much more often. And that takes maturity. You can't have it all ways. You either have a minimum age where 'most' can be expected to have matured, you continue to let every yahoo on the planet ride an ambulance, or you have no minimum age, but instead have an intelligently developed, verifiable 'maturing' system that all must pass through regardless of age. I don't really see any other options? If we reduce EMS to monkey skills, then sure, anyone at just about any age can do it. But I don't want the 'average' 18/19 year old responsible for Barbara and Dylan while s/he's explaining why they've decided to leave my dead body on the living room floor for the coroner. And that job is also a critically important part of what we do. Until there is a system for verifying the maturity level of a medic, I'd be happy for a 21 year old age limit, or older. Plus, this would help to reduce the glut of medics in the market. Of course, this will not happen any time soon because it's much, much harder to get mature people to spend two years in school and then work three jobs at near minimum wage and call it a career.

Yeah? What's it called and where would one buy it....just out of curiosity...

You need to find the one that gives him a woody as soon as he smells it...I'll bet he'll complain about it less... :-)

Man, great case. For the record, at the top of my list of differentials was a transient arrhythmia, but you douched that idea before I had a chance to mention it... Thanks Brother, that was educational!

Man, what a bunch if ignorant, childish, "I need a cause that allows me to hate but doesn't force me to think" bullshit. I've said it a million times, and will say it a million more. Muslims are not evil. Compare the evil done by Muslims to that done by Christians and you will certainly have to attack Christian churches instead... Craziness....

Thanks DFIB...I know your donation comes with a ton of good energy...

There was never any doubt in my mind that this message was coming! I just ate another can of that excellent fish you sent us, before coming on this rotation! Thanks Girl...

Hey all, Yeah, it's for real, and Celtic, what a cool friggin' think for you to do... Thanks my friend... Kat, of course it's smart to be cautious, but Babs called me this morning (her afternoon) to tell me of your donation. What an amazing thing for you to do. You should make sure that my name is on the top of your list someday when you need a favor that I can provide. I love you Brother...thanks so much for doing that. Babs isn't really a 'spotlight' kind of person, so I was shocked, and really proud when she told me that she volunteered for the Walk committee. I'll post her email message below... I didn't want to post the amount without your permission, but I would like to. "Hey Babe, I hope you're morning is starting out good! I just wanted to tell you that there is already $200 in donations for the walk. How cool is that? I'm trying to log into Dylan's email to see if they sent details but can't remember the password. So they'll be a reset link somewhere in your messages. If I'm understanding correctly, 1 person Arctickat, donated $xxx and Alicia Sxxxxx donated $50. Since I don't know these people, I"m assuming they are friends of yours. How cool is that?? I read the city post but it took me a minute to figure out it wasn't you who posted it! You have some amazing friends Honey! I love you <3" Yeah Love, they are friends of mine...And knowing them is very, very cool. Dj, thanks man. There's no vanity there. I'm truly grateful for your support. In reference to the recent thread on how we might get more people to sponsor, and why it's worth paying for that sponsorship.... Admin, charge whatever you like. My Brothers and Sisters are all here....I'm never going anywhere. If anyone would like to join Dylan's team, that would be really cool! You don't need to beat the bushes for money, he would just think it's cool to have a lot of people on his team... Thank you my friends.... Dwayne Edit: Babs just tells me that Dylan has the largest single donation from anyone collecting money for the Walk so far....Thanks Kat. :-)