DwayneEMTP

Yeah, that is where you and I are in complete agreement. This makes me just batshit crazy...And FELONY assault and battery! This guys life was changed forever because he called EMS, or they were called for him. And that's not really our job, right? To make people afraid to call us? I'm sure that the hosemonkeys are very happy that this has sent a message to "respect us or else!" But it also sends the message that EMS is to be feared...and I hate that really bad. Don't believe me? Go to that other website and look at the responses to the same story. 100% "Yay! I wish it was a felony here!!" Not a single post about personal responsibility...

A perfect example of a situation that I constantly complain about. Fire decided that they wanted to take him, and that's that. I'm not sure of her level of education as she's once described as a paramedic and another time as an EMT. But they had no right to have their hands on this man. His wife is a nurse and says that he didn't have a seizure, not that it matters, and claims that he didn't consent. It sounds to me like they had to show up twice and decided that he was coming with them whether he wanted to or not so that they wouldn't have to answer another call from him. Instead of them all being fired, and possibly charged with crimes (As the article makes it sound should have occurred) they instead are rewarded with this man being charged with a felony. It's a dark day for EMS when Firemen they can't even be trusted to make such simple decisions as to whether or not a patient consented, or solve such simple problems as dealing with an altered patient non MMA style, and yet the court will call them victims. Good on you boys and girls for beating up on an altered patient, getting punched in the head, as you should have been, and then crying about. Makes me want to spit...

How long ago did you take your practical exam? If it was more than a few weeks then it sounds to me like your instructor is dropping the ball on getting your results to them. I'm with Capt, one or two months seems like a really long time. I can't remember how long it took when I first became certified as a basic, but I'm confident that it wasn't that long. And this is the perfect place to ask this question. There is no need for you to decide if the question is appropriate or not, you just ask away Brother, and we'll help your sort the rest out. I certainly would have asked here before jumping through all of the hoops that can be the NR telephone line. Plus had you gone there without posting here first we would have been cheated out of the opportunity to learn from you. Don't mind Mike...he gets a bit uppity sometimes, but you'll have a lot to learn from him should you choose to stick around. I can't say for sure of course, but it bothers me that your instructor wasn't more concerned, and that he found two months an acceptable waiting period to get your results. My gut tells me that this is going to come back to an issue with your instructor not being as responsible with his clerical duties as he should be. I'd be grateful if you'd report back what you find so that the rest of us can learn from it. Welcome to the City! It sounds like you kicked ass on the NR! Dwayne

Hey Kathy, welcome to the City. First, if you want to get some real, helpful responses you need to redo your post to at least a 6th grade level. Capitalization, punctuation, are all important. About a million people a week come asking the same question, in the same way. If you want people to take you seriously then you need to show them that you came to play, and that really isn't that hard to do, right? Or, you can post a really hot picture. Or pretend that you need information for TV/Movies...those all seem to get people's blood flowing. You truly are welcome, but you can't be successful here, or in EMS with the type of attitude that's displayed by your first post. On the other hand, I'll be curious to see if this tiny little post makes you run away. If you stay maybe you really have the balls/ovaries for this gig, if not, well, you know. We all screw the pooch sometimes, but we learn to depend on our EMS brothers and sisters to set us right again. That is all that I'm trying to do here. To give you a leg up, not to try and slap you down. I really hope that you can see the difference. I hope you stay. Dwayne

Thanks DFIB, but the treatment decision wasn't completely altruistic. It's kind of weird. The company I work for provides medical people on the ground, but their main job is as an insurer, kind of. Making arrangements, guaranteeing payment, setting up escorts and transportation. When we have someone at the mine that needs to be seen in the hospital there is this huge human cascade of events that takes place, it's really a beautiful thing. But when they though that I might have the DVT, it doesn't work exactly that way. I would have had to arrange transportation, which more than likely would have meant taking the crew bus, so an 8 hr drive instead of 5. If I was really lucky I would have been seen the day after I'd checked into the ER, but almost certainly the day after that which means that I would have had to find accommodations for myself in Lae for the two nights. It would have been difficult to find the accommodations, any that I'm likely to be able to afford would be unsafe for an expat, and those that would be safe are well outside of my ability to afford. Plus, the hospital would have been, according to the best estimates that I could find, probably about K4,000, or about $2,000US. All of which I would have had to pay and then submit back to my company for review, upon which time they will decide if they felt that there was a true medical necessity for me to go or not, and if all of the money spent was necessary, and whether or not they would pay any of it back per my "insurance." So my main thought was, "By the time that I can get to the 3rd world medical care, spend most the tiny bit of savings that I've got, all of this will be resolved one way or another anyway. If I start now, it's probably going to be to late before I get to treatment." So I had three thoughts. "Hopefully I won't die before it becomes emergent, at which time my company is obligated to medicac me to Australia and pay all costs, or hopefully it's not a DVT, Orrrr if it's a DVT hopefully I won't die." I didn't really see many other options within my single income family budget...Know what I mean? My biggest problem was that if it was a DVT, I didn't have any idea what to expect for progression. Do they just blow up suddenly? Do they grow, or is it as big as it's going to get? If it is going to grow, how fast will it do so? I considered resigning my position and just going home, but non only if it worked would that mean another 45hrs of travel before getting to care, but my company would simply have refused to arrange transport so I would have been stuck still. My guess is that once they considered that it might be a DVT they decided that if they couldn't get me to pay for my own care, then it was cheaper for them to process my dead body than it was to have to try and care for my living one. It's a crazy world... So I guess, if this threads not dead now from my bullshit ramblings, maybe we can explore what might have been expected? Let's assume that the issue I've described was in fact a DVT. What would the expected progression look like over what period of time?

Oh man, that made me laugh out loud, and not figuratively speaking... Pretty clever on the part of the police..

Thanks Mobes... The issue was resolved that night. By the time of the post I'd been symptom free for about 24hrs or so. And thanks for the review. I'd learned that, but forgotten it, but I recognize it and it makes sense upon review. I KNOW! I could have Googled it, but it wasn't the answer I was looking for so much as the conversation and the thoughts, thought I'm grateful to have an answer. If I've ever had my INR checked it would have been during one of my routine job screening blood draws, so I'm guessing not. I don't think that I normally have any clotting issues. I'm usually really careful about getting up and moving my muscles during the long flights, and monitoring my urine output for hydration status. But on this trip I slept for 8 hrs or more straight, which I've never done before, and the night before had been drinking the worlds nastiest tequila with some folks in the poorer part of town while I was stuck in Dallas. The history combined with the symptoms is what led me down that road. Bizar, good points all. That's not a habit of mine, to take so much ASA, it was only my misguided attempt to stop the growth of the clot if in fact a clot it was. The dosage came from nothing more intelligent than my having 324mg/tab on hand and guessing that I wanted more than a 'standard' dose. Because I thought it would be better? Nah...I had no intelligent reason for it, it was just the only tool that I thought that I had and I wanted to quash this thing the best that I could. I can see why a dose of that level might cause acidosis, but it was for two days only.

Ahh...I see. So I may not have been completely off in the ditch, probably am, but possibly not, for taking ASA prior to international travel, but it really made no sense for the suspected DVT. I can see that now... Thanks guys..that's cool as hell....

But what I don't understand is what makes at DVT special? We get clots all the time don't we? I mean in A&P we had to learn every step of the clotting cascade, creating and destroying clots, though as should be obvious by now the retention of that material was abysmal. Surely I didn't need to learn all of that for an issue that is rare except in DVT, stroke? And yeah, that is my thought, and I get that it's dumb, but I'm still not clear on why it's dumb. Risky maybe, I get that, but why is the theory poor? Don't we give ASA to MIs stop the aggregation, (in my mind, further development of the clot, so maybe that's where I'm lost) of the clot? To queer it's further growth until we can get them to a higher level of treatment for dealing with the existing clot? I can see thrombotics there as time is of the essence, but if it wasn't, wouldn't the body deal with that clot in it's normal way, assuming that the acute cause of the clot development had been removed, as it had been with my international flight/dehydration? And if the body is regularly building and destroying clots due to injuries both minor and severe that aren't treated with thrombotics, then why does waiting for my body to destroy this clot, if preventing it's growth is possible, seem so off in the ditch? And I don't know that stopping this clot or preventing further clots doesn't hold water. Not being pissy, just honest. I have taken ASA before my international flights for a long time...grin...for just that reason. Now I'm starting to feel a bit silly about that... I really, really want to just Google this, but then I lose the opportunity to build a decent logic tree for this issue.., so I'll take my beating, and gladly, so don't worry that you'll hurt my feelings....I just don't get it. And no worries Mobes...before long your pubes will sprout and give you a whole new outlook on life and respect for your elders... :-)

So, after 5 days of traveling I've finally made it to my camp in PNG. For the first time in ages I actually slept for about 8 hrs straight on my international flight...That flight lasted about 17hrs preceded by a ton of doing nothing. I'd medicated, as I always do, with 650mg ASA prior to flying. Walking across the airport to get my next ticket in Brisbane I noticed sort of a sharp cramp in my right calf. I noticed at the time that it seemed strange that the 'cramp' was so localized, but it soon resolved so I didn't pay it much mind. I noted it in my head that a cramp after so many days of travel should cause me to focus on my hydration, which I'm pretty aware of at all times because of my travel, where I live and where I work. Approximately 1.5 inches below the inferior edge of my patella and one inch beyond the medial line to the back it felt like I'd been hit with the round side of a ball peen hammer a few days ago, leaving an uncomfortable bruise. About where I'd expect the popliteal vein to be. (Googling later showed this to be the most common place for a leg DVT secondary to travel.) There is no one here to examine it so before Googling I tried to carefully get a baseline of area, tenderness, and pain level which I called a 3/10 at rest, 4/10 with palpation. Later that day I arrived at camp and noticed that the pain at the site of the 'cramp' was getting worse. Maybe a solid 4/10 at rest, though nowhere near needing to be mitigated. Very localized I called on of our online docs (we have a center with this company that have several medical directors online at all times) and explained the issue including my concern about a possible, and seemingly more likely DVT. She said that it sounded more like muscle strain and that she would call back the next day to check. Out of concern for a DVT I took 600mg ASA 3x/day (no idea what an ideal dose would be, if there is one) in the hopes that if it was a DVT perhaps the antiagreggation qualities of the ASA would keep it from getting any bigger before we figured out what was going on. They called back and said that after further consideration that they wanted me to go to the local hospital (5hrs by jeep) and get it checked out. I refused, as I'd have to pay for it, and it turned into a giant pissing contest. During that contest I said, " So if we accept that I'm not going to go to the hospital until our confidence is higher that it's a DVT, what about continuing to medicate with ASA to try and keep it from getting bigger if it is?" At this point it was getting difficult to walk without a limp, though still not a terribly big deal. She said, "Mr Shithead (not what she said, but I could tell what she meant) you need an anticoagulant, ASA is not an anticoagulant. That means that it won't dissolve a blood clot..." I said, "Yeah, I know what it means. But what I'm wondering is that for now I just have pain, no significant swelling, no measurable localized fever, why can't I use the antiagreggation from the ASA to try and maintain this state until my body dissolves the clot on it's own, assuming symptoms don't increase?" "Mr Shithead! It's a blood clot! ASA will not dissolve it! You need to be seen at the hosptial!" Blah, blah, blah... So I did it my way, wrapped my leg lightly with an elastic bandage before bed, the pain increased to a solid 5-6/10 later in the night though still without noticeable local fever or significant swelling or redness, until it suddenly, softly, 'popped' (Which my mind translated into a killer embolus breaking free, heading for my lungs) and decreased by about 50%, then over the next day resolved to complete resolution other than 2/10 pain with deep/aggressive palp. So, after all of that, half of which I'm sure you wisely skimmed over...does it sound like a possible DVT? I'm about 50/50. Also, I'm afraid that I'm a long ways out from A&P now with few opportunities to even think of clotting factors, cascades, etc, so I don't see what was so wrong with my plan assuming that we remove the non emergent transport to a 3rd world ER from the equation? Understand that I would not have been happy with this plan if this had been my patient, nor confident enough to go forward with it, but this is me, so I was willing to be a bit more cavalier. Not stupidly so I think, but more so. If the symptoms are caused by a clot, and the symptoms are relatively minor and appear to be doing no permanent damage, causing pain only, why would trying to keep the clot from growing further with ASA until my body could deal with the clot be such a stupid idea? I'm sure it probably is...but I'm not sure why?

I can't even tell you how much I hate these kinds of stories... If you're able to live alone, get a phone call from Pops telling you to 'catch a ride' a bunch of miles, and then survive for three weeks in the desert, you are not autistic in any way that I am familiar with. Jesus Christ....every friggin' person with a social inadequacy is autistic now...the water is getting so muddy that it will be generations before there is decent research money, or research direction to make a significant difference...It makes me want to spit... Dwayne

Wendy, what is the difference between removing a life saving intervention or applying a life ending measure? The end result is exactly the same with the exception that those removing a life saving intervention are often doing so to then allow the patient to slowly suffocate in their own bodily fluids, while those administering are allowing a peaceful and more (in my opinion) dignified passing. I've lost many that I've loved and been with them during the last days and moments of their lives as well as many patients in the same situation and I've never, if you leave God out of it with all of his 'gifts of suffering' seen any dignity nor benefit to end of life suffering...

Wait, alert and oriented with a relatively clean EKG and he retains the right to refuse. Alert and oriented with EKG changes and he somehow relinquishes that right? I don't understand... I just got into a major pissing contest with my company because they ordered me to go to the hospital, that I would have had to pay for and then, likely, be reimbursed. I refused, my medical director was angry, my 'voice on the phone' supervisor was angry, everyone wanted 'what was best for me' but no one wanted to pay the bill. What they really wanted was to be obeyed, and for me to spend my money to cover their asses. I believe that this is what's happening many times that we try and talk people into going to the ER. In my case, as, possibly, with yours, we can't try and force people to the ER 'for their own good' while trying to pretend that it's not really just US costing THEM a ton of money to cover OUR asses. (No worries on my account. I'm fine. Am going to post about it later.)

(EDIT: Maybe the best advice of all....Please, please, please don't show up at the clinic in desert cammo trauma pants with a gazillion pockets, a special forces backpack loaded with lots of cool, dangly things that hang off of the outside, walking like you just watched the first few Rambo movies. You'll look like a total tool and it will take a while for anyone to take your seriously afterwards... (And yeah, I wish someone would have told me that but I'm guessing that they'd mistakenly assumed I wasn't a complete idiot...) (Ok, I wasn't that bad, but I did see a ton of wankers show up looking more or less like that.) As was said above by my betters... Depending on the gig you get you may end up in a meat grinder like BAF where we saw 15-25 pts/day with full documentation, or a really slow gig where you'll see one patient every several days. What you won't be doing, regardless of what people are going to want to convince you of, is dodging bullets and sprinting across dust showered fields answering the screams of "Medic!! We need a medic!!" though many remote medics will try and convince you that 'their' gigs were like that. I was returning to Afg sitting next to a guy that was telling the guy next to him, "Yeah, I'm going to BAF. My buddy tells me that they fly us in on old Russian helicopters and most of the guys lay on the floor because you can't breath sitting up for all of the cigarette smoke!" I said, "Brother, your buddy is filling you full of shit.." He said, "You don't know! That's how our company goes in!" I said, "Man, you need to work for a different company because everyone else goes in on a commercial airliner." The point being that you'll hear all sorts of nonsense, but most likely the job will be much less than what you're used to doing only you'll get to brag about doing it in Afghanistan, which really is cool as hell.... Warm weather clothes in the summer are a must, and layers, as Chris mentioned important for the winter, but for the most part you'll always be comfortably air conditioned cool in the summer and warm as toast in winter as a medic. You'll be given a ton of respect that you don't really deserve, and if you're like most you'll accept it, strut around enjoying it, and even come to believe that you do in fact deserve it, which should make you ashamed. Get the time differences now and make plans to chat with your family. If you don't use a program now like the chat utility in Gmail, then learn how to use it and make sure that everyone you love knows how to use it too. Make plans to productively fill your free time, as almost certainly that will be your biggest enemy. Learn to network with other medics. Contract medicine is fickle and I PROMISE you that you will at some point be woken up, or stopped in the middle of your day to someone saying, "Pack your gear. You're heading home tomorrow. We lost this contract. We'll call you if we need you again." On that same note....PUT ASIDE MONEY FOR SEVERAL MONTHS OF LIVING EXPENSES! You will be making more than you're used to and though you have already made big plans to pay off all of your bills and save money to go back to school, I'VE NEVER TALKED TO ANYONE THAT FOLLOWED THOSE PLANS. Sorry for the caps, but you'll soon see why I felt them to be necessary. Before going to Afg akflightmedic gave me the same advice and I promised to be smart and follow it, but of course didn't. If you don't, you'll end up like 99% of the medics that I know. You will spend all that you make, learn to live and expect a different standard, get the "See ya!!" talk from your company and be forced to suck the dicks of every recruiter around to find another gig so that you can "get by." Thankfully that's a habit that I've broken, but only because my friends have helped me land on my feet when I was out of work. But you don't even want to know how many figurative dicks I had to suck in the moments after being suddenly, instantly unemployed in a one income family. Yeah. Not my proudest moments. Probably the most importat? Nothing is ever true until you see it with your own eyes. You have to learn to ignore promises, ignore rumors....they are the mainstay of the bored in the war zone and we all jump all over them at first. I wish I wouldn't have... "Holy shit! I just heard from our boss's, boss's, boss, (Shhhhhh He and I are friends. He lay next to me on the Russian helicopter on the way in) that they are going to shut this site down at the end of this month!! No, really! They lost the contract!" "I just heard, I just heard, I just heard!!" You truly can have an amazingly awesome time, make awesome friends, do really good expanded scope paramedic medicine there...you probably won't, but you can! I miss Afg all the time. I loved it there and would go back but they don't really enough anything any more.... Also, my experience as well is that the Afghanis are kind, generous, amazing people. They care just as much about life, and pain, and loss as you do, they've just seen so much more of it than you have that they don't always react the way that you think that they should. The Taliban is a small pimple on the ass of the giant that is the Muslim and Afghani people. Defining the entire country by them is akin to defining Americans by the relatively few three toothed rednecks that still brag about beating up 'Niggers and queers.' It makes no sense. Good luck Brother. I'd love to hear how you get on.... Dwayne

Man, what an amazing start this is to making this change... Are you OK with this being shared freely Doc? Or at all? And if so, how should it be referenced back to you?

In no medical world do those two thoughts belong together. We have a 'healthy' male, jogging, that is concerned for what he considers to be an unusually elevated and non self resolving 'rapid heart rate' and your advice would be 'just keep running?' 'Your heart rate is well within what the books say is normal for an exercising male so get back at it you wanker...call me back if it stops completely and we'll have something to work with.' Can you get any more cookbook than that? I work with an 40 y/o Aussie in PNG that has a resting heart rate of 32. When he cranks the treadmill up to 10k/hr and sprints for 20 mins or so his relative tachycardia is around 110-120 bpm or so. Would you then tell him to continue running when he calls with cardiac concerns because his heart rate is only 160, well within normal limits for an exercising male? Not sure where that line of reasoning came from Kat, but it's really off in the ditch... Dwayne