DwayneEMTP

Looks to me to be nearly exactly what he asked... I wouldn't accept the online courses, though I'm afraid that I don't have an intelligent opinion on whether or not that they are good enough or not. I just learn better in a class, from the questions of the other students, from the group discussions and interactions. Particularly with the classes that you mention. I found my introduction into cardiology to be really, really hard. It's hard for me to imagine you being able to manage your way through it, and REALLY get it if you have to sort through it mostly on your own. As I said, I wouldn't accept the online courses, but I'll never again take another online course if I can avoid it. But that's my personal bias. I'd be interested to know what you decide, and how you come to feel about your decision after you've had a bit of time to live with it and understand it. Good questions man....

Yeah, what RS and chbare said... Thanks for sharing the article...

Also, this is a really good time for you to learn to think and act when faced with those kinds of nervous feelings instead of checking out and hiding. Much of EMS involves those types of nerves at one time or another. Instead of trying to eliminate those feelings, maybe try to learn and train within them before they're gone? They won't last long, and then the opportunity will be lost. Good luck!

Great points. I can't really defend my contention that 7 months is to short. I guess my comments weren't meant so much to imply that two years is optimum, but that it's, in the vast majority of places, the best available. And it's probably still a knee jerk reaction as the most common person that I see going into the 'short' programs are also wanting to be firemen. I'm not sure how we would be able to design a study to define an optimum educational length, as the length is only really important based on the little bit that we know of the average students ability to obtain and retain information. Is a physician's length of education optimal? I don't think one can say, though I would be willing to bet much that you couldn't turn out competent physicians in 6 months. And who' going to be willing to compare patient outcomes for long unless the 6mo Docs morbidity and mortality rates stay on track with the average 8yr Doc. For a valid study it seems that it would be necessary to turn out 1yr, 2yr, 3yr and 4yr nurses at the same college, with exactly the same curriculum, taught by all of the same instructors in the same way. Yet even then we'd have to try and quantify the variables of the previous histories of those being taught in the study, right? Yikes..it's going to take a much better man than me... Cool question though!

I think that maybe where we look at this so differently is that you seem to feel the man filming has been terribly harmed by having been subjected to losing that right, lawfully or not, just for 'taking a picture.' I see that the picture that he's taking can cause massive damage to someone that has no ability to prevent it from being taken. He's going to suffer a momentary inconvenience where she will have personal images possibly posted on the net, altered to suit the wants of whatever pervert chooses to Photoshop them, for, well, more than likely at least as long as she's alive. He has the ability to avoid his discomfort, she does not. In my mind that makes her the victim and her he the victimizer, which makes the issue much clearer for me. Maybe we've seen that differently and that's why your arguments about loud radios and racist protests don't really resonate with me. Neither causes permanent damage nor am I unable to leave either if I feel challenged by their message or volume. Not so the case of the patient. I'm guessing that by being outraged over the famous image of the young girl that's burned implies that I should be angry with the photographer for shooting pictures instead of helping her? I believe that I'd have made a different decision. But allowing her to suffer further (assuming he had the tools and/or knowledge to help her if he'd chosen to) to make sure that she does not suffer for nothing, that perhaps others will not suffer because her suffering was placed squarely into the world's view is in no way comparable to the issues in our discussion. There is no comparison to his choosing to record horrors without changing them with his actions and choosing to allow horrors so that one can stay safely uninvolved. But you already knew that, as I believe you know this to be a Straw Man argument. Maybe Chris is right, if you interpret Gandhi's message to state that everyone should simply get 'road ragey' then perhaps we are so far apart on this issue that we can't really learn from each others opinions after all. I'll close by saying first, that I certainly see your point, that my argument doesn't hold up logically if held to the OP only, and perhaps not when extrapolated from that to something less easily managed with sheets. Though given my life experiences, in the U.S. and other parts of the world, I've not been convinced of the usefulness of your point of view except where clear, instantly enforceable laws for every distateful situation exist. I've never been to such a place. Second, I hope that you'll see no disrespect in my not quoting/commenting on your posts further. It's an issue of time, not interest. I'm grateful for you taking the time to participate in this discussion.

And I believe rightfully so. The attitude of "People should be allowed to suffer at the hands of douche bags if the govt isn't there to protect them or have created special protections for those that would choose to intervene" is only espoused, in my experience, by those that have always been privileged to hide behind others that will do violence on their behalf, allowing the hiders to pretend to be separate and/or above the acts of violence that protect them. I agree completely. And I'm sorry that I said that. I've been frustrated by what appeared to me to be an obvious attempt to avoid what also appears to be to me a salient point of the conversation and stooped to trying to push buttons. You didn't deserve that comment and I wish I'd not have made it. I sincerely apologize for it. As I stated before, your argument only holds if we wrongly assume that freedom of the press and freedom of speech are absolute freedoms, and as I've stated before, though you chose not to address it, that's not the case. "Article 19 of the ICCPR states that "[e]veryone shall have the right to hold opinions without interference" and "everyone shall have the right to freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of his choice". Article 19 goes on to say that the exercise of these rights carries "special duties and responsibilities" and may "therefore be subject to certain restrictions" when necessary "[f]or respect of the rights or reputation of others" or "[f]or the protection of national security or of public order (order public), or of public health or morals".[1][2]" Isn't running crying to the police what you've stated all along is the correct thing to do if we find a situation untenable? That, or passively allowing attrocities to occur in our presence in the name of moral, legal and intellectual superiority? As with the paragraph preceding this one, you're arguments are all about what's best for you. And with most that make such an argument the decision to choose impotence is most often loudly and vehemently defended. Then the attempt is made to show how the world is made better by that impotence. My life, and therefore my arguments are about 'us.' I've made it clear that I've rethought my answers regarding touch this man for his cell phone, but the argument can be extrapolated without significantly changing the moral parameters. I didn't read all of the court cases. I wasted my time with the first few, showed you the respect to take the time to explain that they weren't relative to the discussion that I believed you and I were having, only to have my comments followed by more cases that were little different than the first. Perhaps you believe that I've nothing better to do than follow such rabbit trails all day. But I do. And if you believe that I've spent the time creating my comments because I didn't like the previous answers, then perhaps it shouldn't be my reading and comprehension abilities that are in questions. And here, as above, you show your hypocrisy. You claim to be above it all, and yet at the first offense you've turned to aggressive talk, to insulting tones. It took only one mention of 'your fancy school' to get you to verbally drop to, and possibly below my level. What do you make of that? This seems to have created two camps. One that says that the injured, defenseless person should heal to have themselves and their family molested with the images of their pain on Youtube because the government didn't come to save them or allow for protections so that other would feel safe doing so. The other camp seeming to have come from a different world, such as the world that I've grown up in and lived in until only recently where people MUST care for each other, defend themselves and their neighbors at times because crowing of morally superior stance of active impotence doesn't really keep people safe when the rubber meets the road. You would call me a thug and douche bag for my thinking, and I would call you a coward for yours. Probably we're both right, and both wrong to varying degrees. The thing that resonates most with me is that I've never heard anyone take your stance in the inner city where they have to fight to get to school. Nor in the war zone where they have to bleed to defend their families and communities. Not even in American rural areas where legally sanctioned help can be very far away. I've only heard this opinion come from those that turn on their TVs at night to see the violence all around them, committed by those acting on their behalf, yet somehow pretend to be morally and intellectually above it, all the while ignoring the fact that it's their privilege, not their actions, that have allowed them to take such a passive stance. "It is better to be violent, if there is violence in our hearts, than to put on the cloak of nonviolence to cover impotence." Mahatma Gandhi.

You know Brother, it's probably hard for you to read the responses above, but unfortunately they are correct. Those of us that went through bonified 2 year programs barely made it through with out sanity intact. 7 months is only a decent primer. As well, when you tell us that you need to overlap your already inadequate medical education with a fire education you've made it clear that you only want to pretend to be a medic so that you can actually be a hosemonkey. Good luck to your Brother. I hope that you get what you want. But you shouldn't expect to be taken serious by anyone in prehospital medicine. You've taken every shortcut that you could find, and that's just really bad juju when people are trusting you to be smart instead of being lazy...

You know JP, it's disappointing that you've continued to consider this a constitutional right despite being challenged many times, at least by me and it seems others, to prove that point when non government entities are involved. Is it really your intention to simply ignore the challenge and continue to parrot the same crap over and over? Is that what they're teaching you in that fancy school of yours? When you can't validate to try simply bury your opponents in repetition?

Do you track those numbers or are those numbers tracked by your company for each person? Another way? I don't doubt you in the least, I'm just curious. I'm not aware of any place that I've ever worked that would have that available, but it seems like it could possibly be valuable?

My desire stems from a couple of places. The first, that we see a lot of symptoms in this population that I've attributed to dehydration and as a person I don't like to see them suffer from ignorance of a simple cause. Particularly when I know that the management that's charge with caring for them is hardly more educated on the issue than the local population. Second, though most don't and I'm almost never expected to, as a lone medic and highest level of care on site I consider it part of my responsibility to do my best to keep the entire population as healthy and fit as possible. Not only to fulfill their responsibilities for the company, but so that they are more able to enjoy their time home. So in my mind resolving the relative dehydration isn't really any different than organizing malaria/hand washing/STD/general hygiene educational campaigns. If a truck driver believed that I was going to get run over, I would hope that he would tell me to move. If the kitchen staff had reason to believe that there were issues with the water, I again would hope that they would tell me not to drink it until they were certain. And as their medical provider I would hope that those that I care for would have the expectation that if I believed that I could prevent them from becoming ill, or cause them to be healthier, that I would do so. (There is Local National medical staff also, but they are in not much better of a position to recognize these issues than management.) Wendy does have a great point though. At least for me the real balancing act is to try and bring education and create a positive change in behaviors without insulting or alienating those that I'm supposed to care for. It's an interesting challenge, as I promise you that the day that I man a campaign that states as fact that demons/curses don't cause disease, I'll forever be impotent as a provider due to the local populations instant belief that if I can be so ignorant of such an obvious fact then following my advice on any issues would be foolish. Anyway, I took the advice here and again tried to reorder the urine dips, but also created a spread sheet that tracks b/p, pulse, s/s, pt age, ultimate diagnosis, # of bottles of water consumed during a 12hr shift, and the reason for that number, as well as some location specific information to see if the issue is general or localized to certain parts of the site. I've also put together an educational campaign explaining that according to most medical bodies that I could Google that 2L is a decent amount of water for an average sized man (which I blindly defined as 80kg for the purposes of this population) during a day at rest. Along with the PP presentation to be dispersed I suggested that each crew member that works outside be given 5 bottles of water at the beginning of shift and to have the full and empty bottles returned at end of shift (without supervisors comment) as a weak, but possible way to track effectiveness of training and changes in attitude. We'll see. It went up the chain just before I left or my rotation home. I'm confident that the results will be pretty telling as to the companies attitudes regarding worker health because though it will be an expensive intervention, compared to the multimillion dollar daily operating expenses it should be doable I think. Thanks all for your interest and comments!

That's funny right there...

Hey Bushy! Good to see you! Yeah, I've gotten pulses back on around 50% or the arrests that I've run but have never had one leave the hospital...And with my current gig I'm guessing my odds are around 100% for that not happening. (No CPR culture, long response times, several hour drive to the hospital minimum.)

From what I've been taught very few people die from rattlesnake bites, but many have increased injury from the treatments provided. You actually want the venom to enter the main circulation where it can be diluted. Ice, constriction bands, etc, keep the venom concentrated which can cause a lot of damage. So as stated above, if you suspect a bite, even if you're not sure, or just see a scratch instead of a puncture, start the ambulance enroute via 911, explain to the patient that though they might feel sick that they shouldn't be thinking about death, keep them calm and go and meet the ambulance enroute. I was bitten as a child, but other than seeing everyone freaked out getting me to the hospital, and then someone at the hospital saying, "This is going to make you sleepy" I don't remember anything. Evidently they kept me sleeping for a few days...that was nearly 45 years ago now, though, so I'm guessing things were likely done differently. As in any emergency, panic is your enemy here....

Hey Jim. What a cool post... I look forward to your thoughts!

Good to see you...

Three of the non paralytic (I've never done a paralyzed intubation) intubations that I've done were on exhausted geriatrics. The person that taught me to nasally intubate explained about nasally intubating exhausted elderly where transport times were longer and assisted vents wasn't likely to be the best option that, "Often you'll get the tube and they'll fall asleep as soon as they feel you breathing for them." And it happened exactly that way. Some panic at the time of intubation, a shocked/relieved look when they could feel me breathing for them, then almost immediately they'd fall asleep. Maybe I did them just because I could, but it certainly appeared that it was a very kind thing to do as well as a verifiably supportive measure physiologically.

That patient advocacy is gospel, unless it will get you jammed up, and then you should cover your ass instead. That no one ever dies in my ambulance. That a PCR should be succinct to the extreme to disallow a lot of stuff to be used against me in court five or ten years from now. That I should never, ever lie to a patient. That ammonia vials are a good way to check responsiveness. That I should ALWAYS follow my protocols, (In reference to confounding comorbidities) That there are 'normal' vital signs across patient populations and pathologies. That I should avoid O2 in COPDers or they'll stop breathing. That I should never reduce a compound fracture (Not sure what the correct term for this is now) as the contaminated bone ends will cause massive infection. That an alert and oriented 'recovered' hypoglycemic is competent to refuse transport after a tuna sandwich but without a significant support system at home. That a good medic can spot drug seekers and should deny them narcotics so as not to bury the system in the losers that he's encouraged. That hypertension is bad, always, and should be managed if symptoms are present. (This one is near and dear to my heart as I once treated a dizzy, hypertensive patient, neg Cin stroke scale, very proud of my progressive interventions to be told by the ER doc afterwards that she was a compensating stroke. No harm done I was told.) That chest pain resolved by nitro is verification of a cardiac etiology. That nitro has a nasty habit of critically dumping people's blood pressure. That equal and reactive, or unequal and sluggish pupils give me way more information than they actually do.

Thanks Doc. As this patient was elderly, and thin today I would most likely start with 6mg and titrate up if I didn't get the desired response. When I used to get migraines I would start my own IV and push 12.5mg of Phenergan (For the record underworlders, it's pronounced Phen-er-gan, not Phen-errrrr-gan, (think Swedish) ) and it would completely knock me out for 6-7hrs. Babs would d/c the IV and I'd wake up better.

Heh...I was just breezing through the thread before jumping into the middle of you with both feet for that question Mike... :-) I'm glad you cleared it up. Though I get that that's not happened here we do seem to have a double standard of "Learn all that you can. You can never have to much education." until someone wants to reach beyond their grasp, at which time we seem to often switch gears to, "Now hold on there Sparky, let's not be getting all uppity." I'm glad that that didn't happen in this case...did it?

Despite the civilized example that some of us have tried to set we still have some bonified shitheads here. Unfortunately some/most of them happen to be the smartest and most experienced amongst us, so we're happy to have them still. It's just harder to train some folks than others. So what I'm trying to say? A Marine should fit right in. Thank you for your service Brother. Thanks for doing your part, and mine, to keep the boogieman out of my families front yard. It's truly appreciated. As mentioned before there is very little to be gained here by watching. You need to ask, and answer, and argue, debate. Be prepared to step up and lead instead of hoping that you'll learn just by reading. Be prepared to justify every answer. Not to prove that you're right, but so that others can see your logic and help you to adjust it if that's what's needed. I can't think of a single opinion that I hold dear that's not been adjust and made better because I've shared it here. I look forward to your thoughts... Dwayne

Maybe not truly in the spirit of the thread but the most humiliating thing that I can imagine is being caught in a lie regarding patient care. I've had several calls where I made what I believe to be significant errors and wanted badly to lie. For example I gave a 75 year old man 25mg promethazine and then had to bag him into the ER. (Though, in my defense, he did in fact stop vomiting.) I wanted in the worst possible way, as I was a pretty new medic, to tell them that I'd given him 12.5mg (even though the protocol dose for his age and condition was 6mg) and just claim that he seemed to have had an atypical reaction. But I didn't, and thankfully the ER doc on duty chose not to excise my only just budding medic testicles. Though that was terribly embarrassing, it wasn't life altering. And besides, I'm confident that the doc was actually looking into my soul when he asked for the dosage more than ready to give me a really bad day when I lied. I don't like lying in general, but with medicine, man, I have just been thoroughly convinced that that is an unforgivable sin. Probably my most embarrassing to date, though I've little doubt that I'll surpass it before long, was on my first needle decompression. I assessed, and assessed before doing it, was confident that it was appropriate, found my place, plunged the needle with great gusto, pulled the cap, and nothing happened. I was sure that it was the right intervention, right placement, but got nothing. This patient soon coded, though I'd like to believe that I wasn't completely responsible for that. Of course I can't be sure. I did CPR into the ER, the doc asked if I'd gotten air with the decompression, I said no, and at that exact moment it occurred to me that though when practicing the decompression needle came out with the cap, in this case I just pulled a cap and couldn't remember pulling the needle!! So in one of those incredibly silent moments that only seem to happen in a group when you're going to cuss inappropriately, or pass gas, I pulled the next layer of plastic, which was ACTUALLY attached to the needle, everyone watched the giant 4 foot long, 6 inch wide needle slide from his chest, followed by an extremely obvious, continuous hiss of air. But I learned two really important things from that call. The first, that pretending to do medicine because it's what I was taught is not the same as actually trying to do medicine which requires verification not only of competent delivery but actual positive or negative effect of every intervention. Also, the next day, while feeling like one of the biggest idiots on the planet, another medic that I respected says, "You did a needle decompression? God damn it! I've not done one yet!" And then a few minutes later, "But then again, it's you, so I guess if I did everything just because I can then I'd have done one by now too." Which taught me to take that kind of criticizm, even when it feels crushing and make sure that it's not also valid. Then, upon a thorough review of such charges, finding them to be invalid, to accept that some medics will hate you if you try and do your best for every patient, particularly if you do things that they are to afraid to do, but wish they weren't. It's a fine line, and as I've shown of late, one that I'm not always confident enough to walk without significant leaning and windmilling of arms. Another medic that I respect greatly convinced me of the value, and taught me to do nasal intubations. I've only done 6, but in each case it was, I believe, a benefit to my patients (RSI not available any place that I've worked outside of Afg. Or in the one place where it was I wasn't there long enough to be able to apply it as they had a one year requirement before training on it.) and I'm convinced that had I stayed doing street medicine that I'd have done many more. Despite that I know of very few medics that have done any. The reason I mention that is that I got the same response from the same medic, and others at the same service, that "Well, I guess if you don't care about your patients and just want to try shit..." I've come to believe that this is the great rallying cry of those unwilling to do what scares them. Anyway, not sure if this is in the spirit of the thread, but was hoping to give something to keep Doc and Kiwi from dragging another off into the ditch... Dwayne

Again JP you bring this back to filming Govt officials, and that's never been the question. Please see my previous post addressing a person or entities responsibilities where freedom of speech and freedom of the press are concerned. I'm curious to see you justify this person's actions in the face of those responsibilities. Though I've conceded that any form of violence isn't practical here, you're arguments only work if we blindly assume that the constitutional freedoms are absolute without the previously mentioned responsibilities, and that just simply isn't the case. And is it possible that we can continue this discussion as stated in the OP from the point of view that you are not filming government officials? Edit: After looking again I can see that that wasn't made clear but perhaps I've assumed it because I know that Mike doesn't work in a government capacity in EMS. But I do believe that that is how the discussion has progressed, no govt involved.