DwayneEMTP

Man, fair question ak.... And I guess if we are to follow the tenet of safety first then no violence is the correct answer. In fact, like all punishment, even addressing the issue if you don't have the proper support to do so isn't realistic and is likely to create a bunch of negative outcomes. If I have a patient damaged enough to trauma stip then they are certainly too sick for me to risk ending up injured myself, or even rolling around on the ground messing with a camera.

I've asked, over and over, and over, for someone to please quote the part of the constitution that protects this activity. Perhaps if you're going to crow about the first amendment, you should read it. I've made my argument early in the thread and yet people still claim that this person videoing is constitutionally protected, and that's bullshit, at least the best that I can tell. You seem to feel very self righteous in your argument, how about if we stop just talking shit and back it up with actual documentation?

I think with significant trauma it's probably not a bad plan. But it should be a stopgap measure instead of a formal plan for EMS support. And I do think that there is a significant amount of EMS training necessary if this plan is to continue. Who will benefit from being left in place? How do you protect yourself from coughed blood, etc? I think that there is an almost certainty that they are saving lives, but as well I think that there is a near certainty that they are also killing people that didn't need to die. I'm not blaming the cops, as that's the rules that they play by there I guess, but I also think that there is a reason that they don't keep track of the numbers, particularly in a violent city like that, if they're transporting 1/3 of trauma patients. If they're not tracking them, then to say that they are ultimately doing more good than harm is premature... Interesting article. It's not my intention to support or condemn their policy as I just don't know...Just thinking out loud...

No Brother...You're good. Thanks for participating...

See, this is where you and I split the sheets... I seem to remember a time where you were interested in exploring psychological/philosophical ideas. But that time has passed. Now you're only interested, as in this case, in participating if you have a pat and obviously right answer to a question. I have almost no interest in exploring issues to which I already have a good, or politically correct answer. That is why I go worst case scenario on these topics to try and avoid the easy, "Just cut their clothes off under the sheet." answers. There's nothing new there, I've learned nothing by approaching any question or subject in that way. And I think that personalizing these issues is very appropriate. I would think that that would be obvious as this is certainly 'personal' to someone else. You're comfortable with the, "yeah, well, it's not my problem, so, sucks to be them if there are no laws protecting them." and I'm not...just two sides of...well...maybe not even the same fence. I'm very interested in people's thoughts on these ridiculous scenarios and have used the logic that I've developed here many times in the field. What were they thinking? Why did they make the decisions that they made? Where does their emotion stop/start. Is there a place for logic and motion to support each other and how well do they/can they work together? I'm not sure where I've emotionalized it, though if you're speaking historically I won't even attempt to deny it. Was I emotional when I punched the shithead a bunch of times in the face? I don't think so, not really. I was pretty wound up, but more than that I was stopping something that I felt needed to be stopped. If you say that you would allow a man to follow your wife and speak to her like that and simply leave the bar, be forced out by that type of behavior, then that's ok. I get that. It's just simply not something that I'll allow to happen if I believe that I have the power to stop it. I miss the old ak that had the ability to participate in conversations even when he didn't know before hand that he had the popular and 'correct' answer. The one that liked to challenge people instead of simply dropping in long enough to explain how their discussion is stupid as the answers are obvious and simple. I get that these discussions don't interest you any more, but they do interest me, as they did a lot of other people that have proved themselves pretty intelligent over time. I'm glad that this could never possibly ever happen to you. That's not what the thread was ultimately about... As to your other points, I think that I made myself pretty clear previously. Dwayne

Flew her to Lae...

I"m not sure if it applies here, but I like it still.. "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.

I hear you Chris, I was poking fun more than anything. This is the first time that I've even had a vial in my hand, so I've not given it any kind of real thought. But from the things I've seen here I got the impression that it was really easy to control, super effective, with few side effects so was really excited to use it. I thought for sure when I called an Aussie doc he's say, "You have Ketamine?? You rock!! Yay us!" But it didn't go exactly like that.... :-) Kiwi, she had a possible reinfection secondary to a D/C of a spontaneous ectopic abortion with retained POC, with POC likely still retained, Syphilis, a badly swollen liver secondary to Hep B infection, and a really ugly UTI/vaginal infection or both. None of those things that I knew for sure of course, but I'd palped the liver and knew it was queered in some way and could smell some type of urinary/vaginal infection, which would have been enough to convince me of her pain, but there was pain to palp in a giant L starting from her liver running right lateral front and back and across her lower abdomen from one side to the other... But anyway, in my opinion, in very significant pain.

I had a patient recently in pretty severe pain. It was my intention to manage her for the helicopter flight with morphine, but while searching the clinic for their morphine, (I only have 30mg in my jump bad and couldn't justify using it for this patient without a ready resupply.) I ran across big vial of Ketamine...(Of course at this moment the clinic who'd recently swore that they had tons of it, noticed that they were out of morphine.) Beings I had heard here over and over how awesome it is I called an Aussie doc that I have access to when needed. I told him the same story and his response was, "No, no no...not for this kind of patient! No, put that away. You're a paramedic? You feel comfortable using morphine when you don't know the indications for Ketamine?" I said, "Yeah..I'm a paramedic, I've pushed buckets of morphine. Are you really an Aussie? I'd heard that you guys love this stuff!!" Anyway, he lightened up a bit and I put the Ketamine away and will make sure and research such things before calling in the future... But I am a bit confused how we got from, "Oh my God! It's like the silver bullet for everything only without any hemodynamic effects associated with most bullets!" to "Yeah, it's kind of dangerous with tons of side effects so shouldn't really be the first choice for...anything really...."

Man, Wendy, those quotes exactly exemplify my point. Thanks for doing that. JP, I truly get your point. I think that we're not so terribly different, but have been arguing at slightly cross purposes. You, from the point of view, "Don't break the law, but instead choose one of the law abiding options available. Human shield, sheets, etc." Which of course is perfectly logical and responsible. Me, from the worst case scenario point of view that there are no such options available. Two people, one patient and a douchebag cameraman. No sheets, no bystanders to help, etc. Though I took this stance because I wanted to distill the conversation down to a blatant 'right or wrong' on the severity of the pictures being taken and released V the severity of physically touching him to make it stop, you are certainly right that my argument perspective isn't realistic. As I dug deeper into my argument I began trying to concoct a scenario that would put me in a position where I couldn't foil the cameraman in any way, where I couldn't protect my patient in any way other than stuffing his phone up his ass, and I just couldn't do it. I sometimes get defensive as I seem to see more and more often people standing by while they, or their neighborhoods are attacked and victimized. Many times because they should be protected by the government despite the evidence against that belief playing out right before their eyes. Secondly because we've come to believe that any level or form of violence is the worst possible thing that can happen to a person. And in our electronic age that is just simply not true. A black eye or bloody nose is really inconvenient for about a half hour, then it's an irritation, and within a few days is forgotten. Not so for the family that sees their daughter spread over the cement. I guess my point is this, that in the given scenario, I concede that getting physical is certainly not the correct course of action when some many other alternatives exist. I allowed my argument to follow my emotions instead of stepping back and making a better effort to approach the problem from your point of view. I'm grateful that you hung in with the conversation long enough to allow me to come full circle on this thinking...

You know, you kind of got after Pox for not answering a simple question, yet I feel like I'm making the same point over and over. In this particular instance you use this example despite my stating that neither I, nor my patient are connected to the government in any way, so I'm not clear how the above statement applies. I get that from you Brother, and respect it. So it seems to be your point that nothing that hasn't already have a specific law made against it is worth defending? If this was your wife or daughter you would simply allow the filming to happen, allow their nude images to be shown on Youtube, and then apologize later saying, "I'm sorry for all of this babe. But I couldn't protect you because no one has made a law about that yet..." Serious question, not sniping. Or, let's say your daughter falls and accidentally exposes herself in her dress. You notice a man aim his cell phone between her legs, taking pictures while laughing with his buddies. Same question, same non disrespectful tone. Again, I know that you're more than smart enough to know that this argument doesn't apply, unless of course I'm not really part of this conversation any more any I'm just flapping my weenie in the breeze. I feel the same about those watching and those filming. I'm disgusted by both when a vulnerable nude person is involved. Again, I'm not sure if you're referring to any of my statement, it's seems not, but just in case, I thought that I made it pretty clear that I didn't care if he was interfering or not, that was simply the excuse that I was going to use to make him stop. The main difference between tolerating the watchers if necessary and not those filming is that the watchers can do very little damage by watching while those filming can do massive mental and emotional damage to the victim and their family. We are morally and ethically charged with protecting and advocating for our patients except in instances where it might obstruct some pervs voyeuristic evening? Also, from the quoted articles of the first amendment that I posted, I don't see where he's legally protected to violate this patient in this way. Maybe you could explain that? You very well might. If a jury of your peers finds that my behavior was outside of the boundaries of what's normally considered morally acceptable in our society, you very well might. I believe that the difference between you and I is that I believe that the government can't make a law for everything that might harm another person. I believe that sometimes we have to stand up and fill the gaps. It seems to me from your argument that you'd be willing (Again, assuming circumstances that we can't realistically mitigate in another way) to allow this woman while in your care to have her pictures, her privacy, her reputation possibly irreparably damaged (Much worse than a simple assault in my opinion) so as not to chance violating the rights of those that would violate her when helpless. That just doesn't make any sense to me. I am, and have, and think back on those memories fondly. Maybe you know from my regular postings, maybe not, that it's not my way to look for trouble, but some things simply need to not happen. And if they begin, they need to be stopped right now. Not argued at some later date after more victims have been created. I was out to a western bar with Babs and a lady friend of ours. As our lady friend was returning from the bathroom I saw some big drunk shithead following behind her. I saw about half the bar watching them, and most appeared afraid, making it obvious to me that he was a local bully. As they got nearer our table, I stood up and could hear him calling, "Here pussy pussy pussy. Come back you juicy little cunt..." I whispered to Babs to take our friend to the car, and I, without warning, punched him in the mouth. As he was trying to get over the shock of that I hit him about 10 more times in the face, I just kept hitting him until he fell down. He crawled, stumbled, ran through the bar and out the back door and I've never had a single moment of guilt over that in the past 20 years. Some things shouldn't be allowed simply because the law has not yet been past that says that you can't follow a woman around singing a song calling her a pussy and a cunt. Or so I believe. Had we called the police I'm confident that there are no laws against his actions and he would have spent his happy pathetic little life terrorizing other women in the same way. I'm very confident that for at least the next several weeks he had time to consider his actions and decide to be a better person. I'm happy that I could help. I can't really see the idea of allowing people to be victimized and then sorting it out later, as opposed to stopping the victimization in the least aggressive way available and then sorting the rest out later. Above I was confident that polite conversation was not going to solve the issue. I am confident that he didn't do the same thing again any time soon. The world is a better place by Dwayne's reckoning. Am I off in the ditch because I don't now consider our cell phone camera man a victim? I don't believe so. He had the ability to defend himself. He had the ability to stop performing the behavior that was obviously a douche bag move to begin with, yet he chose to stand and continue to commit emotional violence against a defenseless patient. I won't shed any tears over his broken camera. I don't doubt you for a second. You just seem to believe that everything needs to be disallowed by the government. I don't believe that we are mature enough as a nation or a world to accept that we can stand idly by, watch our friends and neighbors be victimized by douchebags and trust that somehow the government will make it all better. You and I must define a mob mentality and mob justice differently. I associated myself with no mob in my previous statement but explained my personal choice of theoretical actions. There was no mob in the bar. In each case I acted as an individual. I'm not sure how to make the argument Brother that the government can't solve every ill. And that every man that chooses to stand up for himself or his family or his neighbors isn't simply a rabid dog because he's acting without proper government sanction. On one hand you seem to be saying, "I have the right to film the police so as to protect myself from the government!" Yet on the other, "You can't do that because the government hasn't said that it's OK!" That confuses me. I'm truly grateful that we disagree on this. I think that your attitude is the future, and we need people that think of the future to bring it into being. But your attitude also has people behave as sheep unless backed by a police officer. It demands that you stand by at such moments and spectate pain in the name of 'progress.' I just don't have that in me... I don't know how, though I did try, to write statements like the above without having any of it that sounds petty, or intentionally insulting. I will ask that you believe that at no time was that my intention. I have huge respect for your intelligence and your contributions here. It was only my intention to try and give as clear a picture of my 'knuckle dragger' perspective as it relates to your comments as I understand them. Thanks for taking the time to participate. No hard feelings if this is getting boring for you and you choose not to respond.

Pox, what the hell? Where did all of that venom come from? Plus, it seems that he's asked you over and over to explain why, if you're using public safety as an excuse to move him, or take his camera, how you'll explain not moving the person next to him. Seems like a valid question to me. Or will you simply move everyone within camera distance? That's a pretty big perimeter... JP is sometimes condescending in my opinion, but it's pretty uncommon, and it seems that this topic resonates with him. I for one, having experience with him here for several years would hope that many, not all, but many of the doctors being produces would be such open minded thinkers. As Doc said, I get JP's point of view. I'm not completely sure that it's valid if you're using the first amendment alone to defend the camera users actions, for the reasons highlighted in my previous post, but I'm guessing that he's probably right. I am confused though JP when you reference the constitution (I think you did) and legality, why you're only concerned with violence and have none for the comments about 'responsibility', 'health', 'privacy' and 'morals?' But again, we live in a world where we're supposed to show our progressiveness, intelligence and open mindedness by standing quietly and being victimized, but I didn't grow up in that world. If someone calls Babs a whore, is he legally/constitutionally protected for his free speech? I'd imagine so as long as he does it without becoming aggressive. Is that going to keep me from knocking the shit out of him and making sure that he never even considers doing such a thing again? Not at all. Even in this liberal world where we're supposed to show ourselves to be better than the animals by being docile and submissive regardless of the circumstances, some shit just needs to be disallowed. I'm grateful for your thoughts....

How about one of you brainiacs explaining Marfans and the cause of the signs/symptoms? And if you Googled that Biebs I'll hunt you down and kick your little Bieber nuts up next to your tonsils... Good scenario DFIB!

I like to think of it as patient advocacy. Though it's all in theory, assuming he was such a prick, assuming that there was no reasonable way to deal with it, assuming that the police and/or fire wouldn't assist. I guess I'm still a bit of a knuckle dragger in the fact that I don't believe that someone's right to be an asshole supersedes another's right to have their health and dignity protected.

Is anyone aware of any specific laws/statutes that specifically protect patients from such people? I've not had an issue with it, and it's been years now since I've worked anywhere that any of these things might apply, but I'm curious....

It's a wiki, so I don't have other references now... (Trying to find stuff in between working. It seems that most laws define freedom of the press and freedom of speech in the same way.) 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]

I've just done a quick google search and can't find anything definitive on whether or not a bystander with a cell phone has the same protections as professional press..And if even so, that's a protection against the government, of which I have no legal affiliation except at tax time. But I'd be curious to see at the next White house press conference how warm your welcome would be if you showed up with your cell phone camera and announced yourself as a member of the press..? And as this bystander cares nothing for my patients privacy and dignity in this case I care fuck-all for his rights as a member of the Youtube Press... I'm not, in any way, claiming to be right, just explaining the way it would end up...

Yeah, that's been my experience too...

If I felt the need to strip her on the street then she would be pretty badly injured, or at least I'd have suspicions that she was. I would explain to the officer that his presence was compromising patient privacy as well as patient care as the patient is fighting me to stay covered (true or not) when I need her to be calm and cooperative. Failing that I would forcefully take his phone and let the powers that be work out the details after the call was complete. Yeah, I know. Everyone has a right to take whatever pictures they want in a public place. I can find another job, but I can't ever come back from allowing a picture of my naked patient from turning up on the internet, if I could have avoided it...

To the best of my knowledge I've seen two pseudoseizures. If I had to distinguish between the two.. First, the pseudoseizures seemed genuinely afraid. At times they would be lucid only moments after the seizure activity ceased and seem to genuinely want me to make them stop, clearly begging for help before the next one began. The fake seizures that I believe that I saw knew better than to do such a thing. The second, when the ER doc says, "Let's go ahead and put in a Foley..." and they immediately start yelling, "Fuck you man! I don't want that thing in me, fuck you! I don't need that thing in my dick!" I consider that a positive result for the bullshit test. And though I appreciate the sentiment TM, I don't think that anyone is suggesting that jail cell/court room plus seizure activity equals bullshit. Only that bullshit, after a thorough exam, is encountered in that environment more often than in some others. Though I've seen many of what I believe to be fake seizures I would never assume that in the beginning. Not because I'm a better medic than those that would necessarily but because it just isn't interesting. It's been incredibly rare that I show up to witness the active seizure so only have a bystander's report of what happened. When I show up and see no bleeding tongue, no poop or pee, no postictal state, then I immediately begin to wonder what else they might have seen and try and catch that. It's just more fun that way...

Your thinking is kind, but in a patient that you need to expose completely you won't want to take that kind of time. I've had issues because I want to expose seriously wounded patients before the straps go on as doing it after takes much longer plus can cause a lot more manipulation of their body at a time when you're trying to keep them still. Some people get pissed because I expose many, in fact most, seriously injured patients where I find them. I know that others like to put them in the ambulance first. I'm just not a good enough medic that I want to let someone bleed for another 4 minutes. With practice you'll find that you can cut the clothes in a way that allows you to see one part of the body and then drag the cut clothes back over it. But boobs and crotches is my only real concern. And they're not a huge concern when time is important. In non critical patients, say, a guy wrecked his mountain bike and skidded down the street on one leg, you may choose to only expose that leg at first. Someone in a rollover accident you'll nearly always want to expose completely. Take them down to their underwear, bra/panties, cover them with a sheet when you can, and then make sure that you see inside of the undergarments when you have privacy, or immediately if you see blood in/on them. The rule is "Life over limb" and certainly "Life over modesty." I saw somewhere, probably here that a big cause of traumatic death is undiscovered injury. I've no idea if it's true, but I'm kind of a freak for getting traumatic patients naked and I've found wounds in some very unexpected places. The short answer to your question is that there is no one rule. As long as you worry about life and doing what's best for your patient first, and let all of the other crap sort itself out later, then you won't go far wrong. In the scenario presented above if the person is in the street secondary to being ejected, I can guarantee you that while Fire gets the cot and board and my partner sets up for a trauma in the back of the ambulance I'm going to get the patient naked. Ejections are almost always really ugly on hard surfaces. Fire will, if they're not idiots, bring a sheet and while they are boarding, I'll be assessing for life threats and about that time we'll cover the patient with a sheet...OVER the straps so that I can get access anywhere that I want. And for the record? Everyone peeks at naked people. It's all part of being a sexual being. There's no shame in looking, and even being impressed, as long as the thought is fleeting and you get back to work. I know you didn't ask, but everyone wonders, and too many feel guilty for being human. The first time you cut the clothes off of a Ms. Universe type body, or a penis that rightfully belongs on a pony, it will get your attention. No harm there...Just sayin'... Good question! Maybe what you could do is present some more scenarios that you think might be confusing and allow others to give specific opinions. But you need to be more specific about patient presentation, because nearly all answers will be based on that. Plus, presenting scenarios is wicked good for creating logic trees in the newly developing EMS part of your brain. Just a thought...

No disrespect to you Brother, but this is one of those pieces of advice, given by anyone that's ever taught or learned pretty much, that I completely disagree with. Read your book and spend your class/lecture time learning to understand what you've read. I've hated taking notes since middle school. What the hell was everyone writing so furiously that wasn't already in the book to be studied? In context in fact.... I would read the chapters before class. Then re read them with a highlighter trying to highlight just those things in the paragraph relevant to that paragraph and the subject matter, ending up with each paragraphed being significantly condensed by the highlighter. And then condense the the highlighted material further onto hand written flash cards. By the time that you're done you've read the material three times, condensed it twice, and written it once. Somewhere I got convinced that condensing material is a great way to understand it, and it really seems to work for me. Then, come class time, I'd use that time to listen, discuss, clear up anything that wasn't clear. Doesn't that make more sense??

Man, great advice from all... I would add only this, as I think that technique is often focused on and it's missed... Try and create a useful document. This is a record of a person's life, and sometimes death. There is nothing wrong with Kiwi's version of a PCR that I can see. In fact my car mechanic uses nearly the exact same format. But we're not working on cars, and the physical/physiological absolutes are rarely going to be the only things that I want future care to understand about what I found, what I did, and why. It seems obvious, right? I don't think it is. Some create to cover their asses, others to brag about their clever brevity, some so that no one can get anything useful out of it to take to court. Some are great at abbreviations and 300 character PCRs, but I'm not convinced that those always tell the whole story. We're patient advocates first, rockstar medics that can create technically correct, brief, bragable PCRs second. Your notes are moments in a person's life that will be the only window for other medical professionals to see through into those moments. Make sure that you don't fog that window by trying to be clever instead of thorough. I once heard a medic brag that because she's been chastised for using too many abbreviations that she wrote several PCRs without ever creating a whole word if she could figure out a way to avoid it. She was a bitch, and a shit medic, and the only type of person that I can think of that would be proud of polluting a patient's records with such nonsense to make a point. Abbreviate often if you like, or, like me, almost never, but never forget that you're telling the story of your time with an honest to God human being that not only trusted you to care for them, but trusted you as their liaison to further medical care as well. Your PCR should clearly show that you are deserving of that trust.