DwayneEMTP

How are you using the bag? I'm not seeing it...unless it's a really, really huge bag? (Edit: My response assumed the terms 'infant' and 'baby' to mean any sick child. I was a little slow on the uptake when translating to 'newborn.' But my questions still stands.) I like mom the best too. Of course we're about to start a massive flame war about inappropriately restrained mothers and infants. It seems to me that mom not only to gives you a self regulating heat source but an emotional buffer as well, which can, again in my experience, make a huge difference on all of the respiratory distress calls that these youngsters seem to generate, as well as any call that can be positively influenced by trying to emotionally, instead of chemically, manage rates and pressures. (I have nothing but my anecdotal evidence to back my claims.)

I don't have the slightest idea how to talk you past that, or what I would say if I did, and then something awful happened. If you can afford to stay, and you feel that you need to stay, then you should follow your heart. I won't say that that's the right thing to do, as it sounds like a pretty toxic place if most everyone in your family has been damaged there...Man...these are never easy decisions. I know that you're going to stay, and I wish I had a way to convince you that the flight job was shit so you wouldn't play the 'what if' game later. Yeah, I don't. Screw flight. Do your thing at home until you're done, go remote, have some big fun and make a small, but real, difference...

(Edit: I created my post while working, over several hours. So both Steve and Herbie posted while I was in edit mode. It's not my intention to continue the conversation if no one wants to. I just refuse to delete it at this point is all.) (Edit II: To tell the truth Steve I've not found any support of your argument in your posts other than you're belief that it is 'morally' wrong, and that it is currently PC so it must be correct. I'm truly trying to see your point of view but "It's just wrong" continues to fail to convey the reasons that you seem to steadfast on this subject.) Fair enough. But just to be clear for those that don't know me and may only read this in the future, I'm only arguing for a persons freedom to associate with whomever they choose in the privacy of any place that they create with their own money when no one else is harmed by that. It just seems to me that your stance disallows differences in people as well as an inherent 'sameness' in some ways in people as well. Disallowing women does not only disallow breasts and vaginas but the cultural, sexual, and emotional aspects that can be expected to come with those anatomical pieces. The same can be said for race. I have nothing against the Chinese. But with my limited experience with them in Mongolia I found many of their social norms really rude and frustrating. At least the limited number of Chinese in that environment seemed to share them. I love them, I want them all to be healthy and happy and to spend their days laughing, but if I had a private club I wouldn't be inclined to open it to Chinese tour buses based on my experiences and resulting expectations. It's not about better or worse, simply different. Your argument seems to disallow recognition and recreational separation based on those differences without seeming to believe that someone is being harmed, or those doing the disallowing are doing so out of a belief of their superiority and/or a desire to harm, and that confuses me. I want everyone to be able to excel and find happiness in whatever way that they choose. I just don't see where infringing on one person's right to pursue their happiness with whomever they choose impinges on another persons right to find happiness as well.

It sounds like you're wanting to work within the system without being bothered to 'work the system.' One thing that remote medicine teaches you is that when you go into a mature culture, regardless of the frailties or negative issues you may find, you will never be big enough, or smart enough, or strong enough to man handle the system to your way of thinking. (Yeti, sometimes you're an asshole, but even I'm learning...little by little, by following your examples.Yeah, I know...hard to imagine.) It sounds as if you believed that getting onto the committee was the hard part. I'm guessing that you're coming to believe differently now. Making changes within the system, trying to bend the system to your ways while playing by their rules, that is where the challenge begins. Every yahoo on the planet can get appointed, as proved by your 'I don't do statistics' guy, but do you have the stones to figure out how the system works and make positive changes? Some before you have, as evidenced by the more progressive system that you already enjoy. You're one of the smartest, most dedicated people that I know, but ultimately, the proof is in the pudding. You hope that you'll get away from your current partner so that you don't have to try and improve him, hope that more tact might help improve the committee relationship, but those things are changeable now...I've never seen anyone better at it than akflightmedic (Yeti). Everyone follows him, no matter where he goes or what the project happens to be, and they are happy to do it. Everyone thinks that they are in charge despite the fact that they are all moving in the direction that he's chosen and planned for. You've done the important, but easy part, by placing yourself in a position to be noticed and where you can have a voice in change...now it's left to see if you will be happy with simply talking about it, or if you'll find a way to actually cause it... My money, as always, is on you Brother...

No worries Beibs...I just really want to figure out why it's happening. I think part of it is that you, Matty, Josh and a bunch of other really strong posters stopped posting. Not sure, but you all were certainly good, positive catalysts for the threads... We'll work on it. Every time I come up with one of these beefs I end up finding out that I was often the worst offender...

Yeah, didn't mean you Chris, as I saw that you'd only asked for evidence of it's validity as a physiological marker. I have no problems with that. Your posts are always worthwhile. I don't find the above compelling either, but it appears that I'm the only one that searched at all. But despite not finding it, so far, to be a valuable diagnostic device for me, I did find the concept interesting, and the search turned up a lot of things that I hadn't known before. I would have enjoyed the discussion. More I was addressing the attitude that I perceived in the thread, that I found, and find confusing. What I believe(d) to be the willingness to discount the idea presented without even understanding it, giving it a value of X, and then state than another thing has more value. My Idea is greater than X, though X was never defined. See what I mean? I don't know man..I'm getting older, and maybe crankier, certainly dumber, but it seems, and perhaps this is just my rose colored glasses coming into play, that we used to give a persons' thread some respect and attempt to explore the idea that they found interesting, or choose not to participate. Now it seems that a blase' "Whatever..this is what I've heard" is more the norm. Where did the hunger to explore, to debate, the need to jump on board with a contrary opinion simply to see where thinking differently might take you, go? It seems that only the average Joe is really welcome here lately. If you're new there are to many that can't wait to say, "Ha! You're an idiot!" and they're gone. If they're posts are above average, as I believe this posters often to be, there seems to be an attitude of, "Don't bring your uppity shit here. We're really not impressed." and they're gone. Or maybe it was always this way and I'm just remembering it wrong. Anyway, speaking of disrespect for someone's thread...my apologies for derailing this one. I'll continue this in another thread... Dwayne

"Conclusion: The SI can be a valuable tool, raising suspicion when it is abnormal even when other parameters are not, but is far too insensitive for use as a screening device to rule out disease. A normal SI should not lower the suspicion of major injury." (Journal of European Emergency Medicine, 2011) http://journals.lww....ntiating.8.aspx A Google search seemed to show that though no one here finds any value in it that physician level medicine seemed to take it at least halfway seriously for more than a little while. I'm surprised, particularly in this group, that so many were willing to say "I don't really get it, but I'm willing to say that it's no good, particularly when compared to X." "I don't really know how Amiodarone works, but Lido is sure as hell a better option, I'll tell you that." If you don't understand an idea, one that I've found listed on many physician level sites and in many scientific journals, how then do you decide it's relative prehospital value and then even compare it to something else? I long for the days at the City where this idea would have had the entire thread trying to figure out why it might work, and/or intelligently proving and explaining exactly why it might not work instead of saying, "Meh...It's probably nothing..." Or at least understanding it enough to be able to intelligently compare it to something else. My guess would be that in most cases of 'the unknown v. the familiar' that familiar is a hands down winner. Unless the unknown is easier and/or looks more macho when being performed. I'm curious, to those that claimed that MAP is a more valuable tool, without Googling, can you explain the value that some have attributed to SI, and in what areas they have found it? What are the relative strengths and weaknesses that were discovered in those areas? And if you can't do so, how can you make an intelligent comparison to MAP, or anything else for that matter? I spent about an hour this morning looking into it and though I still don't really get it there seems to be significant interest in it in diverse areas by folks way above our pay grade. Just sayin'...

I read that joke and the part of my brain that seems tasked with coming up with as many possibly plays on the scenario as possible was lit up like the friggin' Fourth of July...but not one funny thing actually came to fruition... Still a good joke though...

Damn it! I had just typed that exact thing but you beat me to it! Sometimes life's just not fair.... (Ok, so it's possible it wasn't EXACTLY the same...)

I was going to make a joke about some medicine that you take for stomach acid, but even I'm not a big enough ass to joke about ANZAC day. I'd actually wondered if the Kiwis were involved, I really didn't know...my apologies for being too lazy to look it up...

But Kiwi, the question wasn't only whether or not it should be taught as a diagnostic aid, but if it should be taught as an adjunct teaching aid to help clarify other more complex issues of perfusion at the EMT level. Why are you guys so quick to say that this is shit? It's an intelligent question presented in a respectful intelligent manner...Perhaps in your infinite wisdom maybe you can explain from a physiologic perfusion point of view why it makes no sense? Maybe I'm just getting City burnout, but these kinds of posts are really starting to piss me off... But I guess if it's not going to change treatment, then it can't possibly have any value...or have you maybe spent a shitload of time battling that ridiculous statement in the past?

Thoughts for those that died, those that suffered, and those that remember for this special day... I know I'm late, but was with you in spirit, but not unfortunately with internet in the jungle... Cheers boys and girls... From the Womacks in Colorado to our Aussie brothers and sisters...

I don't see the value in it as a tool either, though don't read that as a belief that it has none. As a teaching tool, it's hard to say without understanding the correlation of the numbers to hemodynamic/perfusion status. Is there a better description of the relative value of the numbers other than what's given? "0.5-0.7 is believed to be a normal shock index." I don't really know what that means...The value considered normotensive and/or non shocky? Could you possibly give a quick primer with patient examples showing how it might be applied? Again, I'm not making fun of it at all, I just don't get it, but I also, after significant consideration, see no value in the GCS that so many do either. When I ran numbers that might worry me, depending on patient presentation, such as p120, s140 when imagining a compensating patient, or p125 s156 it gave me numbers near the "normal shock index" range, though I would be concerned about those patients being compensated, possibly significantly so. Maybe it's just my little brain works but I'm happier with a 90/40, 130, patient because at least I'm confident that I'm not waiting for the compensation failure but have a relatively 'solid' baseline from which to work and trend. I've also found that attempting to berate patients that I'm confident are about to crump, but present fairly well hemodynamically, into conforming to my expectations has limited value, if any. Though I've seen no studies on the subject. Anyway, again, way to long winded, but the point is meant to be that perhaps it's my relative comfort with decompensated patients over badly injured/ill compensating patients that causes me to miss the value of the calculation. I would argue though that if the concept can be shown to have some predictable relationship to overall perfusion status that the value at the EMT level would be limited unless you're drawing students much more qualified than those that I've been exposed to. The majority, again, in my limited experience, are most interested in finding an Iphone app that will give them values each time memorization or calculation is confronted. (In no way am I pretending that I wasn't that same student, though Iphones were not an option when I became a basic) I would personally like to see that relationship severed. Interesting discussion I think...

Mentally, professionally, morally, ethically, emotionally.... Great point.

I'm sitting here right now wondering if my moderatorship gives me the power to change your name to Capt. Understatement! (Yeah, with the !, maybe more than one.) I miss you, and think of you often, but you are without a doubt the most pigheaded woman, perhaps most pigheaded person of any sex and/or species that I've ever met....And yeah, that includes pigs... Just sayin'...

Remember on the practicals that you practically (no pun intended) have all day to do each one. When they ask, "Is there anything else that you would like to do or say?" Say, "Yeah, I'd like to verify that I arrived on scene with proper PPE. That I verified that the scene was safe?" etc. Too many people believe that the proctors opinion matters in the practicals. But they don't. They are a fancy machine for reading a paragraph and then checking little boxes for things that you've completed, or not, for things that you haven't. Do your thing, then verify every one of the 'fail' points again, then you can answer that there's nothing else that you would like to do or say, ok? Just my two cents worth...

You know, that joke is hilarious to me for some reason, but made even more so when being posted by P_Instructor....

Where did you get your medic in Arizona? If your test is Tuesday, then stop studying now...truly, it is important. Do a search Brother and you'll find a wealth of information. Some of it very recent. I'm truly not trying to brush you off or berate your for not searching, I just want you to be able to have access to those threads..most are really, really good!

Well? How did it go? How is it going??

Sorry Brother, my post really wasn't meant as a "Did you search first, stupid?" reply. But after all the times it's been said I wasn't sure how to phrase it so that that would be obvious. I agree with you completely. There is very often a little life left in the dead horse, but sometimes you'll miss some of the best/better posts if you don't look back because people don't repost them. That was the spirit intended... Your testing date is past now, right? (Back in PNG so can't remember what your date is)...how did you do? How did you feel about the test?

My guess? I won't be long before he has to launch a defense against an attack of him being an enabler.... It will be interesting to see if he thrives!

I'm truly not trying to be a butthead...But on this subject, do a search or look in the 'testing' thread. I'm excited for you! I just retook it after a really long time away from the books and did ok. Relax. Breath. And trust me...stay away from your books! Either you know it now, or you don't. Cramming just screws everything up. Good luck. Report back, ok?

Hey, welcome to the City NG. First, and you'll think that I'm joking, but I'm not, if you're hot then you'll have a lot more trouble. It's truly one of the crosses that you'll have to bear unless you get yourself into a more progressive system. I've known some shitty medics that were hot that did fine, and some unattractive girls that were rock star medics that did OK, but I've never seen, and again, my experience is limited, a hot rock star medic that wasn't treated differently unless she worked for a rock star service like Flight for Life. (I'm comfortable saying that about FFL in the Springs area, perhaps that's not the case everywhere, not sure of their national standards/reputation.) Second, if you don't need to stay in such a toxic environment I can't imagine why you would choose to do so. If you have a roof, your kids have shoes and all that, and you can keep them without being there, then run away...the sooner, and faster the better. I can say with complete confidence, without even one peek at their protocols, that if your description is accurate, then that is NOT a progressive service. It really is that simple. All of the berating and back stabbing is just a bunch of senseless dick/(vagina?) measuring. It shows a service that is still lost and childish. Perhaps those with more experience with more services than me can think of some, but I've never seen even a half ass'd service that treated employees like shit, but patients like kings. All of that aggravation, excuse making, pettiness, runs down hill and all of that aggression is coming out somewhere. There is the whole nonsense hosemonkey tradition of 'trial by fire' which gets people's nipples hard despite it's value in creating and maintaining competent professionals having gone down the tubes sometime around the demise of the Pony Express. Dust said it best here a long time ago, "I get treated like shit because those that trained my trainer treated him like shit, now it's his turn to take it out on me. But soon it will be my turn! Yay!" And the whole bullshit cycle continues... I would much , much rather try and be a good medic in a more restricted, though kind and respectful system than to try and be a good medic in a more medically progressive but mentally/emotionally regressive system. I'm not sure what your goal as a medic is when you say, "Better", but I'd bet dollars to donuts that every single kind, patient medic on this board (myself excluded as I sometimes fail at kind and trip over patient, and am not the sharpest knife in the drawer on a good day) would run circles around the shithead that was voted this months' 'hero' because he dropped a tube or decompressed a chest. Good to have you here!! Stick around...I look forward to your thoughts. This is such a huge, major, disastrous issues that I hope that you'll participate in this thread for the benefit of all... Kaisu? You here somewhere girl?

That's a good question, but based on my personal experience, which is slight, I'm going to doubt that involvement has way more to do with dedication and personal mores than pay. Also, just a heads up, but people will likely want to know more about you before they'll be willing to give very much personal/privileged info. Maybe not, but I would...as many, many people come here for information that they want to use for a purpose other than that stated. My current medical director is from some country where they speak a language that even when using English words I still can't understand at all, my last one from India, the one before from South Africa...so, as you can see, I can't be much help at all...(So why am I still typing? Not sure exactly....But I'm going to stop now...) Good luck

I see your points Steve, perhaps I made too big of a leap trying to exaggerate for clarity. I think that we go different ways on this in three areas. The first, I continue to fail to see why you should be allowed protections on who enters your home when others are not allowed those protections on properties that they've purchased and maintain with their privately earned/spent money. This is not a public club, but a private club by invitation only, which continues to make it synonymous with your home in my argument. Second, I don't believe that women have been discriminated against unless there is harm in some way. Women are fully able to create their own clubs. Intellectually, emotionally, financially there is no need to force them into such clubs (If that was the argument here, extrapolating again) and it would appear to me that the disrespect comes from assuming that they need to piggyback on men instead of find their own way in such a thing. It's interesting to me when you say "...This test is indeed biased. It's biased against people who are not physically fit enough to do the job. In a selection process, this is a perfectly acceptable bias. It's acceptable because it pertains to an actual standard of the expected job performance and because it can be applied to every human being who shows up to be tested.." as it sounds to me as if you are then protecting, as the fire services have been famous for doing for generations, your own 'brotherhood bias' as you don't have to be in this business long to know that many, many firemen could no longer pass such a test, making the test bigoted by it's nature, don't you think? It's applied evenly to 'everyone that shows up' but not everyone that may be responsible for those physical standards is forced to show up, right? If I took a poll here (Which I'm not doing, so please everyone, don't litter the thread with testimonials) nearly everyone could tell story after story about 300lb fireman happily working in the same services that turn women away for not passing the physical fitness that a large percentage of the Old Timers would also fail. Perhaps you work in a more progressive system, but can you honesty say that I'm making up this part of the argument from whole cloth? And lastly, you seem to bestow a 'sameness' on men and women that I don't. You don't seem, and I'm of course making a generalization here, seem to see a place where men and women would choose to be socially separate. But I do. I love women. I love them fat, or skinny, or tall or short, or whatever....I love their energy, their strength, their differences. When I went to Afg I told Babs, "I'm not going to love or hate anyone, that's just to complicated for me. I'm just going to go and learn to do better medicine." But within a month I celebrated every time I heard of a dead Taliban and I didn't want to be within 20 miles of a woman if I could help it. There the sexual harassment stigma was so powerful that if you were accused you were immediately sent home, most likely never to return, an investigation was initiated, and you were at some later time sent a letter giving you the results of the investigation. There was really no defense and I knew of two good people that were attacked and eaten by this monster. When women were present no one, and I mean no one, would cuss, tell jokes, watch shows that might contain something as racy as a woman unexpectedly showing up in a bikini. Casual conversation ceased, and believe it or not, in that environment, casual conversation was really important. All 'normal' life became tense and nearly militant in an environment that was already to much of both. Because this is how 'women' are? Of course not, but because one or two of the thousands of amazing women in that environment used sexual harassment as a tool for progression. I really hated the attitudes that I developed. And I didn't and don't dislike women, but became afraid of them in that environment, as I had/have a family to feed. I couldn't chance being friendly as that chance could result in my inability to provide. I can see where a club filled with powerful men, or powerful women, would choose to eliminate that threat, and I do believe that they should have the right to do so. Should blacks be allowed? My single answer is 'no.' But that would not represent my entire thought on the subject. But my argument would not change if we were speaking of race instead of sex. If I had the money needed to create such a place I can't imagine that I would want to draw those kinds of lines. I'm old enough now to have seen that most of my stereotypes and preconceived notions have had major flaws and some of my best friends came from places and types of people that I would have chosen to avoid had I been able. But it seems to me a very American concept that if you want to build something with your own money, that harms no one, then you have the freedom to do so, and I agree with that morally and philosophically, with few exceptions. I'm truly grateful for your conversation, particularly as I know that this isn't a subject that sparks your interest as a 'hard' issue. I get the impression that you've participated only to be respectful by way of not ignoring my posts...and that's cool as hell. But I believe that this/these discussions have value here, particularly in the EMS environment, as so many have never gained, or have maybe lost, the ability to debate, or argue, or even disagree without without anger or a near instant defining of absolute answers. I'm not claiming to be good at it, but I do enjoy it and the mental gymnastics that an intelligent, contrary opinion creates. I find that it improves my logic, and my language, and almost always broadens my mind. I think those are all good things whether we're speaking of intubations, the relative value of religion in our schools, or the acceptable parameters for relative discrimination. It's likely that we won't solve this problem, though I would truly like to come to better understand your point of view, but perhaps we can help to set a decent example for discussions in other threads for those that come after us. And trying to do such things, I'm willing to bet that on this we agree, is the responsibility of all of us. Thanks for your time. Rereading my post I'm confident that it exemplifies your point on brevity when compared to those posts that ramble for pages without actually saying anything... I'm working on it, I swear I am....