DwayneEMTP

It seems to me that she asked a pretty interesting question. I read back through the thread and still fail to find the point where she's done more than that... When did your entire life suddenly need to be lay bare to ask a question? She asked, now you all are going to debate the status of her health and her character? What the hell is going on? Maybe she's a chick, maybe a dude, maybe sick, maybe healthy, how does any of that relate to her asking a pretty simple question? We seem to have a trend where no one, particularly new folks, can leave themselves even the slightest bit vulnerable without someone getting a hardon (yeah, that seem appropriate as I don't see our girls doing this) by jumping all over them. It's not that hard to beat up on new folks, much harder, but certainly more respectable to mentor them instead. Do I have to be missing a limb to wonder if someone that is can work in EMS? Do I have to be a criminal to wonder where the lines are drawn for previous criminals to get involved in EMS? What the hell is going on?

Thanks so much for posting that... What a miserable situation all around...I'm guessing that that patient was a bitch to try and manage with one provider, though I'm guessing that his ultimate outcome was likely clear before they headed to the hospital. It sounds like an actual investigation occurred with criticizm, likely deserved, (As it's hard to imagine coming out of that call having created nothing that someone could criticize.) for all concerned. Pretty cool.

It might be easier to give a better answer, if only a guess, if we knew why you were asking....

My knee jerk reaction is that everyone in our country in a professional capacity should speak English, but I'm also pretty confident that there are a ton of issues indirectly related that I don't, and may never, understand. So I'm going to abstain except for the comments below. Having worked with with many cultures now that I shared little or no language with I can tell you that I find that sharing a language offers very little in regards to emergent medical care. It's very often, if not most often, when treating patients that speak English that the information that they give me is slanted towards what they think that I want to know instead of giving answers to the actual questions. They often have a hidden agenda that queers their conscious presentation as well as their responses. What is your pain level? "10/10". Do you take any drugs? "No." Where does it hurt? "Sort of over here, but here too, and over there it hurt yesterday." I rarely believe anything told to me if I can't verify it another way, so sometimes in emergent situations things are clearer and simpler when no conversation is available and I'm forced to start in the basement and develop my DDx from physiological markers only. Do I wish that everyone that came here had a desire to speak English. Yeah, but I don't know if that's right or wrong. Do I believe that a person needs to speak English to be a good medical provider? I don't, assuming that we're speaking only of medicine and not documentation, hand-off reports, etc. So, bottom line...I have no idea why I posted this crap and cluttered the thread when I have no idea what the right answer is, only that I refused to delete it after taking the time to type. I'm really interested in the supported thoughts of others on this subject though...

Welcome man, it's good to have you! MI is well represented here in both attitude and intelligence..I look forward to your thoughts.

You know Needles, it's easy at this point to think, "what a bunch of assholes! I was in a tough spot, you don't know what it was like!" But we do man, cause we've all been there, mentored students that were there, and if the term 'major fail' hurts your feelings...it shouldn't. Stack my list of fails against your and yours will look nearly nonexistent. But if I hadn't been taught another way after those fails I would have continued to do things that I'm ashamed of. I'm sometimes ashamed here when I compare my knowledge to others, but I'm rarely anymore ashamed because I was unprofessional, immoral, unkind, or unethical. And that's really important to me. This isn't about making you look stupid, but trying to be really, really clear about some core EMS concepts that are mushy in your mind but need to become rock solid. And trust me..if this thread has made you feel badly...read some of my old post...you'll feel friggin' vibrant afterwards...

You need to immediately decide if you will make every critical decision based on whether or not you will get written up. Accepting a call that you believed was inappropriate for you because you were afraid that you would get jammed up? Major fail. Being to 'scared shitless' to call for an intervention that you were confident was necessary? Major fail. I'm not trying to bust your balls brother, but it's already past time that you reevaluate the reasons that you entered this business. If it's to be a 'cover your ass' provider, well, ok then, you're on the right track and will fit in with the majority of those that you work with. If it's to be competent and do actual good for your patients, you're completely off in the ditch. I like you here, love your posts, hope that you'll stay, but most of all hope that you can take my comments literally and in the spirit intended. A year from now, depending on the provider that you choose to be, you will be embarrassed by the post above. How do I know? Cause I've got a million of them. Just search my early posting history here...But better to be smarter and humiliated later than continue down the wrong road because no one cared enough to tell you to turn your headlights on... Keep the faith my friend... Dwayne

Steve, what a gift it is to have you here. Amazing posts, all. Thanks for sharing your thoughts...

As the question regards getting certified, I can't think of any reason that it would cause you any grief at all unless the terminal illness is contagious. I can't think of any questions on any of the forms that ask for such information. None asked if I had both arms and legs, lung function, mental status (maybe, but I don't think so), nor an estimation of my projected life expectancy. I've seen about a gazillion 400 pounders get certified and if you're able to consider taking an EMT course I'm guessing that you're healthier than they are. If you're in class, rock on! Keep your health info to yourself unless specifically asked and enjoy the ride. Unless the illness makes you mentally and/or obviously physically unsound I can't really see where it's an issue. Not the use of 'obviously.' I've not gotten involved in this thread because I was pretty confident that it was meant to turn to 'poor me'....I'm sorry I thought like that as it certainly doesn't seem to be the issue. If you're in class then I'm guessing that you're speaking of an illness like Huntington's as I'm having a hard time thinking of many conditions known terminal yet would leave you healthy enough to pursue a physical career like EMS. Just keep your personal information personal and if your days are truly numbered, then screw the rest of it, right?

I've little experience with partners, only having had a half dozen basic partners or so, but I think the stereotypical "Spike my fluids and carry my bags" ideal of a basic/medic partnership is most often not accurate. For instance my last basic ran almost all of our arrest where IV access and meds were concerned because he was really good at it and we often had a dozen or so vollies on scene that needed to be monitored and utilized as well. After I had time to get to know him and his work it was common that he would begin more advanced assessments (lung sounds, pupils, abd palp, etc) and interventions (push drugs, apply CPAP, etc) while I did the "lesser" jobs of starting an IV because I could easily do that while gathering a history which I felt was the more important goal for these patients. Sometimes he was given these duties because I was confident that information from others was really important for the diagnosis and I wanted to gather it in my own way, in my own order. Other times because I knew he was to become an medic student and it was good for him to use those tools. But always because I became confident that he would do everything to the best of his ability every single time. Very often better than me. He was, and continues to be, the only provider that I've ever known that goes into every call with gloves on his hands, safety glasses on his face, and an N95 in his pocket, yet not have a whackerish bone in his body. I've heard of teams where the basic was nothing more than a helper and a driver, but I've never personally known any medic that would stay long with a partner that s/he viewed that way. That type of partnership has to be ego driven, as most of what we do can be done by many, and not allowing people to explore the boundaries of their abilities is just contrary to what most of the decent providers that I know consider kind and/or interesting. Not sure if that helps.

But you get that's it's a survey for the purpose of studying memory as it applies to solving immediate emergent medical issues, right? Medcon and written protocols would by synonymous for the purposes of the study, or so it appears to me. And you're always a pain in the ass...No study needed there! :-)

I would think that in the first instance it would depend on your goals. Do 'you' intend to move onto paramedic? Is your goal only to volunteer at your local fire station? What is the level of care provided at the basic/basic service that you're looking at? I can't really give an unbiased answer as I found the City as soon as I began considering becoming a basic, so I can't imagine making a decision that would lead me down a path that contained less chances for increasing my education. The downside to a basic/basic in my opinion is that you would have a built in intellectual glass ceiling. You would learn from, and your behavior/decisions scrutinized by those at more or less the same level as yourself, and there is much less room for growth there than if you were in the same situation with a more advanced provider. Also the opportunity to learn and possibly practice above your scope of practice would be eliminated. The only reason I could see to choose a basic/basic system is if 'you' were a whacker that just wanted to strut instead of advance, or if there were no other options available. Of course this assumes the opportunity to choose to gain experience in a progressive, professional organization, as there are many services that allow little more for their medics than some services do for their basics. I'm curious as to the catalyst for the question, though of course it may be personal and that's more than fine...

it's more about wanting to be better and smarter than experience... You're more than welcome here. Feel free to participate!

1 C, funniest friggin' story I've heard in a really long time... I know it sucked, but the visuals and the telling were priceless!

Man, I wish I could figure out how to say smart things in general, but most of all, smart things distilled as above. +1 What a ridiculously amazing thread this is. I can't really imagine the thoughts that go into treating two patients with a single intervention in a life or death scenario. I've never had to do it. I've now seen death in most of it's incarnations, but the emotions wrapped up in losing the late term pregnant patient seems like it would be different. I don't think that I've ever run an arrest without considering the effect that it was having on the family as a whole. Losing a mom, or spouse, or parent. I'm grateful that the EMS Gods haven't seen fit to have me sort out the emotional abstraction that must be caused while participating in someone's reality of losing a lover and a child all in the same breath. Mobes, you amaze me constantly, but bringing this call, and laying yourself naked before your friends here sets, once again, the most amazing example of the things that are right in paramedic medicine. Amongst a polluted profession of errors and misconceptions I'm grateful that you had the strength and kindness to remind us that we're a family. That we're stronger for leaning on, and learning from each other. That as we learn as individuals that we're obligated to teach, and council, and heal as a group. And I love that you bring the perspective that we can cry without being permanently damaged, that we can care without providing emotionally retarded care, that we can at times be cold and mechanical without also needing to be inhuman. Epic win. Sometimes I hate my job. Sometimes I get really angry at the comments here. But when I see those uncommon times that our docs, and nurses, and medics, RTs and firemen, from very farthest reaches of the planet come together to say, "We're different. Sometimes I think I'm better than you, other times I'm intimidated, at times I want to choke the shit out of you, but at the end of the day we're family, just doing the best we can as one team..." I can't really imagine doing anything else.. Good on you Mobes. I'm grateful to be part of your team... Dwayne

Thanks DFIB, you'll smoke it... Hell, if I can do it you're a friggin' shoe in...

And I'd heard, though unverified as I don't remember where, that it's now 48hrs, as the stress from the last call may have been the catalyst for the death... I'm gonna let that one rest...for now anyway...

Sorry 1 C, not one of my better days, you may not have had that coming...

You know Admin, after sleeping on the video I maybe feel differently now. If the adaptation process means that a person will be wrong 50% of the time than I guess it makes sense that the test would seem ridiculous... I don't completely reverse my previous opinions yet, but thanks to your information, I really have to give it some thought and see how much is poor question development and how much is simply the unsupported 'flavor' that I was left with after the test causing me to form an incorrect opinion. Thanks for taking the time to post the vid..that's cool as hell....

Kiwi, I 'unaproved' your post. It doesn't delete it but leaves in invisible in the thread for other mods to see and decide if it's appropriate. I know for a fact that you're more than smart enough to understand that by posting all that you did you'll queer this person's survey. What the hell is going on?? Do the survey, don't do the survey, but why all of the attempts that seem to be simply trying to destroy the effort?? I took the survey and can't for the life of me see where it's trying to 'villify' anyone. It appeared to me that it was trying to gather information about decision making starting from reading protocols on scene, which I've done a couple of times, to general feelings to specific thoughts from the past, exactly what he claimed it to be. It's a survey!!! The OP came here in good faith, was respectful, asked for help....I'm really frustrated at people's apparent desire to post for the sole purpose of making sure that his time here is wasted. 1 C we're all very impressed that with your disdain for the survey. Good on you man. You're post couldn't have been more productive. Kiwi, what the hell were you thinking posting specific questions and your opinion as to the proper answers for each? Give me a fucking break. I think the subject is interesting. But whether any of us do or not one of our EMS brothers came asking for voluntary help, what do you say that we leave him be, help support his project, and try for a friggin' minute to allow something positive to happen?

Guys, enough is enough. Stop polluting every thread with this bullshit...

I didn't really get the impression that anything was being promoted. I was impressed with the fact that it seemed to be trying learn what I do, and how much of the information came from a document in front of me, a general feeling of the conditions from previous patients that I've treated, or if I pulled up patients very much like the one presenting specifically. I'm really curious about the answers, I hope most will tell the truth.

That did help actually. I still hate it, but it sounds like the intent is good... I'm not sure how money came into to tell the truth. But I guess if cost of testing is our only standard then we really do have it good. From a point of view of testing for competence, I'm not so sure...

So, I just recerted via test on the NREMT CBT (National Registry of EMTs Computer Based Testing) I had a ton of time to prepare, but as I considered doing so decided that as I've so arrogantly crowed that it was a ridiculously simple test that it would be hypocritical to do so, so chose to go in with the info in my head instead of studying. I felt that if I couldn't pass the minimum standard to be a medic without cramming, then I really shouldn't be a medic. I knew from the first 10 questions that I was completely screwed. Many of the questions revolved around "What is the most likely medication that they would prescribe after hand-off at the ER?" (The listed medications most often being PO pharms for disrhythmias) I decided to follow my own advice and take the test as a basic and only answer as a medic when forced to do so as well as follow the multiple choice test taking advice that I'd been given in the past. One question resolved, after eliminating the 'throw away' and 'distractor' questions to 'Hyperadrenalism' or 'Hypoadrenalism' terms that though I could imagine the possible root pathologies referenced I'd never specifically heard before. After Googling I certainly recognized Cushing's disease...I'm not sure why the terms didn't resolve to the same thing in my head. It was convinced that it's time for some serious review. The test shut off after 92 questions, the only thing giving me hope was that the question that it concluded on I was 100% sure that I'd gotten correct. After finding that I had in fact passed I at first wanted to cry from shame that I'd chosen a career that consider such a test appropriate, then got kind of excited that I didn't have to try and find a recert course, and then wanted to scream from frustration that I'd passed with so little confidence in my performance. Having failed would have been a pain in the ass, but would have at least allowed me some respect for the testing process. I can think of almost no questions on the entire test that would have come up had two intelligent medical providers been talking. (Daily our truly intelligent providers prove to me that I have no right to make such a distinction, but you know what I mean.) What a complete waste of resources. If the NR would spend half of the money that they spend convincing people that they are creating a national standard on actually creating a test that was a logical national standard then perhaps we'd have something.... Grrrrrrrrr.....

I've completed the survey, though I'm not sure if I did much good. I have a couple of comments with though my comments should be considered in the context that when doing a Masters thesis that you're so far beyond anything that I can understand that it's like a 6 year old questioning Carl Sagan about gravitational physics.... The word 'referred' was used often in relation to protocols. I always chose 'never' (I'm being purposely vague as I'm not sure if discussion on the forums might queer your results.) with the belief that it questioned the physical act without regard to the mental, and I'm not sure if that was a correct assumption on my part. I also often chose 'other' with an explanation such as, "A combination of a general understanding of the underlying pathology combined with memorized protocols." and am again not sure if I was staying in the spirit of the intended questions or just being an idiot. It was really interesting to explore my decision making process. Will we be directly privy to anything interesting that you might discover through your research? Thanks for allowing us to participate as well for the respect you've shown with your introduction and explanations. Have a great day! Dwayne