DwayneEMTP

Welcome to the City!

Yeah Ruffles, we've had the same argument for nearly every level of EMS. Nurses can't do 'street medicine' because it's a specific skill set that they're not trained in. Yet there are some rockstar flight nurses, right? Paramedics don't have the education to do Flight for Life level of care, yet they do it, and many excel at it right? Those arguments only hold true if the argument had been made that we make this a national scope of practice. But we didn't. I carefully mentioned that medics would have to be screened and trained specifically for this purpose. What is it exactly that makes this a nurses job? Simply because it goes on in someone's home instead of the back of an ambulance? Then it wouldn't be a nurse's job either, right? As it doesn't happen in a hospital? Is a medic, who's responsible for recognizing, when possible diagnosing, and then treating chronically, acutely, and critically ill patients suddenly going to forget those skills because he's not running to an ambulance immediately? All of a sudden he's going to go into a house with a tripoding/diaphoretic patient, crushing chest pain, DOB and say, "Ahhh...I can see that you need some Albuterol." simply because he wasn't called emergent? I am a much, much better clinician now than I was when I transported everything in right away. My assessments are much better, histories very thorough, attention to detail superior in every way, yet in no way have I found that that has made me weaker in spotting emergencies, nor more likely to try and be a superhero when I have other options. To say that a properly educated medic shouldn't give so much as an aspirin, or advice on continuing a Drs prescribed medication unless it's in the back of an ambulance confuses me...there's nothing magic about that other than the fact that it ends up at the hospital. And we've all agreed that the vast majority of patients don't need to be there. So if a home medic can approach all patients with a high index of suspicion for needing to to be transported, and decide from there, what's the problem? Isn't that what we do each time that we consider a refusal? And, as per the article, these patients have all been screened and treated at the ER multiple times, so other than looking for new onset acute issues, (which is kind of what we do, right?) it is only monitoring the continued physician prescribed care. Other than trying to foster a humble attitude towards our education, I don't see the logic being applied here...

Jonus, what is your tax rate there? Do you get mugged, or is it comparable to the U.S? (25%-35%ish depending on income) where we also get mugged....

Maybe not where you are...but this is an international forum after all... In Ulaanbaatar you can get full range of antibiotics, ED drugs, steroids, etc. I think, though I'm not sure about the steroids, that it's the same in Dubai. (Is it a coincidence that you can get Viagra and antibiotics at the same counter? It's a mystery....) In my experience this is probably how 90+% of antibiotics are prescribed remotely by all levels of care. What a great point and a not invalid method of prescription I think as long as one is constantly on the lookout for zebras.

When it comes to the opportunity for pornographic imagery, I'm always paying attention!

You know, this is a good question, but it's kind of like asking, "How good are nurses at intubating?" Know what I mean? Most I know have the theory, but little if any application, others I'm confident would make me look like a monkey humping a football by comparison. If you think that American EMS is all over the board, remote medicine is much worse. And for most of us, worse still in the fact that we rarely practice any significant skills. Most of the remote medics that I know, myself included, are complete douches. They had a buddy get them a job, started out dumb and then were placed in a position where there is almost no oversight allowing them to become dumber still though all the while looking in the mirror day after day praising themselves as a rock star. It's really easy to be a legend without an audience to provide feedback. But, as at home on the street, there are the rare, inspiring exceptions. Mongo Medic, our new member is one of those. Friggin' knows everything off the top of his head, treats every patient with love and kindness...I hate his guts. Though in the years that I've been doing this now, I've met several hundred medics, I doubt that I have more than a dozen examples of the exceptions. Many fall somewhere on in the gray between douche and inspiration, but I'd have to say that douche is the dominant category. For me, I think I had about 8hrs concerning antibiotics several years ago, and then about 5hrs at my last gigs...but I don't really understand them very well. I can hand them out all day if I want...I just don't want to. So I nearly always consult with someone before prescribing them, unless as I mentioned before, say, PCN for toothaches. Why am I comfortable with that? Because I've treated about a gazillion of them, and the first half a gazillion the medcon doc prescribed PCN. Man, here they give amoxicillin for EVERYTHING. Had a guy in with a lac to his leg, healing pretty well, no sign of infection, cut with a rusty machete. I recommended a tetanus shot. "No, that only works if it's still bleeding. I'll give him some amoxicillin." (And before anyone gets started!! No, I didn't make them do it my way...there is only so much change that you an make so fast in many of these environments without alienating yourself to the point of impotency.) Just sayin'...

I got this when I tried to access your blog, unless I got the wrong Baby Medic. Since your blog there are a gazillion now using that title... This blog is open to invited readers only http://babymedic.blogspot.com/ It doesn't look like you have been invited to read this blog. If you think this is a mistake, you might want to contact the blog author and request an invitation. You're signed in as dwayne.*****@gmail.com - Sign in with a different account

Hey Fiz! Man, have I been missing you around here!! Thanks for your comments. That's exactly what I was wondering, and it makes perfect sense the way that you describe it. Have you come across any descriptions about how these types of devices deal with compensation/decompensation? Or changes in demand say, secondary to catecholamine release? I'm not sure why this suddenly grabbed my interest, but it has. And most important of all....any chance that we'll ever have access to your blog again? I've probably spent 25hrs reading it, and miss it still, and I know that many here would benefit from it. It's truly one of the most amazing EMS related things that I've read, at least where my experience base is concerned. It not only matched the things I thought and felt from memory, but often predicted the things that I hadn't thought or felt yet...it was like a friggin' drug! Anyway, it seems, if I remember right and I probably don't, that you took it down secondary to legal concerns? Whatever is best for you Brother, but if there's the possibility of opening it back up as a resource for the City, that would be awesome. I hope all is well with you Fiz...The City is certainly less when you're not here.

Went and checked it out...pretty cool Denny...

I don't know those things. The only antibiotic that I feel relatively confident giving without advice is PCN for tooth pain. Most times the issues go through a higher level of care and/or is a condition that I'm confident that I recognize as identical/near identical to one that has been previously diagnosed by a higher level of care. In my experience this is the way that most antibiotics are delivered. One or two patients that require direction, and then another 10-300 pick up the same bug and can be treated likewise with a relatively high level of confidence. Despite the tools at our disposal, I've always really felt like a poser prescribing antibiotics. It's never really made my willy hard as it seems to for some medics, so I have no issues seeking guidance when I believe it's necessary.

Man, good question. I've never known of a mandate that an employer help a medic stay qualified to perform as a paramedic. And I think that that is most often a benefit offered to nurses and not mandated either. Now, should they demand that I attend, say, site management training, site specific expanded scope training, or something not pertinent to being a registered paramedic, then they would be required to pay me, the same as they'd be required to pay any employee for additional work, as they've made it an additional requirement to my job, above being a paramedic as I was hired to be. The only times that I've been paid for continuing education I considered it a really big perq. But I don't believe that you'll find anywhere that employers are required to pay you for it unless they require you to attend their training instead of getting it on your own. Good luck Brother...

It seems to me that if the additional education was required, that though it would be ok I guess, I don't see why a significantly expanded scope of practice would be necessary? It's seems that for the most part assessment, excellent communication, and an ability to organize non emergent services would be more important. I've done sutures twice, handed out skads of antibiotics, but each time only because there wasn't a physician realistically available to do it instead. In an environment that has a medical clinic on every corner I'm not sure that that would be necessary. It seems that a few places have started, and the tests seemed promising, I'm curious as to why it's not taken off like wildfire...

Hey All, I ran across this today, http://www.ems1.com/...requent-flyers/ This program is several years old. Is anyone familiar with it? Is it doing well? Why aren't more programs like this being developed? And "Because American medics are idiots and you could never trust them to care for patients in their homes" really isn't an answer, as it appears that this program developed a way to screen and then educated the non idiots. Seems like a good idea, right?

Really? You said that here?

Not wondering so much about short term failure, as they seem to work, at least in the reported patients, pretty well. I just wonder if over time the body's mechanism come to count on the pulse for some reason. If it changes the bodies natural compensation mechanisms? I wonder how the pump manages compensation? Any idea where it get's it's rate from?

That site is blocked for me, but is that the guy with the mechanical hear that has continuous blood flow, instead of pulsating circulation? If so, it's a pretty amazing story. I wonder though if the circulatory pulsations serve purposes other than being an expression of the heart filling/emptying? Could there be side effects from it's absence?

You lost me here. I'm not sure if he's succeeded in making you feel guilty for your point of view and your new job? If so kudos to him for his argument and you for being willing to change your mind... Firemen got into a career where they believed that they were untouchable, where whether they worked or not, were needed or not, that they would receive above average pay and benefits. Now they're screaming tragedy (In general, not this situation specifically) any time one loses a job. I would ask you this...why is it more tragic when a fireman loses a job than when anyone else loses theirs? And smsturms....good on your for sticking man. Maybe 2% would stay after the way things started here with you. And yet you stay, continue to stay pretty much on point and make your argument, and I think that we're all the better for it. Pretty friggin' cool...

Why is the mayor vindictive towards the fire services? Serious questions, not trying to bust your balls. What is it that would cause him to, as you say, allow people to suffer and die simply to see firemen out of work? And I agree with you...whenever we put 'meat in the seats' everyone loses.

Good on your Brother. Feels pretty friggin' amazing, right? Welcome back to the City. It'd be cool if you stayed and participated. And look how good that turned out! I get a bunch of completely undeserved credit for the quality of your posts, and you've become a really strong member of the forums.... Yep...life as it should be.... You're a gift here Brother...I'm grateful that you stay...

You know, I don't like to cut anything 'cool', but have rarely had issues with that. And most times that I've needed to decide to cut clothes there's been little time for or question about debating it. Most often you can pull tshirts, button shirts, jackets, etc over the head with very little body movement if you just grab the back/middle of the garment between the shoulder blades and pull them up over the head. The only times that I've really had personal/emotional issues with cutting people's clothes is with homeless people that had stuff that looked like it would be hard to replace. An insulated or leather jacket, a halfway decent looking shirt/pants, etc. I'm always careful to preserve as much as I can and transport all of their belongings with them regardless of the value that others may place on them. Again, as mentioned above, it's about respect. If I pull you out of your new car I'll likely give little thought to cutting off your Levis because I'm confident that replacing them won't be terribly taxing. If I pull you out of a box, I'll try and remove them in one piece instead when practical. Dwayne

Yeah man, the follow up articles show that the first was desperately slanted. The judge decided the case on the evidence based on American law, and then gave a personal opinion regarding purposely desecrating anyone's faith or beliefs. His opinion included Muslim specific commentary only from the point of view of his doing tours in the Army in both Afghanistan and Iraq, and his experiences with them there. Personal opinions are not uncommon following legal rulings. In fact, I once heard from a friend of a friend, we'll call him Dwayne for the purposes of this conversation, that after one ruling a judge looked down at him from the bench in front of a packed court room and yelled, "You disgust me!! If I could give more pain to your stupid ass I would do it in a heartbeat! Do you hear me!!" Of course, that's just hearsay.... Though I've also heard that his friend's grown up a bit since that's happened..... In a later statement the judge makes it clear that he is, and has for a long time been, a Christian.

Debate is the life blood of EMS...A vital skill. I'm curious, how hard did you find the test to be?

Actually Brother, she mentioned a statement like yours, plus others. Nothing personal here...great question though.

That is funny as hell right there...

I think that the error in the concept that one can't stereotype without also providing varied treatment is that you seem to assume that the stereotyping is somehow bigoted instead of simply a recognition of a common behavior within a certain population. The comment on the 'hysterical black woman syndrome' or whatever it was. I has been my experience within the limited places that I have worked that this isn't an inaccurate description of many of the black patients that I've treated. If you use as a baseline the actual signs that experience has shown would normally be forced out of a patient by a given pathology, the exhibited behaviors appear to be exaggerated. It can sometimes be frustrating trying to separate fact from the cultural exaggeration. But this is their way. It's not good or bad, it just is. No different than being kind and competent to someone with dreadlocks, or tattoos, or that may be an illegal immigrant, or exaggerates their symptoms out of fear of being ignored or under treated. When I trained animals it was my experience that the vast majority of the blacks that I trained for, or near, were terrified of dogs. Not just, nervous, but terrified. Have I created a negative stereotype than when I'm very cautious about approaching ANY black people when working with dogs out of a courtesy for the likely, fearful reaction? I wasn't offended by his comment as this behavior isn't uncommon in many cultures. Though in our culture, in the states, we're supposed to pretend that we don't see it, as seeing it makes you a bigot. I've seen it in the U.S., the Afghanis are hugely dramatic with minor conditions but heroically stoic when severely damaged (generalizing again). The Papuans, even when they speak English make it much like working on an unresponsive patient as their behavior is so far removed from their actual condition as to be nearly useless as a diagnostic aid. (Observed nearly 100% in over 100 patients now) I've loved all of these patients, though do I somehow love them more should I pretend that what I see with my own eyes isn't really happening? The poster mentioned above was simply reporting, in a certainly un PC way, what he's experienced. I was sitting with a black Safety officer on the oil spill in LA. One of the white women sitting next to us was telling a story about a friend that had started dating a black man. She said, "If she's going to lay down with niggers then she'd better expect to smell like a nigger in the morning." I really had no place in my brain for that kind of talk and asked the Safety officer, "That doesn't bother you?" He said, "No man, they're not talking about people like me." With my inexperience in this culture I'd naturally assumed that the term applied to all black people, but there are, it turns out, many distinctions for those that live there, though there remains none for me. My point being this, I believe that some cultures have certain identifiable behavioral distinctions, and I don't believe that it makes you a bigot to recognize them. I don't know if it does if you laugh about them...That's not my way so I've never really given it much thought. As to firefighters, I'm comfortable that those here that are in the fire services are comfortable with my respect for them. And if not I hope to be made aware of that. I've tried to make it clear that my beef is with the services, not individuals that prove to be professional. It's just been my experience that professional, intelligent firemen are the exception instead of the rule. As has been my experience with medics and basics as well. I don't think that recognizing strengths, weaknesses, or cultural differences in a population dictates that there will be an automatic stereotyping of an individual. I expected all of the Afg men that I treated to have black hair, black eyes and olive skin. Yet sometimes they had blonde hair, blue eyes and freckles. Did I treat them different, or less because they didn't meet my stereotypical expectations? Possibly a little bit better, because I found them more interesting, but certainly no worse. But other than admiring the topic, what would be your opinion on it?