DwayneEMTP

Hey all, In the U.S. the guidelines that I was trained on and have been exposed to call for Benadryl for allergic reactions, and Phenergan (Promethazine) for nausea and vomiting. Though when in Afg working with Aussies, and here in PNG, the combination is reversed. Is one pairing superior to the other? Why?

To lighten up my being pissed at the fire services, again...I thought that this was pretty fun, though sad in it's accuracy... http://paramedictv.ems1.com/Media/2297-Hitlers-day-on-the-ambulance/

Edit: To make special mention that my post title says, "Fire services" and not "Firemen." As a whole, I despise the fire services, but within them I've found many, many that I have great respect for and have become lifelong friends with. (None come to mind at the moment, but I'm sure it's happened. The law of averages practically demands it.) I just wanted to make that distinction. Dwayne Is anyone else surprised that it's a fireman in the story that accepts credit for saving a life when he in fact simply sat next to and held the hand of a woman snowed on motion sickness meds? I love how in the story all of the thanks go to the crew except for the fireman speaking of his own heroism...no one else even friggin' mentions him. "Everyone on the plane was, like, "he's a hero" but I was just doing my job, even though I wasn't working..." Friggin ridiculous... What do you suppose the odds are that the fire services will now have a big ceremony, complete with a tearful reunion with the woman that was never really in any significant danger, so that the press can have their pictures? Every real medic that I know would have said something like, " After assessing her I discovered that she was altered but not not dangerously so. I sat with her to make sure that she didn't compromise her airway while sleeping, but she was never in any real danger." Only the shitheads, (which of course are not only from the fire dept, but it's only fire that I see exerting so much energy to get such nonsense on the front pave of papers.) would say, and it appears, believe, "I held a hand....another life saved!!" Is it just me? Is anyone else not getting completely over this bullshit "I'm a hero!!!" nonsense? Why do we not burn these shitheads down in public when this happens? http://www.ems1.com/...life-in-midair/ Edit: And another reason... http://www.ems1.com/...son-lieutenant/ He admitted to putting toxic substances into another man's canteen... "Firefighter Moore is in jail without bond and suspended with pay until the fire department finishes an internal investigation. He has also been charged with aggravating stalking in the case." Man...I think that I may finally be out of words to describe how I feel about this shit....

Like I mentioned above, it seems to me that most of the 'checks for responsiveness' are providers not looking for information but instead visiting pain on someone that they feel is faking, a victim of their own poor choices, or shouldn't have called in the first place... One of the things that makes me want to go postal in EMS is hearing a provider screaming, "Don't you hit me! Keep your hands down!! Don't you hit me again!" regarding a drunk, hypoglycemic, postictal pt that is randomly flailing, and yet moments later grinding the hell out of their sternum when they appear unresponsive. So violence is ok when provider delivered, but not when from the patient? Craziness... Dwayne

The local tribes have got the main bridge between here and Lae shut down with protests. The mine is down to about 30% staffing for not being able to get people in and those that can walk from here leaving. There are a bunch of dead fish in the river and the tribes are blaming the mine and demanding K10million (10 million Kina) for damages. I've heard that around election times, or times like this, when the tribes get pissed, that things can get a little bit hinky..making me think about chemical restraints if necessary. This one worried be a bit as it says that you can repeat every 6-8hrs...that makes it sound like some pretty potent stuff!

Maybe it's like hip-hugger jeans on chicks? It's making a comeback?

It sounds kind of like an anitpsychotic online...but couldn't find the specifics, onset, duration, pt presentation post delivery, etc... Has anyone used this? What do you think? I've rarely given these types of drugs much though...but I'm thinking that here, as things are getting pretty froggy, that it's possible that I might use it here...

Hey all, I've got Haemaccel in my jump bag here in PNG. I've not used it, or even heard of it before to tell the truth. Due to the dorky spelling I'm thinking that this may be used by the Aussies or Kiwis.... Some Googling would lead on to believe that it's only significant advantage is that much slower elimination than NS would mean that it would be eliminated slow so smaller volumes would/could be used. Am I missing the point here? Do you have any experience with it? When would you choose it over NS? Thanks for any help that you can provide. And I wouldn't be opposed to the physics/pharmacokinetics/physiology lessons that may be attached.

Probably the scariest call I've heard of, sort of in the same vein, was a tiny little lady medic I worked with. I've posted about it before, but probably can't hurt to do it again. 5'1 medic, maybe 110lbs on a fat day. Picks up a patient secondary to driving his truck off into the ditch. Covered in blood. She gets the patient in the truck, starts to interrogate him about his injuries while she's cutting his clothes off and he says... "Oh, don't worry. It's not my blood." She says, "Oh? Who's is it? He says, "The owner of the truck." She says, "Where is he?" He says, "Back at his house. I killed him and stole his truck." Pretty hinky situation if you're built like me, but if you're hardly more than an oversized Barbie I'm guessing that the pucker factor is significantly increased. She sneaks out of the ambulance, calls for 'everyone!' but, due to a pissing contest that happened between her and one of the dispatchers 20 years previously in high school, the dispatcher tells her that beings she's out in the county that she knows damn good and well that she has to call the Sheriffs dept herself. Welcome to small town, redneck EMS. Not having cell service where she was, she finished stripping him, he acted fine, and she treated him for the 20 min ride to the ER. Being a good medic, and due to the fact that he seemed to be calm and subdued, during the ride she tried to extract exactly where the owner was located and the way that he had been injured in the hopes of being able to dispatch another ambulance to his aid in case he wasn't in fact dead. Though he did tell her the whole story she was unable to figure out where he was describing. The Sheriff's dept found him dead later. She was later reprimanded at work for involving herself in police matters that didn't pertain to her patient's care and a letter to that effect put into her file. I'm sure stemming from the fact that she had to be paid for court time as well as a replacement paid for her time away. The dispatcher was given a verbal warning for refusing to send her aid. Crazy women... Being fired from there was the best thing that's happened to me in EMS...

Try not to derail the thread with your personal fetishes...

I haven't, but that's a cool idea! Well, assuming that I can keep them from sneezing all over me...

I'd commented on her claim that "I make more than twice as much as an American in any state." or something to that effect. That is what she was responding to I think. Do we have any Canadian medics following this thread? You all are truly making $35-$40/hr straight time at your lower certification level? If so, kudos to you! Dwayne

I can't get your post to quote for some reason, so you'll have to try and follow.... I get pissy when I see people taking bows for shit that they've not earned, and implying that they are 'greater' than they actually are. Plus, being pissy is just sort of my nature. Though you disappointed me, we had a pool going as to how long it would take you to claim that all of my opinions came from my unfilled Viagra prescription, as you've done in the past. You were on your way with the 'medic-head' comment. If I'd left it alone for a few days I'd probably have won that bet. I've assumed nothing. I've got several good friends from here that do medicine in Canada, and a couple of days experience listening to them speak of their scopes of practice. You can crow all that you want about the options that your someday to be finished education is offering you, but sometimes you've gotta get real. That is what my post was about There is no question that you created accounts and ran up your popularity points. We've got posters here that create amazing posts month after month that haven't done that in years, yet we're supposed to believe that you're just so much more awesome that you did it in a week? Bullshit. Or that you were a victim of someone running them up without your knowledge? Double bullshit. And again you try and lie your way out of it, I didn't benefit from that, nor anyone else that I'm aware of. Good try, but it just aint gonna fly. That's where you and I are different. You ran up your count to where you believed it should be. I believe that if mine was diminished by 3/4 that it would be much more representative of my contribution here. And yeah, it's been a few years, but that's not nearly long enough for me to forget that you defended it. I would have forgotten in the next week had you simply said, "Yeah...I kind of went off into the ditch." But to continue to lie about it shows issues with your self esteem and morals. Own it and it goes away, continue to pretend that you were simply a victim of people loving you to much and it will stay forever. I could care less either way. See, you go again to the 'medic-head' shit instead of addressing the issues at hand. This has nothing to do with me competing with you. You're not out of school yet. I've been blessed to have done things, and you're only just bragging about the things that you may do. Again, your assumption that I'm offended by you because I feel that your awesomeness somehow diminishes me illuminated your arrogance and self delusion. I felt that my post was pretty clear, yet you ignored the obvious points. How is your schooling going? When do you graduate? And I hope that nothing stands in your way. I truly wish nothing but happiness, peace and success for you. Again, you try and deflect by pretending that in some way I'm attempting to block your access or success, because that is the easy, bonehead argument. Nothing could be further from the truth. My hope for you is that you'll back up a few steps, take a breath, get real and do the things that you need to do to succeed. You arrogance, excuse making, deflecting of anything that you find uncomfortable....perhaps you can succeed with those things firmly in place in your personality, but I've known few who have. I wish better for you than that. Dwayne

How so? What scope of practice do you currently have? You're still in school, right? When do you graduate? Where are all of these options from all over the world coming from for someone that can't operate beyond a pretty basic BLS standard, and do nothing autonomously? If you make over $65/hr, which would be about double what the best paid U.S. medic that I'm aware of , if you skip fire, makes, it doesn't seem like that would be much money to you. Plus, that's nothing for an AMI. I'm guessing that you dropped a zero unless he has pretty good insurance. I've been watching this thread and trying to stay out of it, but man, the whole, "Yeah, people all over the world are scrambling to hire me..." bit is getting old. I questioned you when you managed, what, like 150 popularity points in one week, and I'm questioning you again... What do you bring to the table that makes you so confident that you have all of these 'options?' Dwayne

Are you kidding me? If that was my front yard I'd have to go back to construction, as I'd never be able to pass another drug screen again... Have you had them? Oh....My....God!!

This is an article about doctors pediatricians refusing to see patient's any further if they have chosen to remain unvaccinated secondary to autism or other possible side effect fears. For the record, to perhaps help keep things on track, the vaccination/autism link has been well and thoroughly debunked to the satisfaction of most of us in that community. http://www.kxlh.com/news/doctors-fire-patients-who-refuse-vaccines-for-their-children-ethical-/

You know what Brother, I don't think that she's stupid at all. Anyone that has had these knows that you finally reach a point where you will do absolutely anything to make them stop, and the rules of the world be damned. For most of my life I suffered from migraines that lasted from 12-18 hrs and delivered such exquisite pain that I most often lay wishing one would finally kill me. My doc told me to go to the ER when it happens to get treated. I tried once, but was instantly labeled a drug seeker and left to sit in the waiting room. I ended up, and I swear that this is true, crawling on my hands and knees, vomiting all the way, out of the ER to try and climb into my truck to get someplace dark. I didn't make it and ended up spending the night under some bushes outside of the ER doors...the only cool, dark place I could find. Not my proudest moment, and if you've never had these headaches you probably won't understand how it might happen. I spent most of my life trying different antidepressants, anti seizure meds, anti migraine meds. My brother in law asked me to try http://altmedicine.a.../a/Arginine.htm , though I don't remember the brand. I had no faith in it, I only bought it because he was selling it as part of one of the multilevel marketing companies he was involved with. Within a few weeks I noticed that the headaches started changing, feeling different, and in another week or so, they were less severe and only lasted about 4-5hrs, and perhaps a month after that, they were gone completely. Up to that time I'd never known what it was like to be pain free as I had painful, non migraine headaches daily my whole life as well. I took this for the few years, and it worked really well 'it seems', but if I didn't take it for a week or so the headaches started coming back. After about 2 years or so, strangely, it started giving me headaches. If I didn't take it, I would remain pain free. But being terrified of going back to where I was before I kept trying. Finally I decided to trial reducing and then eliminating it and now have maybe one or two migraines/year lasting 2-3hrs and if my others were a 10, these would rate perhaps a 6-7. And that has been the case for the last 5 years or so. I've spoken to many Dr.s about this and other than it's vasodilation properties none had any idea even what it does, much less why it may have helped. And of course, the pink elephant in the room is that it may not have helped at all. I was 40ish when I started taking it, and many find that their migraines taper off at that point anyway. I also didn't document when I took it and how dosing times related to the times that I did or didn't have headaches. My experience is all 'it seems like.' Having said that, none of the life that I live and love now would be possible if I went back to the way that I was, so perhaps it's worth a try? It's relatively inexpensive (I think it cost me about $60/mo and would have gladly paid 10x that), I can't find anything that causes concern for significant risk, and it's easy. Though I hope that if she does try, that she will be smarter than I was. Document the dates, times, severity and duration of her headaches...starting now, and then the dates/times of her medication. In that way she can truly see if there is an effect or not. And I hope it goes without saying, though I'm going to say it anyway. I'm not a physician, only a regular guy that's been down this path. I am not recommending that she take this product, but only relaying my personal experiences. No treatment should be undertaken unless every effort has been made to diagnose her condition. Any treatment should be discussed with and monitored by her physician, as well as any change in these headaches should be reported to her doctor as well. Ok, that should do it. Just some thoughts. Dwayne

I'm not a big fan of the trap pinch or stern run only because they seem so aggressive. If you rule out the drunks and drug addicts, a big percentage of the people that I find faking syncope are doing so out of some form of desperation. And of course I'm not saying that I would mistreat the drunks or drug addicts, only that I tend to deal with them a little differently than the categories below. They felt faint at work and someone called an ambulance. They feel better now, but don't want people to know that all of the commotion was possibly for nothing. The ill patient at home fighting with their spouse that can't really find any way out of their domestic mess other than having us come and take them away. The college student having an anxiety attack that is humiliated by all of the drama they've caused and doesn't know how to cope with it once they can breath again. And on and on... These patients, in my limited experience are usually pretty emotional, embarrassed, often confused about what got them into the situation before they began pretending. I don't want to begin our short relationship by showing them that I'm willing to hurt them to show my medical prowess. I too touch the eyelashes, or tap lightly on the eyelid. And if I'm lost and really need them to speak with me then I pinch the nail bed which usually makes them jump and 'wake up.', usually looking around as if believing that it happened on accident. But most times any effort to rouse them will be done in the ambulance where they can save some little face at least while admitting that they aren't really dead. But most often it goes something like this...Tap the eyelid and see a response. Make sure that the vitals speak to a relatively safe patient. Go to the ambulance. Give a little speech like, "Babe..I know that you're having a bad day. I kept quiet inside and let you freak out your family, but now it's time for you to open your eyes and talk to me. If I can't wake you up then you force me to do some painful things to make sure that you're life isn't in danger, so open your eyes and lets sort this out, ok?" Usually, almost always, whether man or woman, they will start sobbing at that point and assist with their care. If not, I say, "David, could you set me up a couple of IVs, I'm going to have to run some fluid." and as I'm putting on the tourniquet I hear, "Whaaaaa? Whaaaa happened? Where am I?" Tricks for exposing fakers are nifty, but rarely, in my opinion provide good patient care or significant medical information. Without question the largest class of instances where I see 'testing for responsiveness' is actually providers taking one of their few, safe opportunities to punish people that they're pissed off that they've been called to treat in the first place. And then of course....What Mobe's said... Dwayne

System, I've never felt more like a poser than I did after reading your post. At each paragraph I thought, "Holy shit! I don't have any idea what to do with any of these people!" Thanks for your post...it was awesome. Brandon, of course anyone with any time in EMS has had those kids. The problem I find with most people with that attitude is that it doesn't apply only to those kids, but a general 'breaking in' time of trying to show the pussy college kids how it's 'really' done on the streets. We've had a gazillion firemen before you crowing about "I don't need to take a bunch of Home Ec and Basket Weaving courses to know how to treat patients on the street!" As our good friend Rob used to say, "there seems to be no one that has more understanding of the complete lack of value derived from a college education than those without one." And your 'lilly ass' nonsense doesn't impress nor intimidate me brother. I've done medicine and nurtured newer medics on the streets, in Afghanistan, Mongolia, and now Papua New Guinea. How about you? What is your history, work and education, that allows you to know that your 'tough love' approach is what's needed to turn out good paramedics? Where did you get your medic education? No one is discounting your theory that street smarts is important. Only your need to deride education while doing so. When I first started on the street I was significantly more educated than my basic partner, yet his street smarts were commonly useful and several times saved my ass. You work in one of the most notoriously damaged systems in the U.S. with educational standards that are completely in the toilet when compared to the more progressive systems represented here. That's not a terrible thing, and a committed paramedic can over come that. But when you come here with your initial posts representing exactly the ignorant attitudes expected to come out of such places, you shouldn't realistically expect them to be welcomed with open arms, right? And, in case you're missing it, the 'new' medic with the God complex that needs to be mentored without anyone being all 'lilly ass?" Today....You're him. I hope you stay for a while. I look forward to your opinions. Dwayne

Not likely he'll be back to this thread I'm thinking....

I think that the closest that I've gotten to that are statements like, "Consider med control consult if uncertain or inexperienced with treatment." or the like... And for the record? This is America...you can do all 6 of those things all at the same time if you want...

I've never, nor am I aware of anyone, except second hand, that has to ask permission to act within their scope of practice.... The remainder of this message can be found below... :-) http://www.emtcity.c...nced-protocols/

Isn't that what he was doing here?

I have no idea what a PMD class is. Unfortunately brother your post parrots most of what is wrong with EMS. "All that fancy learnin' ain't worth shit next to my heroismness!" Someday when you leave Florida, and the fire services, and work in a truly progressive EMS system you'll understand the value of all of that 'shit' that others were taught in school. I'm confident that you've been misled by other forums to believe that all forums hold education in contempt well below heroism and 'street smarts.' You were on track when you said that sometimes the most important lessons are learned on the streets, but then went off into the ditch with the whole macho bullshit "when they get on the truck with me" nonsense. When they get on the truck with you they should be nurtured and encouraged to be stronger, smarter, and more confident. But that's not really your goal, or the goal of most fire services in general, is it? I look forward to your thoughts... Dwayne

I think you missed my point Kiwi...The fact that there is no medical control is often held up by you as a standard of excellence, yet in nearly every instance that I've see it that has not been the case. And also, listing degrees for medical cert is not comparing apples to apples. Just as the standards of medicine vary, so do the standards for education. We're all very proud of your brains and logic, and I mean that with complete sincerity, but I've spent quite a bit of time now working with Aussie, South African, Indian, British, etc medics/nurses/doctors, those with the education and lack of oversight that you speak of, yet have spent almost none of that time thinking, "Holy shit! They are so much smarter, and more confident, and more professional that I am!" as you would seem to lead us to believe that I should. I'm not bagging on you brother, only your oft spoken implication that working autonomously is a a sign of increased competency, as that's not been my experience. No more so than a drug box full of advanced pharmaceuticals indicates an advanced provider. Should it? Sure. Does it? Not in most of my experience, nor according to the comments here, the experience of others. I went through orientation with a couple of Aussie medics that I'm confident couldn't find their asses with both hands and radar. And our Kiwi nurse and doc in Kandahar were such complete douchebags that it was nearly impossible to even get them to comprehend their mistakes. Not to mention a UK and American doctors that weren't any better. I had to fight the Kiwi doc off of a patient that I was trying to cut the clothes off. Because the pt was shivering and the doc was fighting me trying to cover him with a blanket and take his temperature despite the patient having 4 gunshot wounds. We argued with the Kiwi nurse one night about the error of giving a 140kilo make with a near complete degloving of of one lower leg and tib/fib fracture of the other 3mg or morphine before a 20 minute transport over rough roads. After an hour of James' and my best effort he still felt that that was an appropriate treatment despite the trauma bay immediately giving him 30mg upon handover. Why? "Because I didn't want him to stop breathing." Lack of oversight doesn't necessarily indicate increased competence, in fact in my limited experience it often seems to signify a lack of quality improvement as the detection of errors and reporting seems substandard. Point being that you hold up these standards as accepted benchmarks, which they may be, but in my opinion shouldn't be, as they don't hold true for much of the world, nor, even your part in some, if not many cases. Dwayne