DwayneEMTP

The way your link truncated? Funniest friggin' think that I've seen in the last year... Still cracking up about it...so all's not lost... Dwayne

I've proctored the NR skills a few times before, and you know what? In my opinion most people fail because they freak out, not because they didn't know the skills. I'd watch them practicing in the hallway, hear them walking through assessments, easy peasy. Then they'd come into the room, start to shake and stutter, get their brain all messed up with nerves...and fail. I finally walked out into the hallway and yelled, "Boys and girls! You've done this a hundred times. It's easy, and you have ALL DAY practically! Slow down, relax, it's all going to be ok!" And that helped some, but not others. Also, on the nerves side. It makes no difference at all what the proctor thinks of you. He is there to give instructions and then check little boxes if you say certain things, and not check them if you don't. Just like a machine. You can go in drooling, farting, and talking in tongues, but as long as you hit all of the relevant points and miss all of the fail points, s/he has to pass you. It really is that simple. Just check off the little boxes, go home and get laid, or drunk, or whatever it is that you use to celebrate. (Both at the same time can sometimes be awesome, but it's a balancing act...just sayin') Take a deep breath. Know that for every few points that you allow your pulse and respiration to rise you are decreasing your chances of passing first time through. And, C'mon man...have you looked at the medics around you that have passed this friggin' thing? Exactly....how hard can it be.... Dwayne

Yeah man, not much luck necessary...you're going to rock it.... Let us know what happens, yeah? Dwayne

Gonna come back with your trick man? It is hard to know if we know your little trick or not when we have no idea what that little trick might be. Dwayne

And you know what man? The energy that it takes to stay positive, and remain the kind of provider that you want to be can be enormous when you get in a bad environment. I too kind of wish that I'd done some time at Denver General, despite their not being very well respected prehospitally any more, just to say that I worked the 'knife and gun club' and survived. But, now I've survived a lot of other shit, so it doesn't seem so important. For me, though I'm getting a little older now, I choose to try and pick places that help be stay mentally and emotionally healthy for me and for my family. It's just too friggin' exhausing to work with negative yahoos every day.. I work with a major prick now. Fat, grumpy, dumb as a brick, and I'll tell you, it gets old fast. Someday I'll have to transfer off of these one man sites... :-) Plus you said that this is a casual position? I'm guessing then that you don't need to work at this point? (Truly asking, not sniping) What if the casual doesn't pay the bills? Any way to stay where you're at and run PRN at the urban service now and then? Either way that you jump...good luck. Dwayne

You can send it to my email if you like Bieb's....not sure how much help I'd be, but I'd be glad to give an opinion.. Dwayne

Man, great discussion... I think it most likely boils down to the cost/benefit discussions that we've had with a couple of our favorite posters. It can be seen many ways. If you're in a system where there are a ton of whackers that walk nearly everyone out of laziness, your c/b scale may be tipped simply because you feel better for showing yourself that you're not one of them. Or if your experience has been that Grandmother/father nearly always seems to somehow bang their shin on the coffee table that's still 4 feet away from then, then perhaps you're happier wheeling them whenever you can. If, as has been mentioned, you know many strong, healthy people with injured backs despite being professional and conscientious, then walking is a no brainer for you. Maybe you're doing 15 calls in a 12hr shift in a place where nearly all patients are hard to get to, then carrying everyone has got to seem insane I'm thinking. For the professional, it will always boil down to cost/benefit I think, but what tips your scales will likely be different for all. For the whacker, cost/benefit will likely never be as important as convenience, so I'm guessing that this is the persona that Bieber was more than likely looking for protocol advice on. Dwayne

Yeah, I don't think that anyone is questioning field termination protocols at the paramedic level. But I think that most of us would either cease on scene, or continue to the hospital. I'd never heard of starting to the hospital and then reversing course to return the body to the scene. I'm not in any way saying that there is an issue with the protocol, it's just strange to me. As if you'd said that you could leave the body on scene as long as you painted the face orange first. Probably a fine idea, but I just have no place in my brain for it upon first blush. I answer to your questions, nearly none, No, and every place that I've worked since becoming a medic has had field termination protocols in place. Dwayne

Hey R123, is English your first language? I'm truly not taking shots at you Brother, but if it is, you need to try harder, but if it's not, then WE need to try harder, which we're happy to do. See? Dwayne

No, I would be mourning, and spending time helping my family to cope with the unexpected loss. I can pretty much guarantee you that I wouldn't be on the phone with the media. Kiwi, you're starting to get cynical in your old age Brother. We'd not forget you, we'd honor you with the "The Thorny Fucker Finally Dropped Dead Anual EMTCity CAP Lap Scholarship." I'm a little bit hurt that you believe us so calous as to just walk away from your dead body... Dwayne

Didn't someone post an article here a few years back, I think it was called 'The Oxygen Paradox', in which they described some students looking at fresh hearts from cardiac arrests under slides? It seems like it talked about one of the students being reprimanded for creating slides from the wrong sample, as after a significant amount of time had passed there appeared to by no damage to the cells. After a time they began to see this as a trend and would load the healthy cells from the donar heart and then wash them with blowby O2 and noticed significant cell death very quickly. Kinda sounds like something young Mr. Beiber might have posted back in the days when he was still bright eyed and enthusiastic....but not sure. I think that they (I can't remember who 'they' were or if the article had any significant scientific value at all...just that it was really interesting reading.) attributed it to apoptosis...but again, I don't really remember. It's stuck in my head since, and I've looked for it a few times without success... Dwayne

Thanks Doc, exactly in the spirit I was hoping for... My guess is that she was mean, panicked bitch. But again, 'the side of the road' is pretty vague. If she jumped in the back despite being told not to and they pushed her out, then the side of the road could actually be the side of the parking lot. Or the side of the road with the ski lodge on it. Maybe this place is really remote, so the protocol allowes for securing the body so that you don't have to either shut down the resort or leave it under manned for emergencies? That was the hardest thing for me to figure...I can pretty easily see needing to kick Ms "I'm a nurse and you need to fucking listen to me!!" out (Not a general shot at nurses, but at the type of provider at any level that most of us have seen behave in such a manner.), but I couldn't for the life of me figure out why the hell they would have driven the body back to the scene. I do think that it's interesting that everyone involved had to be notified that there were problems, and complaints being filed, from a reporter. She was so crushed by her husbands death and mis-care that her first thought was to begin shoring up the jury pool for her lawsuit....grrrrrrrrr... Dwayne

Hey, While in Sydney I was talking to one of the medical directors about LBBs. I made the argument that it was relatively common knowledge that LBBs were not only not useful as a spinal precaution, but that there seemed to be evidence that they caused damage to many people, by many different mechanisms. She had never heard this line of thought before and challenged me to back it up with research. Here in PNG my internet is super expensive so I can't really afford to do much searching until I get onsite, so I thought that maybe you all could help me out? The evidence needs to support the concept at the physician level. I'm sure it won't make any significant changes in protocols likely, but perhaps it will convince her/them that paramedics are concerned with actual issues as well as other cert levels. Thanks for any help that you can provide... Dwayne

Hey, I ran across this article on Link'd in, used as an example of the deterioration of EMS. What bothered me about the article is that it was just accepted that this call made the authors point. I don't care, in this thread, what you think of the call, or the providers. I only want to hear your scenario as it might have happened to justify the providers reported actions. This is an exercise in imagination, not morals or ethics, see? I've been running this through my head for a few hours, and I truly have a hard time creating a scenario where everything makes sense, though it's not too difficult to make one where most things do. I thought that this might be fun. Please, lets keep it serious for at least a half dozen posts, then it might be even more fun to get more creative... Hmmm....perhaps then we should move it to the members forum... :-) http://www.emsworld....by-side-of-road Dwayne

Heh...I already laugh, and I can't even friggin' hear it! Dwayne

Riblett, where did you go?

Though I'm sorry to hear it....good on you Babe. You know my number, right? Nothing would make me happier than to have my phone ring.. Love you Kaisu.... Dwayne

Yeah, one of the three patients that I've treated with Nitro was for a CVA. Slightly altered, bad headache, very flushed, BP through the roof, but I don't remember how high. I didn't call it in as it was obvious to me that the extreme BP was causing the headache and altered mentation, so shot her with nitro two or three times in succession. And she did seem to get much better, she 'seemed' to be mentating better (though of course having hoped for that result I my caliberation could have been askew), less flushed, claimed to feel much better. At the ER the doc asked why I had chosen that course, and I explained, in a really long winded way, that it was obvious the BP needed to come down, and obvious as well that she felt better, which meant obviously that I was a rockstar medic stud. Yeah, I know you already know the end of this story, but I didn't then. The doc explained that it was a CVA that was causing her pain, altered mentation, and yeah, driving her HTN. Not the other way around. He was as kind as he could be, but I couldn't have felt like a bigger douche...I was just so certain that I was right about that.... Anyway, when I got smart enough to look at HTN as a possible compensation to a pathologic event as well as a possible pathological even on it's own, or perhaps with it's cousins, (more or less), I've not since found a reason to treat HTN in the field. I'm just not really sure how you separate the HTN Yin from the HTN Yang in the field. Dwayne

And about 4 1/2 months since you stopped posting! What the hell Denny....?? Didn't think anyone would notice, did you? Neener neener. Get back and get busy Brother. You were off to a really good start. You need to keep your head in the game if you're going to keep all of the things that you learned available. Don't slack off now... Friggin' pharmacy techs...don't we have a couple here that some times give us some trouble? :-) Good to see you back man... Dwayne

Actually, I thought that he was right when he typed Paramedic Socialist.... Dwayne

The diffence is honest errors v a significant lack of effort. No one was busting his balls, only explaining the best way to get the answers that he's looking for. Speaking and writing to the best of our ability is simply good manners, and practice for professional development. It's when folks get offended at good advice that things go down hill fast. As Maine said, that is my best understanding of the issue. If it's just a ticket, it won't likely be a big deal. But if the ticket is indicative of your maturity level in general, then it could signify bigger issues for you in the future. Worst case scenario? You stay at your current job while you look for another. That will give you the bullet proof answer for sure. Good luck Brother. It's be cool if you could come back and let others know how it worked out for you, as this is a common question here. Did other companies ask you about it? What were their comments? Did you have to take additional steps to overcome it? Like that.... Dwayne

Ter, I'm thinking that we've worked in different places if you are comfortable taking what is given without seriously considering the possiblility of having to reject a transport. Hauling everyone I'm given isn't my job, patient advocacy is my primary job. I had an extremely drunk patient, blew in the .6's I think that the ER hit with Haldol to control his behavior. Called my truck to take him back to detox yet I was unable to rouse him, regardless of stimulus tried. Detox will only take patients that can walk 10 steps without assistance and answer questions. I refused him. An 80ish year old female that was being discharged home. U/a pt is clutching her chest saying that she's having a hard time breathing, like someone is sitting on her...Right? No current ECG, positive significnat history of cardiac issues, ect. I refused her until her PCP could evaluate her. Nurse says, while standing in her room, "Jesus Fucking Christ! If we call you have to take her! Now fucking take her!" I think that it turned out to be angina, but still...I'm not taking that patient to an unmonitored home. More paper, more bullshit. Called for an unresponsive patient at a nursing home. Pt is breathing about 40 times/min, hypotensive at...something, lungs show crackles to clavicals (after sitting her up, she was laying with her bead tilted so that her head was the lowest part of her body. I think that they were trying to help her die)...DNR is for no heroic measurs only. I get to the ER at about 0300, and the nurses are pissed that I brought her, as she has a DNR. Dr. wakes up, is pissed because we brought her because she has a DNR, despite my explanation that it is very clearly heroic measures only. Pt is now sitting up, breathing much better, lucid, listening to the ER staff complain because we didn't let her die. Doc says to take her back, I refuse and put her in a bed...(at this time I wasn't really sure where the lines are drawn for them to be legally liable, so wanted to make sure that they were invested.) I wrote paper....it turned into a mess, but they never had such a conversation with me again. I could go on, and tell more stories more or less like these..but the point is this, depending on where you live, and the quality of the local hospitals, taking each patient that you're given is not always a no brainer.... Dwayne

That post seemed very 'un-island' like... I'm wondering if someone left their computer logged on and got spanked... Dwayne

Edit: Why were you surprised? Sure. For example in Mongolia I was called to the quarters of a woman that reportedly took an overdose of some drug that I was unfamiliar with and the Dr and Nurse were unable to explain to me. She was obtunded, groaning, when I tapped her eyelid I seemed to get a retarded response, yet she seemed to adjust herself very slightly a couple of times, as if to get more comfortable. My driver had gotten the cot inside, but I pushed it aside and had him help me lift her a bit, still not really sure if she was bullshitting, partially bullshitting, or if I was missing something. After we got her standing she was allowing most of her weight to hang on our arms, so I kind of grunted and released my pressure, as if I was going to drop her...and she caught herself. Now I knew that she was at least partially bullshitting. So we left the ambulance at the quarters and I walked her towards the clinic, her clumbsy gait seemed to be fake, so I just talked nicely to her, her eyes mostly closed, her head hanging, yet veered away from the clinic and could feel her kind of nudging me back in the right direction. At that point I was pretty confident that it was at least mostly bullshit. Was it important that I know how much bullshit was involved? Yeah, in this case a larger clinic with an expat doc in it is several hours away and I have no idea what the drug is and have no way to find out. (it was a small bottle that the doc said came from prescription, but the writing was in Chinese, so no google! God damn it....) Another time there was an older woman, a frequent flier that was always having a stroke or a heart attack, or was trying to be unresponsive. This time she was kind of confused, but not in any way that I wasn't used to. I was unable to do a stroke scale, as always, but her facial expressions/extremity movement was purposeful/equal/coordinated bilat. If I lifted her hand, she would groan and let it drop...you know the patient... I could see her peeking at me, as if to see if I was buying the act this time. I had them leave the cot in the other room and told her I had to help her walk...I helped her up, she could always walk without issues, but as soon as her butt left the bed I could feel her fingers dig into my arm causing me to look at her face, which appeared genuinely afraid that she was going to fall. And this was really unusual. I lay her back on the bed and we loaded her up on the cot...I think that it turned out that she'd had some flavor of CVA or other. So here we had genuine bullshit combined with genuine pathology...And I think that attempting to walk her gave additional information that fed my suspisions. In fact I don't think that she really even knew that she was sick until she tried to stand. Was it important that I walk her to try and get more information? Not really...I was only about 5 minutes from the hospital, but I friggin' wanted to figure it out on my own. And I do think that trying to unravel every patient, every single one, makes us stronger providers in the long run. In the end I still didn't predict a CVA, but at least I was able to develop a strong suspicion that I was wrong in my initial assessment, and though that didn't do shit for her, maybe it will do something for the next patient. Anyway, it's probably not a good way to do it, but it's my way, and I find that gait, facial expression, body movements, anxiety levels, which details a patient pays attention to and whether they seem to make sense in that context or not, when they breathe, when they hold their breath, etc...are often as, or more, telling than a good set, or sets of vitals with many patients. Dwayne

Yeah, I think that answer to this depends largely on where you practice. I walked less than 1% of the people that I was called to probably. But my call volume on the street has always been low, without old skyscrapers, etc... I just don't like to walk sick people, and most of the people that I was called on were sick. Some drunks I'd walk, the person with their suitcase packed got to walk, and most times carry their suitcase. Sometimes patients that had me confused I'd walk if I thought it was safe so that I could see how confident their gait/balance was, if they seemed to have a sense of direction, how they'd breathe, what things drew their attention along the way, if they really needed support or were trying to pretend that they did, etc. I've found that there can really be a lot of information in a short walk... Dwayne