DwayneEMTP

I'm scared to disagree with you...you' always hand me my ass.. But I tend to be braver during the holiday season for some reason... :-) Merry Christmas Brother... Dwayne

You know, when Romney first became a member I expected to hate him because of his 'in your face' political screen name/avatar, but that's been far from the case. He's participated in every type of thread and his posts are intelligent and well considered. I'm not sure what his point is either, perhaps he has none that matters to anyone but him, or maybe it will be made clear later. Either way it seems to me to be placed in the correct forum for either purpose. Eydawn, I'm not sure how you can say, "I don't see the point" and then, "The scope seems wrong" as if you don't see the point then I'm not sure how any of us can know what the scope should be? Mobes, those that have been truly sexually assaulted, in my opinion, have dealt, are dealing, have chosen not to deal with their issues, whichever option, it's hard to believe that bumping into this poll based on one article out of a gazillion is going to push them over the edge. Personally I think that this is a great 'place and crowd' as I'm confident that my past is part of the catalyst that thrust me into EMS. But whether I think it's good or not, or you think it's good or not, I don't think that purposely torpedoing his thread is productive in any way. It's an anonymous poll. You can choose an option or not. No 'free text' was asked for, nor expected. Participate or not, but how about if we just let him roll and see what happens? Dwayne

Transfer of patient care to whatever level of provider would be the Doc's call I believe, though still the crew's as to whether or not to accept it. My feeling would be though that the apparent pronounced cyanosis alone would likely be more than enough to rate an ALS transfer if we're talking about more than going across the parking lot. Dwayne

When you say 'we as a group' I'm not sure if you mean 'we' at the City or 'we' as in prehospital EMS? I've not seen this so much I think, though much of my EMS career has been spent working in non typical services and locations so it's likely that I wouldn't. I don't think that my history taking and assessments are better than anyone elses, but I do tend to believe that they are better than many of the medics I've worked with. But I do get your point about us seeming more confident in our working diagnosis than many in hospital providers, and often more than we have a right to be. I wonder though if it's really that way, or perhaps only appears that way when we discuss. I know I make people batshit sometimes for wanting to get to EXACTLY what happened when compared to my assessment and DDx. I've often asked an ER doc about a patient to hear get a flippant, "Not sure, we'll see what the labs say." And I get that as, not only is he way smarter than I am, but he's also surrounded by other really smart people and has the luxury of time on all but the most hinky of patients. The flip side of course, and what I believe that you're addressing, is the medic that automatically knows what's going on. "Seen it all, done it all...blah, blah." I do think that that is a way of shoring up one's self esteem in the face of ignorance. "I don't know, but if I sound certain enough no one will know." Unfortunately it often works. Some of the more respected medics I know gained respect by posturing instead of solid medicine. In fact I've been gifted with that on more occasions that I'd like to admit. I've never worked anywhere that I had 5 or 10 minute transports. Not ever. So I think that there is a big part of me that wants to know that I can still do my job when the monitor doesn't work, or the pulse ox is 'missing.' I had a basic partner that I drove a little bit crazy. He'd check the ambulance for the collapsable cot, the stair chair, etc, etc. I didn't really care about any of those things. I'd say, "If we have them, great. If not, then we'll figure out another way to solve the problem, right?" One night he said, "Jesus Christ! It's like you want to make problems for yourself just so you can see if you're smart enough to solve them!" And I think he was right..it made me stop and think, and I came to realize that I was afraid of not being able to think my way out of problems so I would make situations where it was necessary so that I could verify to myself that I would always be smart enough, no matter what went to shit. Again, I think in the end that that made me a better provider and that my patients didn't suffer from being carried out on a quilt instead of a soft cot, or a dinning room chair instead of a stair chair. But I'm also happy that I don't have the need to play such games any more. :-) There is no doubt that machines make me a better provider...I just want to try and be the strongest and most competent provider that I can be without them. And that is different. I feel driven to try and learn to notice and assess facial expressions and body movement, anxiety levels and skin color/condition before putting my hands on people. Not sure why, but there you have it. Does it make me a better medic, or is it just some stupid game I play? No idea.... Dwayne

Yeah, that the down side to your being a respected member here for so long...no one gives a shit if you're offended or not... Can we say 'respected member' in this thread? No offense intended... Dwayne

Man...gave me a semi....but then again, it seems like there are a lot of things on there to break... That seems like a great system to let another service test for a few years before sinking a lot of money into it. Dwayne

I hear you croaker. It's one of the main reasons that I use Firefox, it spell checks everything. I run it through FF, proof, preview and reread then post...and most often go back and edit for the crap that I swear popped in on it's own between proofing and submitting. Not busting your chops Brother, just helping to look after you, like you do with me. And this thread friggin' rocks. Any time you can get Systemet's attention and have him invested you're certainly in for a ride! Dwayne

Myopic - 1. Ophthalmology . pertaining to or having myopia; nearsighted. 2. Unable or unwilling to act prudently; shortsighted. 3. Lacking tolerance or understanding; narrow-minded. A multipurpose word for EMS... Dwayne

I think the issues is beyond me to define, but that sounds like an excellent starting point. Did you get the poll fixed? My answer would be Male/More than once. But all childhood stuff, so not sure if it applies. Dwayne Edit: I see that you did, and voted.

All are excellent points, and I get exactly what you're saying. I think that this thread, and your previous post particularly where you mention withholding tPA without a 12 lead, is painting a perfect picture of the complete provider. That we can't be what we maybe should be if we lean to heavily on our tools, but certainly would be relatively crippled without them. Pretty cool... Dwayne

You have veins, right? :-) Gotcha Brother...sorry, I lost track of your conclusion before posting... I love the fact that you've tried to make this a group exercise! I hope some others step up to the plate. It's too seldom that we have threads that want to physically play with science instead of only theorizing about it. Though I believe that both are valuable, hands on doesn't happen often enough. And also...use your spell check...great thread with horrible spelling. Dwayne

It's not an accent, it's an affect. Completely different. Dwayne

See, I think that this is an excellent opportunity for you to begin making arguments instead of simple, useless statements. No one cares what you would 'never do' without some logical idea as to why you would never do it. Good on you for posting your protocols, but a simple, "I don't know why" would have made you look less arrogant and much less silly. Dwayne

Yeah, man, though I think it's interesting, I don't really see how much good information can come out of it without defining sexual assault. The attitudes are so diverse and varied, especially in this day and age. Babs was telling me about watching Dr. Phil about a woman with a broken foot that wouldn't have sex with her husband, using that as an excuse. He pressured her until finally she said, "Fine! If I just lay here with my legs spread will you be happy??" He said (all paraphrased and hearsay of course.) "Well, if that's all I can get." and did his thing. She has been in rape counseling now for 5 years. Babs was outraged as she said the show ended up with Dr. Shithead saying, "You realize you're a rapist, right? and the guys saying, "Well, I never thought of it as rape, but I guess I'm a rapist.." What bullshit. Also, are you looking for anyone that's been touched in any way that's made them uncomfortable at any time in their life? 'Cause hasn't everyone? Not trying to ruin your thread brother, as I think it's really interesting, just giving my thoughts on how it might give information that most of us can put into context. Dwayne

A couple of things.... First, yeah, I was a bit altered when I wrote that.... Second, I think I've lost track of the conversation somewhere as I don't see the arguments of those claiming that we should use no machines, only that a provider should get at least the basics of clinical assessment before being allowed to add them to their care. I've seen many, myself included that have been grateful many, many times to have all of the tools. The problem is that I've seen no providers that started out as strong clinicians that didn't remain strong when adding the machines, but I've seen few that learned to use machines first and then became strong clinicians. Though of course my exposure to either group is fleeting, the motivations during that short time seemed to be telling. Systemet, don't ECGs miss near, or greater, than 50% of acute MIs? That's not a great percentage it seem to make your argument, though it's likely I'm missing your point in regards to Flaming's post. I've many times treated on the assumption of an acute MI without clear ECG verification to later have that assumption proved correct. So just to be clear, my argument isn't really against machines so much as developing decent clinicians at our level before introducing them. One group seems to use them as a tool, the other as a crutch, and I think most often mental crutches are bad. I think that there is no question that it's optimum to give good tools to a good clinician. But I think we do damage by allowing weak providers to believe that they are good clinicians because they can compare numbers on a machine to their protocols. But it does raise a question in my mind...as we've had a million threads laughing at the hosemonkeys for their constant stream of trauma pics with the automated BP cuff hooked up on trauma patients, do you all then trust your automated BP cuffs too? I'm not being facetious as maybe I'm missing the boat on this. As late as the LP12 it seemed to be, when comparing values during long transports, that that automated cuffs are either pretty reliable on some patients, or just crap. Why it would be patient dependent, or if that is even true, I have no idea. It's just what I've seemed to have observed. Also, as I'm still recovering from my predeployment premedication with tequila, if none of this makes sense either then I'm using that as an excuse... Dwayne

Yeah, man, but I like your geekiness a lot... Likely this experiment would be different if run into a patient. I'm guessing that you ran this onto the floor, or into a bucket which offers no vascular resistance, right? I'm sure that there is some vascular resistance but am not at all sure what percentage difference it might make. I would play but am at home now without access to those supplies. Dwayne

If that is truly the case then you shouldn't have machines, nor an ambulance... If you're 5 minutes from a hospital, then ok, as that's rarely real medicine, but further? If you feel that providers can't provide without machines, at least for a little bit, then man...I hope I hope I never fine myself obtunded in your area when your monitor and glucometer bite the dust... Dwayne

LMFBO

Squint, though I didn't understand much of your post, (Though I did relish the descriptions of you being old, fat and blind), I think perhaps you come from a different place in your ideas of the machines than many of us, certainly different than me. Your education regarding the machines, experience with them in and out of hospital, as well as knowledge and experience regarding the information delivered by them when compared to pt presentation is vast compared to mine. I believe that allows you a lot of confidence in them that I don't have. Though I'm relatively young in EMS, and in spirit, it's possible some of my attitudes are slightly older. I think the tone of the conversation here isn't against machines, but against the inability of many providers to manage patients without using them. I think in prehospital EMS, and again, certainly in my mind, there is always the attitude of 'worst case.' What if you don't have them, what if they don't work, what if they don't make sense compared to what your assessment has shown? And I think that that is a healthy, particularly in the remote setting where you're more often in a position to say, "Why does that guy seem so pale and sweaty? His gait seems kinda unsteady...I'd better snatch him up and take a look." I'm not aware of any machines that are going to do that. Would I expect an RT to develop an ongoing treatment plan without the use of machines? Of course not. Would I expect you to be unable to develop an immediate, 'circling the drain' plan for a patient that had just been brought into the ER without them? Yeah..very much so. We sometimes argue these points as if a call, is a call, is a call, kind of like we do when we discuss disciplining children. But that's of course not the case. If I come to the old folks home to find an 80 year old woman with slightly altered consciousness, somewhat cyanotic, RR 26/adequate depth, P 120, am I going to want an SPO2 and ECG? Of course. If I arrive to find the same patient tripoding, RR 36, P 130, appearing to be wearing her favorite pale blue lipstick, exhausted and looking like she's about to tip over from exhaustion, is the pulse ox going to be the first thing out of my bag? No...it's going to fall a far bit behind in priorities to my stethoscope, but I do believe that it will be the first thing out of many providers bags. But again, perhaps that's my ignorance speaking, in fact, most likely it is I'm guessing. When BEorP mentioned checking the wave form of the SPO2 my immediate thought was, "Well, I guess I could do that.." but I never have, and in fact had forgotten that it was even an option. I've just never given the pulse ox enough respect to want to go so far. Either is says what I expected it to when I put it on, or it doesn't. If it doesn't then I start to follow paths to try and verify which of us is right. It's not about, "I'm so smart I don't need machines.", but "I want to be so competent so as not to be reliant on machines." A different mind set I believe. Dwayne

Except for those rare folks that have pumps it's always 'spit balled' though, right? Brother where you do work as a volly EMT/medic student that you're setting up these kinds of drips, particularly Dopamine? Dwayne

Don't be hatin' just cause all of us youngsters make you old shitheads look incompetent. Plus, I think it's friggin' hilarious that you saw yourself in that post! Me? I had no idea what he was talking about... Dwayne

When I saw the title I thought maybe someone had started another gay thread... Hey 2c4, you know I've used that, or a version of it forever to carry people out of difficult houses but it never occurred to me to use it in that way. That's a great idea! Thanks man... Now I can't wait to try it. Dwayne

I truly believe that having a preceptor that made me define my expectations before being allowed to apply any technology changed everything about me as a provider. Still in my head I develop my theory, if only a knee jerk quickie, before putting on the O2, monitor, SPO2, capnography, etc. I think it's made me much stronger. Maybe not as strong as those that use then at the same time as developing a theory, but pretty good still. The many if not most of the most significantly ill medical patients I've treated while doing remote medicine I've discovered before they were reported to me. Diaphoretic, inappropriately anxious, speech off, noticed that they stumbled over nothing, distant look when part of a conversation, etc. I find that to be really uncommon characteristic in a medic. I used to say, "Hey! What are you doing? Don't you see that guy? Go and get him!" But now understand that mostly remote medics don't see much until someone hits the ground. I'm nothing special, but I do attribute my desire and ability to develop hands off suspicions to being forced to develop a working diagnosis without the aid of technology. Again, not saying that my way is the best way, or that machines are useless. But in the remote arena at least I think it's a strong approach. Wendy....Potato, potaato... :-) Point taken...thanks. Dwayne

DFIB, no, only the SPO2 values. You know what was really weird? I remember that I'd started to have trouble talking, and felt kind of drunk and hungover, slurring my words a bit, which is why the other medic got involved, I think hoping to prove that I was drinking...but mostly the moment when I thought, "Holy shit! I'm one of my patients!" The idea of medical providers not diagnosing and treating themselves became real to me then. Had I seen you in that condition I hope that I would have gone down the right path much sooner, but my role was to treat people, not get sick, so having something other than a bug I could shrug off just didn't even appear on my radar. Good experience though. For the record, to those that may treat these in the future it was symptoms were sort of like having a really bad flu, at least the last few days, nausea, joints/skin ached, really bad headache, combined with being motion sick..a little dizzy, slower than usual when thinking, had to focus to pronounce words clearly... Dwayne

Well, we all knew that already....