DwayneEMTP

Thanks to everyone for the well wishes. I'm having an amazing time! Having so few here that speak any English at all has been more wearing than I expected...but it's good still.. Some pics.. Welcome to Mongolia Album: Mongolia Uploaded 28 Oct 2011 - 03:27 My Mongolia Team Album: Mongolia Uploaded 28 Oct 2011 - 03:29 Part of the Mongolian Clinic Album: Mongolia Uploaded 28 Oct 2011 - 03:47 South Camp at Night Album: Mongolia Uploaded 28 Oct 2011 - 03:32 And a few more... Pretty basic Album: Mongolia Uploaded 28 Oct 2011 - 03:51 My Snazzie Ambulance Album: Mongolia Uploaded 28 Oct 2011 - 03:50 At the Chinese Border Album: Mongolia Uploaded 28 Oct 2011 - 03:52 My Mongolian Quarters Album: Mongolia Uploaded 28 Oct 2011 - 03:30 South Camp Walmart Album: Mongolia Uploaded 28 Oct 2011 - 03:28

Yeah man, you will need to supply more information... Depending on where you live specifically, and the type of system that you want to run in, a few possibilities might be.. To white, or to black. To male, or to female. To gay, or to straight. To fat, or to skinny. To slutty, or not slept around enough to hit the right people. To educated or not educated enough. But one thing is for sure...if you're whole class is employed, and you're not, there is something significant that you're missing. Have you thought about looking a few of them up and asking them? Dwayne

As the doc explains, that is why I believe that the relationship between medics and the ER staff is so vital and must be defended. Certainly not defended to the extent of covering up life altering errors, but absolutely to the point that there is the necessary trust to report honestly and completely. I can't think of a single time, to tell the truth, that a ER doc has jammed me up for being honest about an error. ER docs seems to be about 3/4 doctor, 9/10 educator, 1/3 councilor, 9/17th lawyer, and 5/8 hospital politician...which seems to keep them pretty busy for the most part. I've rarely had a shitty experience with an ER doc and those that I have had I've been able to write off to being tired or behind as it wasn't consistent. But I'm confident that I've never had a doc that was willing to take the ride necessary to get caught trying to cover up an error made by some chucklehead paramedic... If fact, as it seems to be your contention Flaming that this happens all the time...what motivation do you find that a Dr or nurse in an ER would have for covering for a paramedic, or any ambulance crew in general? As the vast majority of services are not hospital based, why would they risk their careers to do so? Just curious. Dwayne

It sounds like a good system man.. 33/hr...isn't like like six chickens and some beads in Australian? Dwayne

I think one pay scale for every level is ok as long as it's good, there is a very solid way to measure proformance, and it's really easy to remove bad employees. Otherwise you end up in a bit of a socialist bind...poor performance equals all the perks of good performance and there are very few people that can maintain peak performance in that environment... Dwayne

Now there's an interesting concept...considering the law... Dwayne

See man, this is the bullshit that makes it near impossible to take you seriously. It was a simple question... Who has done that here? Dwayne

Fixed the topic title for you. Dwayne

Richard, I'm not sure how failing to make every new gadget available to every segment of the population is a violation of civil rights? I would argue that paper books are continuing to be published in non braille versions, cars, to the best of my knowledge are still blind exempt, etc, etc. How is this device not being blind 'friendly' a civil rights issue in any way? Or, likely that is for another thread... Dwayne

I'm asking again, Flaming, HLPPs..... You continue to rant and be disappointed in our moral and ethical behavior in this field, yet who, in this entire thread has made the argument that it's ok to cover up life ending/altering mistakes? Who....Did.....That? Dwayne

I was reading some articles on a Wall Street protesters web site. It made me so mad that I could just spit... The 1% not paying taxes is a myth. Perhaps they don't pay federal income taxes, but almost certainly many, many dwarf my yearly salary just in the sales taxes that they pay. The one thing that the radical (notice that I say radical) Left seem to miss is that it is the wealthy are creating jobs. There are few middle income citizens, and even fewer lower income citizens individually creating any significant number of jobs. Putting people to work takes money, but it also comes with huge risk. If you want to encourage people to take such risks, they have to get paid. Right? As was said before by others, I'm not beefing with their right to protest, but with their often stated premise that if you're not with them, then you are obviously a member of the pampered elite.. Once again a tiny but vocal minority actually represents almost no one but speaks for almost everyone. Craziness... Dwayne

(i) $300-$500 depending on the type you decide to get. (ii) Ridiculous in my opinion. About 8 hrs with near continuous use, on hers anyway. (iii) Exactly like reading on the Nook/Kindle, same eInk technology, or whatever it's called. (iv) I got her a screen protector and a pretty good leather case for hers. I do know that the chopper pilots that ferried us back and forth from the oil rigs used them for maint. logs and check lists and they threw them around all over the place. Bouncing them off of the floor, etc. But, perhaps they got a new one every week..who knows. And taking it out in public? They're everywhere now...though may not want to leave it laying around as it's also pretty easy to walk away with. Everything on Babs works in amazing, intuitive ways. I would never have purchased one for that price, we got the better model for a safety reward on a rig. But just about anything you want to do on it you can so without thinking very hard. I'm guessing that textbooks will be the same, but I can't say. I'm hoping someone will chime in that can. Dwayne

Man, I like this a lot... https://www.facebook.com/#!/photo.php?fbid=2604455794371&set=a.1814320481482.105650.1344170271&type=1&theater I can't figure out how to post the pic directly here... Dwayne

Hey Mike, I'm confident that the Nook isn't what you're looking for. Though I have the older version. It's just not versitile enough in my opinion. I gave Babs an Ipad 2 that were were given on my last job, and man, it's pretty amazing. Though I've not tried reading books on it you may want to take that for a test drive before making any decisions. Me, like most of the people I know were, "I want a REAL book in my hands" people until we actually got an e-reader...and then, though I still love books, don't ever look back. Being gone a min of a month at a time, not only are the e-readers really easy to read, they beat the hell out of trying to pack a ton of books. Especially for those of us that sometimes have multiple books going at the same time.. Dwayne

Is anyone familiar with this site? http://www.daviddarling.info/encyclopedia/S/skull.html I've only just begun to explore it, but it looks like it can be really useful! Dwayne

Holy shit Nick, welcome back! I didn't click the link because my net is so slow that no matter what it is it would take days to load. (I once got the message, I swear it's true, on a download window of a file, 50megs or so, "Time remaining, 209 days 16hrs.") I just wanted to say hey...start another thread and give us an update, would you? Dwayne

Yeah...that was pretty much my plan.. :-) I know! But....(add something really smart here.) Screw you...and the horse your argument rode in on... Man, I was so far off in the ditch on this it's ridiculous. I was sort of trying to free associate and just posted an opinion that seemed like the actual course I may followed had I been actually presented with this situation. And I'm glad I did. Because I think I would have...and been completely, horribly wrong. Awesome answers all..thanks for taking the time to explore this. I know the 'a bus load of nuns was hit by a plane full of infant hemophiliacs, there's no flight and the radios are down' scenarios can be silly, but sometimes they pay dividends I think. Yeah, I kind of imagined asking this over my shoulder as I'm running down the street with my jump bag, yelling to my partner, "Ask them if this is ok! If they say no, touch em with a little Versed and then ask again! Don't forget to get them to sign!!") (Of course in this nightmare Flaming jumps out of the bushes, jumps into the ambulance screaming, "He's retarding your treatment! I am hereby notifying you that this is not an optimal treatment plan!!") (Having a little fun at the expense of your argument brother, wasn't meant to be a cheap shot. Funny, though, right?) Can you tell that it's really past my bedtime at the end of a long day? Great discussion all, thanks for playing. Though, apologies to whoever's thread we hijacked to have it. Dwayne

From a triage point of view, the most good for the most number. If I've got a critical patient onboard, and one in the care I've not improved the triage situation by stopping. But one for many? Man, like I said, I know the right answer, I'm just not sure that I could ever just drive by, wait 15 mins for a radio signal, or whatever the scenario states, and then know that I'm 15 mins down the road and EMS has only just been activated...tough call.. Dwayne

Actually, though of course I wish the circumstances could have been changed, it's really an inspiring story for me when I share it. Though there was no saving her life, she was blessed to have a provider that viewed her as a woman, a person, and someone afraid an in pain. That is not always the case for many I think. Yeah...actually, I love that story, though those that have not been in a like position may not get that... Dwayne

Yeah..though I know beyond a shadow of a doubt that you are all right... I'm thinking that the school bus would be the end, or likely end of my EMS career. I can't imagine any way that I'm not going to stop and try and render what aid I can...30 minute response to that type of scene is going to cause all sorts of unnecessary morbidity/mortality likely, much of which can be easily mitigated... It's not the same as choosing whether or not to stop in my car. I've got an ambulance full of shit, the MOI makes it likely that I can make a difference here for many... I know the right anwer, but I also knew it in the last job that got me fired when the right answer conflicted with what I believed to be the right treatment. I just always have this silly awareness that I can find another job, but I can't ever go back and undo a terrible thing, when I could have avoided it, to the best of my ability to see such things, from a human point of view as well. I've had to triage...and I hate it worse than anything in the world when lives are possibly at stake...but I can and will do it...I'm thinking that this would become a triage situation for me...not the car possibly, but the bus. And I will move on, after they jerk my cert, to something else.. Yeah, stupid answer I know...but it's as honest as I know, at this point in my life and career. Dwayne

The problem that I believe that Flaming is having is that intelligent investigation is not dramatic enough. Any solution that is not likely to cause people pain and make him appear to be a hero is going to be unsatisfactory. And for the record. My wife and I cared for my mother, my mother in law, and my father in law throughout the entire process as they died slowly and painfully from assorted cancers. And in each case possible errors in their care were reported to us. It was made clear that the best known treatments available were being brought to bear in the most intelligent manner that they were able, but that there were simply no sure answer. One of those errors almost certainly brought about the death of my mother in law much earlier than necessary. A misdiagnosis of the return of her cancer caused her return to cancer treatment to be delayed by approx. 8 months. That was a sad meeting, where the doctor was obviously upset and understood that he was putting his and many other people's asses on the line, layed out the errors and explained why he believed that they occurred. It made sense, and, for the record, no law suits were initiated. My mother was unwell during her Kemo treatments and her condition was believed to be a side effect of those treatments. It was later discovered that a shunt placed in her ureter had been pulled loose, allowing the ureter contents to leak, causing some of the symptoms that were mistakenly attributed to the Kemo. Again, the Drs were perfectly honest, admitted that upon hindsight that it probably should have been discovered sooner, and repaired the issue. No law suits were filed, nor considered. (Side note. Maybe the most compassionate medicine I've ever seen came from this same doctor. She said, "Myrt, with your type of cancer, near the end of your life the pain will be terrible and almost impossible, if not impossible to manage. You need to be very careful about the shunts that we've put in your ureters. They pull out very easily, with almost no pain. Should that happen, within about a half day or so you'll begin to feel kind of drunk and happy. Over approx. the next day you will feel more and more 'stoned' until you become unconscious. Not long after that you will die. Do you understand what I am telling you?" My mom smiled and said, 'I hear you babe...thank you." Of course she was telling my mother how to kill herself when the pain became unbearable. That is medicine in a near perfect world. In a perfect world she would be allowed to do it for her. But that is another thread.) For some reason you seem to believe that life altering/ending errors being hidden is the rule instead of the exception. You think that providers/institutes are exposed to liability and possible financial consequences when reporting errors? It's not a drop in the bucket compared to the consequences of being discovered trying to hide them. Running around reporting not yet understood issues is not good for anyone. Had the doctors simply said, "we made a misdiagnosis of your parents and now they are going to suffer more than necessary." it would have been a really bad things. Saying, "We've made some mistakes. We believe that those mistakes are going to cause these consequences. This is why those mistakes happened, and what we're doing to try and make sure that they never happen again. This is our plan to try and mitigate the errors that were made. We're truly sorry." There is a completely different outcome for that. One that was healthy, and understandable by our loved ones and their families. But again. There are no heroes or whistle blowers here. No way for you to make the news for doing only what is responsible, so I can see where you find the current system unacceptable. Dwayne

No change if we turn the scenario from a car to, say, garbage truck v loaded school bus? I'm truly not baiting, but trying to explore if there is no gray area either in the duty to act, or as a moral/ethical provider. Dwayne

If keeping clothing in the car is too much effort for a professional appearance, then you are so lacking in committment that you don't belong anywhere near an EMS scene. (Not addressing you in particular Jessi, but my experience with vollies in general.) The the fact that there is so much excitement that the time can't be taken to change into proper clothing speaks volumes. This is just me, but if you're so excited as you can't take the 60 seconds necessary to present a proper image of EMS then I'm not going to trust you to do anything, as that shows inexperience and a lack of dedication. If you've been doing this any length of time then you know that that 60 seconds will make no difference. And if you don't know that then it shows that you're moving to fast, almost certainly driving to fast, and you don't 'get it.' That you don't yet understand that EMS is not about doing everything fast..that is TV bullshit, but doing it more slowly, and correctly the first time, every time, to the best of your ability. Now, you can tell yourself that you're in such a hurry that you can't change clothes but that you DO do everything else slowly and correctly...but I'm going to call bullshit on you. I stop before leaving for any call and make sure that I've got gloves on me, a couple of pens in my pocket, that my stethoscope is on the dash, write down the address and my dispatch time and that there is no one around the vehicle. Probably longer than it takes for you to grab a shirt out of your car and tuck it in and go. 'As often as I can' shows either a lack of committment, or an inability to plan for something as simple as having clothes available when you may respond. Neither of those is terminal, but both of those should cause you to give them a little thought...see? I'm not bagging on you either. I think that you can I chatted for a minute in chat one night, didn't we? You struck me as smart, and funny...but you're off in the ditch here. Your responses drip of the common, "You can't judge me because I'm a volunteer!" Yet, I have the feeling that there is nothing common about you at all... Dwayne

Of course I get the 'duty to act' on not retarding care...And I don't disagree with anyone's answers to this scenario, as I can see it both ways. But , I am curious.... Does anyone see a case where a long response time for a discovered accident would constitute a triage situation? Or does Duty to Act mean that the needs of one will always overried the needs of the many? Dwayne

And at my last gig <3hrs for strokes. While I love the flight medics with Flight for Life in the Springs/Denver area, they are great at teaching the proper uses of flight and their advice is certainly valuable, don't forget to compare their advice to that of your services protocols for utilizing the flight services. They want you to fly more people, as it's a business too of course. Your service, and current studies, will likely will suggest that you fly less. Flight isn't something to be done for the cool factor, as it most often is. Though yeah, it's cool. :-) Utilizing flight is a clinical intervention like any other, only it comes with the possibility of hurting/killing many instead of just one. You need to always keep that in mind. Having said that...I've never met a Flight for Life medic that didn't make me feel like an ignorant child when it came time to discussing medicine...though my exposure is small. I've not been around a service that will fly active CPR, though I've heard that it's done in some places with larger helicopters. And strokes, as was mentioned above. But as I said, it has to be considered whether or not it will be a beneficial intervention. In the service I last worked for on the street it never was with any of my patients, but was sometimes for the ER. 45 mins Flight response min, 20 min transfer time, 45 min return...I would have been to the stroke center 20-30 mins ago. Good question. Dwayne