DwayneEMTP

That's what you get for sucking face with the folks you transport in the back of your ambulance! Building up your immunities is all fine and dandy...but there's a line...Just sayin'... Dwayne

Yeah, but you watch musicals so that means that you practically have a vagina, so you don't count. I don't think that she's implying that anyone shouldn't be able to handle anything that comes their way, only that some folks are more comfortable with one sex or another. Also the legal liability is bound to be smaller with same sex care providers. And as we've had this conversation, I know that legal issues would not prevent either of us from rendering appropriate, compassionate, care, but if I had the option of allowing my 80 year old Female to expose her bleeding rectum to my female partner instead of me..I would do so for a plethora of reasons... :-) I think male/female teams are best simply because it's more pleasant in many cases, in my experience, to hang out with the opposite sex. Also, many of the strongest providers I've known have been female. I think that perhaps Crotchity is telling tales for the sake of teaching a lesson as there is not a service in the U.S. that wouldn't be sued into oblivion for making such comments... Also, to anyone bragging on their continuing education....Good to have you..it truly is, but you should really attempt to create posts at at least the high school level when commenting on your college education to avoid looking, in the very least, like a bullshitter. Dwayne

Heh Jim...no worries man...

God Damn it! I've spent the last few years convincing like...three our four people here that I have some decent opinions and now you have to come and stick your fat head in again?? Let me talk to your nurse privately for a second, would you....? As most here, I have very few, if any, opinions that haven't been shaped by you in some way, and that's pretty amazing considering I wasn't a child when I started.. I know you're life isn't easy now, and I also know that you've made your peace, but apologizing for pissing people off? That is just pitiful..though I'm confident that we've not pissed each other off any... Good to have you back Brother...This will be good for you! You're going to find that there are some tough, wicked smart, determined new providers here that will challenge you...I'm guessing that you'll manage ok. Plus, some folks you knew before will surprise you with their new cert levels... I think that you'll soon see that not only have we missed you here, but that you're still needed here as well. Dwayne

Gotcha, thanks again. The two times that I've recerted I've had plenty of CEUs and the office took care of the rest. Yeah, I get irritated sometimes when people bag on the new folks for reviving old threads, or starting new topics that have been discussed before because I believe that the value is participating in the discussion. Where one can get a ton of benefit from actively discussing a topic, they may get almost none by simply reading the thread. And hopefully there is plenty of this also, happening to all of us. It's good to have you back man!! Dwayne

Get the paperwork signed by who? Thanks for the help Medoc...been missing seeing you around here! Dwayne

Man, I missed this thread somehow...I'm sorry that I did. I am sorry to see you go. Some of the most mature and focused posts we've seen here in a while have come from you. Also some royal bullshit. But you know what man? Sometimes we all step on our dicks. I wish you luck with whatever path you choose, but trust this ol' medic on this..though I'm not happy with much of the direction or presentation in this thread, you will come to learn that you were given some good advice here. And you will come to see that your attitude brought about some of the beating you received. But hopefully all here will also see that you had much to offer...and we'll miss that here now. As in many things, sometimes the joy of proving that you're smarter, and better than another over rules the more important need to prove that you're also kinder and more productive. You should have been guided instead of ridiculed when the opportunity arose...and believe it or not, that is how it most often works here. Good luck brother... Dwayne Edited to fix a formatting error

Yeah, man, he could be talking about me too. Babs and I were just talking tonight about the City and I said, "Man, I don't know what kind of a provider I would be if I hadn't started my medic journey at the City..." And that's the truth. I was on my way to AMRs 7 month program, 5 hrs or A&P...man...I hate to think of it... You all are a gift..were then, and though we've lost some amazing posters over the years, are still a gift now... Dwayne

The problem is, his lawyer will turn this into, "I just love my community so much, I just have such a strong need to serve, that I forgot myself for a minute....I was just trying to help." When the truth would read more like, "My dick is just so tiny, my self esteem so MIA, that I was willing to sacrifice my childrens safety just to pretend to be important for a few seconds...." Pitiful. Dwayne

Probably? Probably??? Go back a bit and every time you posted I wanted to kick you in the head until it turned to mush. Man, brother, some things have certainly changed....Or maybe I just mellowed? Lone, I can tell you one down side your education in particular... I actually had way more fun busting your balls a few years back than I do now hitting the positive button under 'em...But it's a close thing. Ok, not that close...I'm proud to be your peer now...Thanks for taking the time to help us learn. Great post brother. Dwayne Edited for spelling only.

I agree LP, the problem is that the vast majority of those that argue against the degree program don't have one. So you end up with a lot of crap like, "I don't know why I should have to take basket weaving just so I can put on oxygen!" Now, that doesn't apply to everyone that disagreed here, but it's the most common type of comment. Those without one are experts on the value of having one. Kind of like when you ask many basics about ETTs. I do agree, this have been a really good discussion. And your post was a great addition! Dwayne

Welcome man, good to have you. Jump right in... And I"m with the guys..you do make the homeliest Amber I've ever seen... :-) Dwayne

Welcome HC! Good to have you back brother... Dwayne

Man, great responses. I'm glad others have chimed in to defend protocols, as I have no general disrespect for protocols but find that patients often don't fit nicely into any one protocol. Example. 80ish female, known diabetic, CVA x 2 within the last year each leaving pt with deficits, bedridden x 2 years. Called for 'unresponsive.' U/A pt is laying propped up on pillows in soaking wet bed clothes secondary to diaphoresis, arms clamped tightly to chest, a puddle of drool on her chest, very thin even when age is considered, BGL 27, unresponsive, airway patent, very obvious R sided facial droop not present when she went to bed last night and it's 'believed' that her face appeared normal when checked on two hours previous by daughter, PERRL, skin turgor very poor with significant tenting. Hopefully without trying to go through the entire presentation I'm making it clear that my initial impression was likely hypoglycemia/possible CVA. Fire is on scene, has Glucagon/syringe layed out on the bed for me. When I try to straighten her arms to check for IV sites I get a nauseating grinding in the elbow/shoulder joints bilat...I've not really felt anything like it before but it concerned me that I may damage her if I apply any firm pressure to straighten them. Access very poor due to dehydration. I make one attempt on the back of her forearm and miss, my partner makes two attempts in her legs, neg x 2. We are both competent when starting IVs. I decide to start an IO, (pissing of Fire with my 'cowboy shit'), as I don't want to wait on the Glucagon to work before deciding if I'm going to alert the stroke team secondary to the facial droop. I'm also not confident that the Glucagon will create a significant benefit for a patient in this condition that may not have sufficient glycogen stores. Also, I don't want to complicate her in hospital care by burning up any glycogen she may posses if I have an option, thus the I/O. Now, this is where we have to think, in my opinion. Protocol says that hypoglycemia with 2 or more IV attempts and access unlikely to give Glucagon. But the protocol is unaware that my patient may also be having a stroke. Stroke protocol says that if the patient is positive for Cin stroke scale to activate stroke team (after gathering competent history of course) and transport L/S to appropriate center. But the protocol doesn't know that I am unable to do a neurological assessment secondary to hypoglycemia. So I set my I/O, push some Lidocain and sugar, pt wakes up, straightens up, face goes back where it belongs, stroke scale negative, transport is uneventful. I believe that I have helped the patient, I am way ahead of the game had the stroke scale been positive. I feel good, the patient is doing well, I'm proud of this call. Yet it's one of three calls that they cited when they terminated me. Their argument was that it was "too aggressive and outside of protocol. You just don't start an I/O for hypoglycemia!!" For the record, my protocol for an I/O at the time was at least two missed IV attempts with IV access unlikely but access appears necessary. For Glucagon at least two missed IV attempts when access appears "impossible." I explained that we made three attempts without the likelihood of success with future attempts. And that I didn't use the Glucagon as access wasn't impossible, as proved by my successful I/O placement." I don't believe that there was one single 'cowboy' moment here. But my employer felt differently. So, I went on my way, now work for a really cool company, doing really cool stuff, and life goes on. So, hopefully this shows that I have no disdain for protocols or guidelines, only that they often, maybe even rarely, address more than one condition at a time and my experience has been that medical patients rarely, and trauma patients seldom, present with a single issue. 95+% of the time these issues can be resolved without any 'cowboy' shit, but sometimes, in my opinion, you are forced to decide your loyalties...to your patient, or the powers that be? Great thread all! Thanks for taking the time to participate.. Dwayne Edited to correct a grammatical error only.

I think usalsfyre has it exactly right. My good medical directors expected medics to do top shelf paramedic medicine, within protocol when possible, with MD help when not, and to do what's necessary when out of contact. Supervisors often freak out over aggressive medicine, but that's not always a bad thing. The service that you work for does have to be protected from yahoos and cowboys, and those are the folks that do it. They sometimes walk a fine line. I was told when I was fired from my last job, "You don't do bad medicine, it's just not paramedic medicine. You try to make everyone better, and that's not your job. It's our job to save them if they're dying, but transport them otherwise." I won't ever be that kind of medic. But it's important to me that our younger and/or newer medics understand that though the balance between aggressive medicine and management may at times be adversarial, it doesn't need to be negative, if both sides see the value of the other. Is there a chance that my outside of the box medicine created a positive outcome for my patient? Sure. Does that make me feel like a rockstar medic? Absolutely. Is there also a chance that my outside of the box medicine will get my service sued into extinction should I get too far outside of the box? Very much so. But if I have good, intelligent QA/QI then I don't have to spend a lot of time worrying about that. As a team we'll monitor that line and do the best that we can for both entities. As dumb as it sounds, we just need to stay withing the positive energy. If you do good, kind, competent medicine while thinking, "Fuck those guys! I'm going to do what's right whether they like it or not!" then you're going off into the ditch and looking for trouble..and you'll find it..trust me. :-) If you do aggressive, competent, brave medicine while thinking, "though I know 90% of my coworkers wouldn't do this, I'm confident that my medical director would want me to be super aggressive here...." I can't think of a time that you would be wrong. 3 or 4 times an ER doc complained about my decisions at my last job. Each time my medical director said, "Their thinking is a little bit archaic. You don't do less medicine to make them comfortable, you do good medicine and educate them if necessary. If that upsets them then they can continue calling me." Stay in the positive energy brother, where you seem to live anyway, and you won't go wrong most times. Just keep in mind that EMS is notorious for wanting to bump you over into a lazy, unhappy place if you let it. I choose not to participate in that nonsense..I'm confident that you will too. Dwayne Edit. It occurred to me when I noticed that akflightmedic was watching this forum....If you think that I was being modest before, about not being able to constantly compare my best care to cover my ass medicine while others can, well, he's a good example. When I worked with him I discovered that he can assess, develop a treatment plan, figure how it compares to protocols, what is worth risking, what's not, who needs to go to lunch, when it's time to tune up the ambulance, remember that his anniversary is tommorow, all while intubating and managing the monitor. (Friggin' pisses me off...) So it can be done. I truly tried to emulate him but nearly gave myself a stroke/MI combo so gave up and went back to doing it my way. :-) Just sayin'...

Hey man! Welcome to the City!! We're always happy to have new grads. You bring a fesh perspective, enthusiasm and the latest information. That's really cool. Where about in Minn? I lived for about 7 years in Mora, but have been gone for 20 or so. And do yourself a favor..don't just hang around. Jump in. The City is a lot like the streets...you don't learn by watching, but by participating and getting your hands dirty. Ask, answer, argue, debate, suggest, mentor, be mentored...those are all good things, and things that those of us that post regularly do in almost every thread. Hey! And if you feel like it..fill out some of your profile info. It sometimes gives people a little bit better idea of your perspective when considering your thoughts. Good to have you. Dwayne

You know what man, I couldn't have been prouder than when I talked to you today. You took responsibility for what you did and didn't do, and I'm very flattered by your comments. But there is a flip side. And many here are about to explain that to you. I've been fired twice now for doing what I believe was top shelf medicine. (Another time for just being an asshole..heh..but that's another story.) And each time I left my family without an income so that I could follow my morals and ethics as I understand them. The vast majority of the medics/nurses/basics that post here on a regular basis make me look like a monkey fucking a football when it comes to knowledge and practice. That's just simply the truth. You know why I focus on patients first and protocols second? Because I'm not smart enough to do what I believe to be the very best medicine that I can and at the same time constantly be comparing it to my protocols to make sure that I never get jammed up. I tried in the beginning and found that I could paralize myself with second guessing care vs covering my ass. I'm just not that smart. There are many here that can, and do, do both. So I had to make a choice. When I was in Afghanistan, I called my wife Babs once when it appeared obvious that I was going to get fired if I followed my conscience instead of my supervisors orders..she said, "If you choose to hurt your heart so that you don't get fired, I won't ever thank you for that. If you choose to damage your paramedic spirit so that you can keep earning that paycheck..don't come home expecting me to call you a hero, because I won't. Do what you always do...do the right thing. If that gets you fired then fuck em...come home and we'll get naked..." And I have followed her rules every day, on every patient, since that time. That works for me brother. Some people that I respect trememdously have shown me respect in return because they are confident that they won't ever have to question my direction. But if you're not prepared to get fired, not prepared for people to call your medicine bullshit simply because they are afraid to do what they think is best...then follow you protocols only. People rarely live or die based on our care. Some times they suffer more or less, and yeah, sometimes they live or die. But you have to make the decisions that are right for you, and the beautiful young woman of yours. Billygoatpete told me after I got fired last..."You know, I've never known a good paramedic that hasn't been fired.." And I believe EVERYTHING he tells me... You had a couple of good calls my friend. The lesson here is to find the happy medium. Don't become a "Screw the protocols" cowboy, but don't be afraid of every intervention because someone else may have been afraid of it... Protect your patient...from illness, and death, from pain, both physical and mental, and do so to the very best of your abilities within your guidelines and you should be coming up roses. But someday when you get your ass canned because your supervisor wants you to be a protocol monkey? Call me, or any of about 100 other decent medics on this forum, and we'll get you hooked up... :-) Dwayne

Yeah babe..you get nothing. Not only does Crotchity not answer any tough questions, but you don't deserve shit, being white and all... Dwayne

Hey Chad, thanks for following up on your previous post even though you got no feedback. I seem to remember this post but had nothing to add so stayed quiet. Maybe everyone else was the same.. So that was 100% of your recert requirement, or was it only part of it? I would love to recert via NREMT test as its one of the easiest that I've taken as a medic. Thanks again brother for the follow up. I would be grateful for any info you can share. Dwayne

It's awesome that you are able to see that your perspective has so much to do with your view of things. In this case, I'll loan you my perspective...they sucked. And whoever chose to put you with untrained preceptors sucks too. It was their job, for those few hours, to make you welcome, get you dirty if possible, but above all set an example of professional EMS and make your time productive. They failed in every category. You know what man? As much as I hate to admit it...sometimes I still feel like that too.. I'll tell you what. You have a lot to learn, but you seem to have a really great ability to judge yourself and those around you from a position of honesty. That is a rare thing...It reminds me of fiznat to tell the truth. The very, very best quality for a provider to have in my opinion. (Speaking of which...Fiz, any chance there is news on your continuing education situation??) I am really, really excited for your future and the things you may bring to the City. Dwayne Edited to change the way I displayed my link only.

Blacks early ability to compete was certainly retarded by their start, but the true poison that American society continues to deliver not via water, or food, or medicine, but by electronic signal is a sense of entitlement. And unfortunately Crotchity's dose appears to be fatal. How does one explain the amazing blacks of history? How did they manage to succeed in a country that, per Crotchity, has made it impossible for a black man or woman to read or write above the 6th grade level? Martin L King Jr, Cosby, Oprah, http://www.factmonst...a/A0775682.html, http://www.factmonst...e/A0812421.html, and of course tens of thousands of others. Thank goodness they didn't jump on board the, "We can't succeed because Whitey has programmed us to fail" bandwagon. I have spent the last 7 months in the deep south, and there it is easy at any gathering to hear talk of 'the coming revolution.' In bars, or supermarkets, you hear the whispers and moans of bigotry. White, Black and Hispanic. I'm confident other races are involved as well, but I am nowhere that I might overhear the group-speak of those. I lived in California when Hispanics were marching the streets carrying Mexican flags demanding an illegal workers right to work without fear of prosecution/deportation. Had they carried American flags instead, the flag of the country that they wished to become part of, I maybe could have gotten on board. We've actually come to a place where we have races and cultures that actively and openly express their hatred of their own country and desire to actively attack it from within, and they are encouraged to do so as an expression of our support of their independence. Us being anyone currently not them. This may sound like I'm trying to be witty, but that is not the case. At times blacks and hispanics hate each other, but at other times, when their agendas line up they become an oppressed us, fighting the oppressive them. Other times blacks and whites may be opposed, then a feminist cause appears causing black and white women to love each other, as of course, they always have. See? It makes it much easier, in this climate, to appreciate Teddy's comments on immigration, and apply them today to our inherent black population as well as past and current immigrants. It will also hopefully explain my comments that I have no African American brothers or sisters, but embrace with all that I am my black friends and neighbors that choose to be simply, American. "In the first place we should insist that if the immigrant who comes here in good faith becomes an American and assimilates himself to us, he shall be treated on an exact equality with everyone else, for it is an outrage to discriminate against any such man because of creed, or birthplace, or origin. But this is predicated upon the man's becoming in very fact an American, and nothing but an American...There can be no divided allegiance here. Any man who says he is an American, but something else also, isn't an American at all. We have room for but one flag, the American flag, and this excludes the red flag, which symbolizes all wars against liberty and civilization, just as much as it excludes any foreign flag of a nation to which we are hostile...We have room for but one language here, and that is the English language...and we have room for but one sole loyalty and that is a loyalty to the American people." http://urbanlegends...._immigrants.htm I've long ago committed to hate no one, to oppress no one, and to allow no one to be oppressed in my presence if I have the ability to prevent it. It truly hurts my heart to see Crotchity, who seems to me to be perfectly capable and able in every way, to choose voluntary oppression...Oxymoron? I used to think so.. Dwayne Edited to add the text in Bold, hopefully for clarity.

That was awesome!