Eydawn

http://www.emtcity.com/topic/21493-recognizing-your-own-bias/page__pid__276144#entry276144 Ladies and gentlemen... shall we?

It's come to my attention that we on the City are often very inconsistent as to what biases we will accept, and what kinds of "stereotyping" we take for granted. For example... the shit storm of a thread prompted by a single joke about hysterical black woman syndrome. Wow! Just looked at that this morning... and I gotta say... holy Jesus (hey, zeus!) what a mess. On the one hand, you have the ethical provider, with a no-tolerance policy... (but nobody likes someone who likes to point out the rules...) On the other, you have folks saying "well, we've seen it... and no, we don't treat patients differently..." But I challenge you.... how can a stereotype NOT influence how you view someone? The second you know they are (let's keep the original group here) a black woman, you're going to have that little joke pop up in your head... and consciously or unconsciously, the way you interact will be influenced. Doubly so if you happen to be a different race than said black woman. We could get into comparative racial psychology, if anyone wishes... that's a tangled web all unto itself, my friends. But wait! There are those who purport that just knowing someone is in a certain group won't change how they interact with that person... and then turn around and DO THE VERY THING THEY SAY THEY WOULDN'T. Want to know what group I'm referring to? Fire personnel. The second some of our illustrious posters hear that someone is a member of the fire services, or a person steps up to defend their group, whom they perceive as being unjustly attacked, some of us jump both feet forward and go so far as to cast PERSONAL ASPERSIONS on that individual. Wait! I thought we said we didn't make broad assumptions, just because someone was a member of a particular culture? Hmm.... it appears that we do. I know a lot of us have an axe to grind and feel that the fire system in the US is holding back some of the development of EMS. This is true. The system is rigged. There are injustices. But to point fingers and play the blame game with individual peons who are within that power system, who really have no influence over how it all works? That's just plain stupid. It's like those of us who become frustrated because minorities cry "unfair!" with regard to academic opportunities and job opportunities... yea, there are some institutionalized biases that most of us don't even see, and boy, don't you feel attacked when someone points the finger and says "You have all this privilege because you're white, so YOU (as an individual) suck!" Sure. There may be some advantages conferred by being a member of a certain race or culture. But is it MY fault that the school systems in the ghetto suck? Well, my friends... simply insert "firefighter" for "white" and "EMS" for "minority".... take a good hard look at this parallel, OK? Recognize your biases. Own them. Illuminate where they are influencing your arguments. But don't pretend you don't have them, as that's hypocrisy at its finest. Wendy CO EMT-B

Ooh, didn't read anything casting aspersions on her at all... no worries. Just wanted to go into why she was using that particular example. She was a young nurse when it happened... so she was reaching out to connect to where we're sitting right now. Thanks, Chbare! Wendy CO EMT-B

The worst possible learning environment IMHO with regard to clinical preceptors is someone who rides you for no reason, shuts you down, and creates a hostile working relationship. That's impossible for you to fight against, because you're already in a disadvantage in the power dynamic and they hold the power to pass you or not. The best preceptors I have had were unafraid to admit what they didn't know, welcomed being questioned, challenged me to think, held me accountable for erroneous thinking or poor planning, and encouraged exploration. The worst preceptors I've had hovered intensely, interrupted my thinking processes, insisted I do things a certain way "just because" without explanation, refused to allow more in-depth thinking, and were nasty for no apparent reason. Find yourself a new one. You don't have to just sit down and take it. Unfortunately, that's the feeling you get being on that lower end of the power relationship... but it's absolutely not true and don't be afraid to fight for what you need. Wendy CO EMT-B

Don't'cha hate it when the person you're trying to engage in debate runs off and says "nah, I'm bored" instead? Passive aggressive indeed... lol... but we'll come back to this thought. Hang tight. I think the judge's explanation makes sense. I also applaud the judge for wishing to be sensitive to those of various faiths, and for trying to educate a couple of doofi. Too bad the interwebs took the story and bulshitted it out of proportion. As far as nasty, awful demonstrations go, yeah... they get our ire up, especially when they target those who can't defend themselves. But I know you're a smarter bear than you make yourself out to be, and I know you'd rather teach your son how to handle things like an adult... the sentiment of wishing to beat the shit out of someone and the ability to restrain ourselves are two different things. I know you would not land yourself in jail just to make a point, because that's not what's best for your boy. And, offense is in the eye of the offended... some people just overreact. A zombie Muhammad seems innocuous to us... but it's a matter of different cultural lenses here. Anyway. Sometimes, the best offense is simply TO walk away, and deprive the person trying to bait you of an audience. Oop. Wait. That's what AK did. But, I think he walked away from a valid interchange... I think it's a tactic best used against those you truly wish to shut out, or those who need to take it down a few notches before you can engage meaningfully with them. I think AK jumped the gun a little... but maybe he just didn't feel it... *shrugs* I'll always fight with you... (isn't that what female friends are for?? LOL) Wendy CO EMT-B

Ah, true that, especially if you start to build up fluid in there... however, what she was trying to illustrate was that knowledge is power, and not knowing that something other than an MI could cause ST elevation (early early on in her career...) caused a really funny phone call to the cardiologist on call. However, she emphasized that the cardiologist recognized what was happening, prescribed the right course of treatment, and then came by later to run through the strip with her and teach her what she didn't know. Half of what was interesting was her delivery. She wanted us to realize that we won't know it all, not even close, when we get out of school and that learning is a continuing process; you can either be ashamed of what you don't know, or eager to learn and ready to acknowledge that you didn't know something before. This person is so smart she scares me... and she's energetic... I love it. It's nice to see someone who's excited about teaching and not afraid to be asked questions. Chbare, since we didn't really get into it, what's your primary concern when you see pericarditis? Tamponade? Wendy CO EMT-B

Yeah... I'm lucky enough in my program to have a paramedic turned nurse turned law student... he's a wicked resource. This particular instructor that I'm referencing above is an ICU nurse, and she's just absolutely fantastic. Loving it for a change! I got to ask a question today about the ACLS algorithms (referencing changing from lido to amio) and nobody bit my head off- refreshing to say the least! Wendy CO EMT-B

Oh, I got more. Talking about carotid massage and baroreceptors... my instructor is a code blue nurse at her facility, so she was saying "Yeah... if you stimulate baroreceptors, you're activating parasympathetic, and just making them more dead. Oops! So check pulse at the femoral. I put on gloves and go right for that groin." Best lecture I've had in a while... Wendy CO EMT-B

I love this new instructor. ST elevation in all leads... global MI? Nah... just pericarditis... (you really have to be here, but I never knew that before and I could totally see freaking out seeing ST elevation all over the place if I didn't realize it was pericarditis!) Wendy CO EMT-B

I sing semi-professionally in an auditioned regional choir... we are working on the Brahms Requiem right now! I have also started running, training for 5k races keeps me motivated. I love to bake, read and sleep. I also am on my local SAR team... teaching helicopter ops in the AM after I get off shift. I do a lot of fundraising and public education for the team as my work/school schedule makes it hard to field on missions right now. If I had more time I would Irish dance again... miss that something fierce! Wendy CO EMT-B

True heroes really hate getting called that in my experience. Does pay make the difference? No... but obligation might. Someone who is obliged to perform a certain action is doing their job, someone who steps up to help when no obligation exists, especially at some sort of risk, qualifies more as "hero" in my mind. Every hero I have known absolutely refuses to allow themselves to be called one let alone referring to themselves that way... Can a paramedic save a life? Sure. So can a Basic or a schoolteacher or a cook... given the correct set of circumstances and knowledge to act accordingly. Wendy CO EMT-B

If Kiwi has you pegged and what he says is correct, you just made it apparent to anyone who wishes to google your name that you are a prime bullshitter. Tagged to your EMT license, no less. But wait! Here is a golden opportunity to fess up! Truly looking to start anew online, sans double life? We allow that... but only if you apologize and humbly accept that it is far better to honestly be whatever lame-ass you really are than to bullshit and pretend to be what you know you aren't. After all.. the City has allowed people their past mistakes... we let people start over (though we remember the past drama... oh yes.. don't think we forget just because we have the decency not to bring it up all the time) and move forward. Hell, everyone gets lied to... just hurts when it is someone you have grown to trust. Hence my internal conflict RE the late Dustdevil... but I digress. Kiwi- the second post made sense, the first not so much. Sorry bro... it looked just like another one of your "taking the piss" tangents... Wendy CO EMT-B

Ok. I'm still having trouble picturing this, but from your description of serratus anterior and latissimus dorsi, it's basically punched through and is being held by the major muscles of the back, right? It pierced on the lower back and is coming out the upper back... so I'd put him on his left side... so we have questionable involvement of the chest cavity but it appears to be lower index of suspicion if I'm reading the position of the impalement right... any changes in patient presentation/condition once we get them in position of comfort and some meds on board? Can't comment on fentanyl vs. morphine, but don't physicians prescribe medication all the time based on personal preference/past experience? They often have access to the data, but will go with what they've "seen work" before for patients... right? Everyone's got their favorites in the little magic basket o'pharm... and I don't think that's necessarily a bad thing as long as the indicators for a certain drug are there and the provider's willing to switch gears and use something they don't use as much if their first choice doesn't produce the desired effect in the patient... Hell, you learn best by what you actually see happen, all the numbers in the world won't tell you more than treating a high number of people requiring a certain class of drug and watching different responses... Wendy CO EMT-B

What, the, hell. Kiwi, can you post ANYTHING serious? Really. Welcome, Mr. Frazier. The one thing I will say is, now that you have identified yourself to your license and employer, you'll have to be careful not to say something that an employer may get you for. It's a double edged sword, this transparency thing... you may say something innocuous about a call that didn't go so well, but your employer may see it as grounds to bring discipline... or if you say something about friction in the workplace, and refer to anyone (even indirectly!) they may cry slander/libel. Just so you know... We've had members run into that before on the forum. In any case, welcome! Hope you learn a lot here! Wendy CO EMT-B

Do the right thing. So you potentially lose a job opportunity in that area... do you really want to work somewhere where the system is rigged? Seriously. If you're willing to be quiet about this, what other things will you find yourself silenced over, because you are afraid? Will you stand quiet, as patients are abused, because "oh, that paramedic has such a great rep... no one would believe you anyway..." or witness improper care that is "documented away"? You know what you need to do. Do it. You have the support of a community of individuals whose ethics are some of their greatest pride, if I've read Paramedicmike, Chbare, Dwayne, DFIB and others here correctly. A job is not worth your integrity, and it sounds like you'll end up butting heads hardcore one way or another in this region, as you're not comfortable with the idea of silence... So do the right thing. Wendy CO EMT-B

You did the right thing. We care for our patients both psychologically and emotionally... and in this case, the family was your patient just as much as the woman who was dying. You recognized that need... and you responded to it, professionally and compassionately. It's OK to cry, too. You were moved by the tragedy that hit this family... that's normal. Blubbering mess, no... shedding tears in empathy with a patient? Sure. Who can say why this particular call got you... but it did. And you responded very well, IMHO. Now, if it starts waking you up... then it's time to see someone to help you process it. But if you move on from this knowing that you were able to use your compassion and that you still recognize your patients as human beings, rather than just puzzles, then this was a good experience for you. Maybe there was something you were meant to learn on this call. *Shrugs* impossible to say for certain. Pancreatic cancer is a bitch. They caught it at stage I in my father in law, and he died just a little over a year from diagnosis after nano-knife surgery to get at the tumor... surgery went well, his body couldn't cope with the stress of it though and that was all she wrote. It's one of the most deadly cancers out there, and it is brutally painful as well. Wendy CO EMT-B

Thanks, I tried to point that out but kind of failed. Really, the whole deal is that the article sucks, and it really doesn't have much to do with the fire hero guts/glory problem at all. It would have to be better written to have any bearing whatsoever. Wendy CO EMT-B

FYI Denny: Naloxone = generic for Narcan. Good thread start! I would have to agree with the idea if you're not confident that this patient will be safe after you leave them, hang around for a while. If they go down again, then put them in the truck and don't wake them fully back up till you're closer to the ER... then there's implied consent, and you did the best thing you could for the patient while preventing a needless transport. What's the duration time of Narcan, average? I don't have my Epocrates window open... is it dependent on how much opiate is in the patient's system? (That's for you paramedic/MD type folks... I guess I could go look it up, but I'm really tired tonight!) Wendy CO EMT-B

Denny... I'm having trouble reading what you're saying. During orientation, an EMT who is already riding with the service brought up a situation in which the instructor thinks they erroneously let the patient sign a "refused medical assistance" form? I don't think you can force someone to go to the hospital if they really don't want to... but I'm not in your area, so maybe "found down" = ride in whether they like it or not... Can you clarify this above situation any? It's ALMOST to where I can figure it but not quite... Wendy CO EMT-B

Hang in there. It sucks. I am hearing what you're saying- there are people who graduated a year ago from the RN program I'm in who still haven't found employment. That's why I'm trying to network like crazy right now and get my foot in the door somewhere in the hospital system as a CNA. I'm also very resigned, and not at all peeved by the fact that I may need to commute or work in long term care until I can break into the hospital systems up here, which are very choosy... it is what it is, and I have no illusions about the job market. Take part time, per diem positions if you get the chance- you will eventually move to more hours. Get yourself out there. Dress well, practice interviewing with friends if interviewing sucks for you, and don't let the fact that "needs experience" is the buzzword of the day get you down. You'll get there. Chin up, kemosabe! You'll make it. Wendy CO EMT-B

Man, it's funny when you go to mass and then people spend the rest of the day trying to "wipe that smudge" off your forehead... no, really! It's s'posed to be there today! Lol. The priest was funny today, he said we'd already put in a good 60 minutes of penance, just by attending a mid-week church service! Cracked me up. Wendy CO EMT-B

First article: Such shitty writing... why bother whinging about it? Seriously. Also, please note: Chinese family that had a translator speaking to her husband... cultural perceptions of what happened, and perhaps misunderstanding the level or risk may have skewed things a little bit. Add to that a reporter probably asks the firefighter to comment, after he receives a thank-you note from the son... got some time inconsistencies here as to when different statements were made. Whatever. Not worth bothering about, seriously. Second article: Go to jail and stay there. Nobody in their right mind responds to pranking/hazing (even escalating intensity stuff) with putting something toxic/poisonous in a bottle that's meant to be drunk from. I say audit everyone involved, and disciplinary action for everyone involved in escalating workplace violence... that's what this is, you know. It starts out psychological, and if not addressed can sadly turn physical. Wendy CO EMT-B

Holy thread resurrection! Welcome to the forum...

I would say there's value in being able to balance the book learning with experiential information. However, if one does not have the educational foundation to understand the medicine that we are working with, all the "truck time" in the world will not a competent paramedic make... actually, that's a very dangerous thing- someone with a knowledge deficit who thinks that their blind operation, though smooth, is the same as excellent patient care. Wake up, buddy. It's not about breaking down someone who's smart or who's learned a lot and making them your mini-me. Learn from each other, and teach the person with less "street time" the skills that will enable them to succeed- don't belittle them for what they can't possibly be expected to know yet. I've been on the receiving end of that kind treatment, and it farking SUCKS. Be the leader, not the follower- break stride and do the right damn thing instead of what was done to you. Wendy CO EMT-B