Eydawn

You hit the nail on the head here, Dwayne. Drug seeking, attention seeking through parasuicide attempts, cutting... all of these are SYMPTOMS OF A PROBLEM. Just because you cannot effect a CURE in the short time you have them with you doesn't mean that you can't do anything for them... Wendy CO EMT-B

He doesn't seem to understand that getting up in the bar and dancing with his wife makes her feel SEXY... which then makes her want to horizontally dance... see the dilemma? Lol... I love dancing. He doesn't, makes him feel really self conscious. It's a work in progress... ;-) --Wendy

Holy shit, how did I miss this thread?! Thanks guys!!! I'm super excited. And nervous. And trying to figure out finances and how much I can actually work at my job while I'm in school lol. --Wendy

My condolences to you and your family Herbie. --Wendy

ROFL! That was just funny... As my husband just said... at least the neighbor's daughter was legal *_* The gender war thing is just hilarious no matter which way you spin it. Now if only I could get my husband to dance with me... been working on that one for a while! Wendy CO EMT-B

Amazon search for "wobl watch" reveals: http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=wobl+watch&rh=i%3Aaps%2Ck%3Awobl+watch&enc=1&ajr=3 Good luck! Poor kid, wonder if there's some kind of nerve damage there... that really sucks! And kids are definitely brutal. --Wendy

Well, there goes my top two differential diagnoses based on that leukocyte count... Ok. I'm stuck. Autoimmune is what I'm thinking but beyond that I can't figure it out. Bugger! Wendy CO EMT-B

I decided not to click the spoiler and take a stab with my own half-baked idea... the diarrhea, fever, anorexia, weakness and malaise all point me towards a couple of ideas. 1: Immunodeficiency (Could be a malfunction of his normal state with no infectious case, could be HIV, you never know). 2: Leukemia, especially with weird pain in hands (bone pain and inflammation around joint capsules) Too bad there isn't a blood count to look at as well... that would really be helpful... especially white cell counts. So on to the third idea that just occurred to me... Hmm... could be a hyperreactive immune system responding to vestiges of a bacterial infection, attacking connective tissue (forming the nodules) and prompting the fever and pain... I wonder how recent the cellulitis was? Wendy CO EMT-B

See, I told you it would be good for you... This is the crux of it here. Nailed it on the head, Dwayne. Except I think the monitor is more than a shiny toy, as I certainly can't distinguish between different kinds of cardiac without seeing a rhythm... (I over-generalize, but you get what I'm saying...) Ding ding ding! We have another winner here... this is an example of good in-depth thinking with regard to expose/not expose. And yikes on that psych call... any chick that can stab herself in the vajayjay and anus with an ice pick needs some serious help... Sometimes we all need a good smack. It's just the way it is. Myself included. Spenac, take heed here. You get so wrapped up in your own posts sometimes that you become *impossible* to actually debate with. Playing devil's advocate is all well and good until you get too lost in it and lose the actual purpose of your debate. And I prefer individuals playing devil's ad to clearly state so within a few posts. Spenac, I don't think you are playing devil's advocate here, I think you're consistently taking an over-exaggerated stance towards the exposure issue, and you always have. Hot damn, Matty, I didn't realize there had been 4 go-rounds with this... and that to me says it all. Want to inject some life into the forums? Don't troll. Part of why I've been absent from the City so long is because I've had better things to do. Seriously- I love the forums, I've learned INCREDIBLE amounts here, but I got sick of the bullshit. That last little bit with Ventmedic coming back as a sock puppet really disgusted me, as I used to respect her and look forward to reading what she had to say. When you're starting nursing school in January, working full-time, taking 14 credits, husband back at school full-time and trying to have a life in between SAR commitments and everything else mentioned above, playing with trolls drops pretty low on the list. I now read a lot of food and healthy living blogs- because there are excellent authors there with very little "ME ME ME!" ego going on. I can read a good, insightful blog about body image issues and nutritional status without getting pissed off and distracted from the million other things I *have* to be attending to, and it provides me with relaxation instead of irritation. Wendy CO EMT-B

The difference here is that a pelvic exam, without enough history to warrant us doing it, seriously compromises the dignity and comfort of our patients. I know I'm going to defer a back-of-the-rig pelvic/groin exam (that's me personally, as a human being) unless I'm pretty sure I'm going to die before they get me to the hospital where a gyno can look at me. There's windows on that damn thing- I don't want the neighbors to get a look see as well... and no matter how you try to provide for patient privacy in the back of an ambulance, it's not as private as an exam room. Blood pressure is part of your global exam and indicates the general well-being of the patient. You are far more likely to have to change your destination or chivvy the ER into moving faster based on any given patient's blood pressure than you are to have to change destination based on a pelvic/abdo complaint. And it doesn't compromise the patient's dignity or open you up to lawsuits. If you've got someone with severe pelvic pain/bleeding/testicular woes, you can bet the doctor will be examining it in short order. Since you couldn't provide the doctor with more info than he will already be gaining, as trending will offer minimal information from a pelvic exam (whereas it offers a lot more info with regard to vital signs), then to my mind there is little indication to do it. Of course, this differs on a case by case basis. No, I do not always expose. Yes, I am willing to expose if the particular patient's condition and history seem to warrant it. Wendy CO EMT-B

Expose if pertinent to your imminent assessment and treatment. DO not expose if no purpose other than just to have a look-see. Testicular pain? Expose. Might be swelling, torsion, something indicating immediate surgery. You may need to speed along the ER a bit. Pelvic pain? History-->expose if indicated in history... do not expose for just any complaint of pelvic pain. History is the key here. Building patient trust leads to a more accurate history. Pelvic exams won't tell you if she's ectopic, PID, menstrual cycle, etc... that is something that requires a doctor's evaluation to definitively establish, and they will be looking for clues in the history first before performing any exams or tests. Also remember that preserving patient dignity is paramount for us... where will they be most comfortable and who needs to see it the most? My answer: A hospital room, and the doctor. If it won't change your immediate course of treatment, and won't greatly add to the info you will be passing along from your assessment, don't do it. Rectal bleeding? Not much you can do for it... and gross bleeding is evident... so don't expose, unless suspected trauma or obvious gross bleeding. Spenac- I *like* you and I think it's dumb that you started this topic again. Round 2, same arguments, same viewpoint from you (always expose no matter what) and same people agreeing/disagreeing. So... it's not just the spen-haters who are going to rag on you for this one. Sorry bud! Wendy CO EMT-B

Patch- interesting comments. Do you really think people develop tendencies towards killing all on their own without influence from their religion, social custom and sociological surroundings? I'm not saying that all moslems (or Christians, or Jews, or Rastafarians;-) propagate murderous intent. The issue here is that culturally speaking, these Islamic terrorists in Afghanistan are not only not willing to embrace your viewpoint of "put it all aside and look at humans as humans" but will capitalize on the ignorance of anybody who thinks they'll give it a shot. They look at people like that and go "oh look! Easy target." An individual, placed on their own, will show very different behaviors and tolerances than an individual surrounded by their normal cultural group. Group-think is a very dangerous thing, and if you take into account the "save face" "personal image/male honor" stuff in Islamic culture (kind of similar to culture in Japan in ways if you think about it, where dishonor is the height of personal problems) you will find that most people will go along with the consensus of "kill the stupid infidel Westerners" rather than taking a stand in their own space against intolerance. In order for that gap to be bridged, both sides must be willing to concede. Guarantee you that it will take hundreds of years for a religious-run Islamic group to concede without some sort of drastic occurrence. You have to understand some of the psychology of Islam... really, God has nothing to do with this particular war, as I don't think God is the focus of MOST organized religions. They wouldn't be so f*cked up if God was the central issue... just my personal thoughts. As far as "I hate god as much as the rest of you"... not all of us here on the City are atheist or agnostic. Try not to generalize too much there. I would agree that money/power are central to almost any conflict, but I don't necessarily think that money always = power. They do often coincide, but sometimes they do not. What financial advantage to guerrilla warfare in Afghanistan do you see happening for the Afghani terrorist side? I sure as hell don't see a financial advantage there... As far as the issue of those who choose to be missionaries while providing care, I say more power to them. Who has the right to say they should or should not present their viewpoint? I may not agree with what they're presenting, but I surely agree with their right to present it. They knew the risks of venturing into this territory with the message they chose to deliver. Looks like they found the consequences, more's the pity as we need all the medical personnel out there we can get. Wendy CO EMT-B

Dwayne- Here's where most people are knee-jerking. Many of us, both males and females alike, are *sick* of seeing something broken down into "the women of" as it automatically confers a separation that so many have fought to overcome. This, to many of us, looks like another "Hey, we're gonna appreciate a minority again! Everybody look- there's single mothers working on ambulances!" It's like "The African Americans of Technology" etc... I'm a person working in the medical field. The fact that I'm a newlywed chick who also happens to do Search and Rescue may color my individual story, but nobody should look at my role in my workplace as "a woman in a nursing home." See how stupid it looks to put it like that? I know women aren't the minority in long term nursing care, and they aren't the majority in EMS, but focusing on a group because it is a minority is missing the point entirely; we aren't defined by our gender. That's why everyone was crying out so vehemently "but what about the single dads? What about burnout, that affects all of us, and how it affects men and women similarly and dissimilarly? What about those caring for elderly parents?" Those people are every bit as much a minority, and looking at a sampling of people with ALL KINDS of stories would give a better picture of those who work in EMS. It's nice that the person wants to take a look at women in EMS, but lord, couldn't we look at the people who work with the women too? Gender studies classes have made me very hyper-aware of "artificialized" lenses. Just looking at women is a very artificial viewpoint, as it automatically casts the men they work with into some sort of subordinate role. That's totally not how it works on the scene and in day to day life... so why not take a better bite out of the issues? Also, the fact that there are "few" strong female role models... excuse me? Politics aside, what about women like Condoleeza Rice, Michelle Obama, and Oprah? What about Olympic athletes like Amy VanDyken? She's every bit as cool as Lance Armstrong, IMHO. Look around you. Female role models abound... With much love, Wendy CO EMT-B

That's the whole point!! The nature of SAR is such that the RESPONDERS are at more risk the longer the person has been lost or injured. Sure, the patient is also screwed... but as put earlier, it takes WAY more resources the longer something has gone without attention. Without fail. Wendy CO EMT-B

EMS and Fire don't face additional risk to the RESPONDERS from people waiting to call. In most cases. SAR does. It's not the risk to the patient that we're worried about here (of course we worry about the patient...) it's the risk to US. As it was put in my earliest training.... MA1. My Ass FIRST! Wendy CO EMT-B

And then you could donate, and recompense the team because you understand the work that goes into it... Charging for rescue HAS been considered. It's been thoroughly considered, argued over, and firmly rejected. Where do you think those policy statements came from? It's not worth the risk, in the general SAR community, to have people NOT CALL until way too late. Wendy CO EMT-B

Ruff- I'm not picking a fight either, I'm defending a professional position in an emphatic manner. ;-) Medical helicopter expenses are billed to the patient- that's the air EMS company billing for care provided. Nowhere did I indicate that medical helicopters are expected not to charge- if the patient requires one, they will be paying for one. Search helicopters are often provided by the military. They have to log flying hours, which are paid for ANYWAY. It is much more productive for them to get those hours flying out on an active search. They have to fly- no matter what. So when we request help, surprise! They get to fly and be useful, instead of just flying randomly to log hours. http://www.nasar.org/nasar/downloads/No_Bill_for_SAR_Position_Statement_-_NASAR_4-2009.pdf Please take a look at this... Also, please explore the links here: http://www.mra.org/drupal2/content/charge-rescue As far as the analogy of the driver who gets hurt, driving is an everyday occurrence, and most accidents statistically happen in areas with very rapid EMS response. You will pay for the ambulance care, and the ER care, if you are a SAR rescue as well. The problem is that most SAR responses occur in non-typical geography, AKA not the city street. Responders who are delayed in responding to an auto accident on a city street (or even a county road) are not exposed to greater danger as a direct result of the delay. Responders who go into the field to rescue someone in the wilderness ARE exposed to greater danger if the response is delayed as a result of someone fearing a bill. A stupid while driving is different than a stupid while hiking- most people hike much more infrequently than they drive. We value the safety of our responders more than being paid for the work we do. It's that simple. There is a direct correlation between charging for SAR and increased risk to responders. By taking this position, you are going to cause ripples... willing to bob along for a little? Do you do SAR? Do you know anyone who currently does SAR? If not, then please don't clamor for SAR to be paid. Unless you are DIRECTLY AFFECTED by whether or not SAR is paid, please don't insist upon it. It is a choice that has been made by the INTERNATIONAL Search and Rescue community. Unlike EMS, where it is your primary bill-paying gig, SAR is a volunteer profession. None of us does SAR as a career. It is a side volunteer opportunity. Do you want to insist that all homeless advocacy volunteers be paid? People doing homeless advocacy choose to do so and choose not to be paid... does it make any difference to YOU, as an individual, if they choose to do it for free? Most SAR teams are not providing EMS care except for interim stabilization before handing a patient off to a professional, paid agency. SAR providing medical care is not contributing to the anti-EMS education issue... as the primary focus of SAR is locating individuals and getting them TO professional care, not providing primary EMS care for a region. As far as FireMedic65's statement that a rescue rope never being used for a rescue again after it has been used, what world do you live in, haha? We inspect all of our equipment after every mission, and equipment is retired as necessary, but it is certainly not thrown out after every single rescue. That would be wasteful, ridiculous, and definitely make it impossible to function on a volunteer basis. As far as the one freebie stupid statement- most people never need a second rescue. That statement more indicates that if we have to come fish your ass out AGAIN for the same or similar dumb mistake, you're going to be charged because you can't indicate that you just didn't know any better... the primary concern here is RESCUER SAFETY. Ruff, I'm not surprised that you and the fellow on the airplane didn't part as friends... there's a reason he was vehemently attacking the idea of charging for rescue. See everything I've stated above. Sure, there's whackers in every gig, SAR included... but you'll find the non-whacker types among us just as much in support of not charging. Wendy CO EMT-B

ABSOLUTELY NOT. No way, no how. *Except* in cases of willful gross negligence, or "faked" disappearances. Then those people should not only be billed, but sent to jail. Case in point: Someone in Boulder County faked getting lost in the wilderness to cover up an AWOL. They found him a few years later and sent him to jail... lots of wasted time, risks taken, and resources drained on that one. Most SAR teams are non-profit, volunteer agencies overseen by their local sheriff. Volunteers are NOT PAID- not even pay-by-call. Your tax dollars, at least in the case of Colorado SAR, are *not* going to fund SAR operations. Many SAR teams do fundraising to get donations to fund training and equipment, and many of the SAR members invest their own time and finances to make the team function. My team pays yearly membership fees, and all members are expected to provide the bulk of their personal equipment- climbing harness, response pack, etc. Those who go into SAR do so realizing that they will not be compensated financially. Compensation comes in the form of opportunities to attend classes and conferences at low or reduced cost, increased knowledge about wilderness survival and safety, the ability to enjoy being outside while also being useful, and the camaraderie of a team of similarly minded professional individuals. Problems with billing for SAR response: People are *afraid* of a bill, and thus wait LONGER to call for help. Even people with cell phones, which in the backcountry are a spotty safety device at best. Waiting longer to call for help means the person is exposed to the elements longer, thus meaning they will probably be in worse shape when they are eventually located, and therefore unable to assist with their own extrication/rescue. This means that even more SAR resources are needed to evacuate them- you can have 4 people on a search team walk out someone in good shape, you need at least 30 to carry someone out. The longer someone is out, the more difficult it becomes to find them and the worse shape they are in, especially if they are injured. We much prefer the hyper-reactive hunter's wife who calls crying because he's an hour overdue to the person who waits three days for their friend to come home and THEN decides to call. Outcomes are generally better with faster response. The longer they are out without being found, the more likely they are to try to "self-rescue" (aka: WANDER AROUND) and the more difficult it becomes to find them. Footprints age more. Scent trails become colder. This makes the job of the trackers and dog teams much more difficult. Lost people will often enter much more difficult terrain in an attempt to get to a "high point" so they can look around to figure out where they are, the longer that they are out. This increases the risk of significant injury from a fall or similar, and puts the SAR responders at MUCH GREATER RISK than they would have been had the person (or their family in some cases) sought help earlier. Those of us who are active in the SAR community, especially teams who are members of NASAR, are firmly against billing for these reasons listed above. See this website for more information on NASAR: http://www.nasar.org/nasar/ Everyone should get one freebie "stupid." Even the best trained people in the world sometimes make poor decisions when they go out into the backcountry. If someone is a repeat stupid, then the possibility of billing them could be raised, but only if it is shown to be a repeat behavior. Most people learn from their mistakes. Also, sometimes the luck runs out and people get caught short. Case in point: I have been trained by the Dive Rescue team out here to be safe in the river. Guess what happened to me two weeks ago? I got sucked into a current, tossed off my inner tube and caught in swiftwater, pinned underwater against some branches. I had to break branches to get free, and nearly drowned. If Dive Rescue had been called to fish me (more likely my body) out, should they have billed my husband? Everyone, at some point, will have a situation that could have necessitated response from SAR or in my case, Dive Rescue. The problem with the idea of billing for people who did not take "reasonable" precautions is that "reasonable" varies depending on the individual in question, the situation, and even the hour at which the person is found. If the weather forecast was for hot glorious sunshine and the person chose to pack extra water instead of clothing layers, but then a freak storm cropped up and soaked them to the bone and they were suffering from hypothermia and unable to self-extricate, do we bill them for not being psychic? At the time they set out, they checked the forecast, took equipment they deemed reasonably necessary, and the conditions changed... Some people free-climb. Do we charge them for falling, when they are expert climbers who happened to not make the handhold they've gripped so many times before? Do we charge them for choosing to climb without safety gear? What about the moron who goes to REI and picks up a harness and pitons and uses them incorrectly and falls on the same wall- do we not charge them, simply because they had the gear and didn't know how to use it or had a gear failure? Or do we charge them for using their safety gear inappropriately? See where I am going with this? Someone could easily raise a ruckus that they were billed unfairly when X guy got away without a bill... which is why it's easier to simply NOT BILL unless it is very obvious, extreme negligence. Balloon boy: false reporting. Negligence. Got billed by the county as well as a variety of agencies. There is a reason that public education is such a huge part of what we do in SAR. We go out to outdoors groups, schools, Boy Scout and Girl Scout functions, pretty much anywhere that will give us a chunk of time. We make outdoor safety education a priority, but we can't reach everyone. Should we hold someone responsible for never having been given an education on the outdoors? Sometimes you get people who come out on vacation and know their own territory well as far as preparing to go out, but there's factors they aren't even aware of in territory they're not familiar with. Should we bill people for venturing into new territory and learning the hard way that they didn't prepare properly? There's only so much that proper preparedness can do. Hate to say it. Many people who go into the backcountry frequently here in Colorado will buy an "insurance" card that donates directly to SAR at the state level- these funds are then distributed among the teams. Also, to my understanding, a portion of hunting and fishing licenses is also similarly apportioned to SAR. So it's not like SAR is operating wholly on the backs of the responders... and many people who are rescued become huge SAR advocates and go out and get donations to be given to the team as a thank-you. I would much rather operate on this system than to start billing for response and increase the amount of risk to myself and my teammates. We expose ourselves to the same dangers that the subject has been exposed to- and often face additional risks as well. I'm all for minimizing risk. I'm also for finding live, healthy people. It's really distressing to everyone, from the search dog up to the incident commander, to go out on a rescue or a search that turns wonky. Finding dead kids is the worst. Having a fallen climber die in your basket on the way down is about second worst. The sooner we are tapped to respond, the better odds our subjects have, and the likelihood of SAR being exposed to these traumatic incidents is decreased. Wendy CO EMT-B These statements regarding rationale for non-billing and increased risk to responders are representative of the official operating policy of my Search and Rescue Team. The phrasing and emphasis are mine only, and are not to be construed as a direct statement from any SAR team I may be affiliated with.

Ouch. That never feels good! Sucks to get beat out by "experience." Hang in there! The right job will click for you soon!!

I think it depends on the type of class and the quality of material provided. I know that I absolutely LOVE online classes. It allows me to not lose points when I get sick over attendance (I HATE ATTENDANCE POLICIES)- I can be holed up in my bedroom and still working on class material in a productive fashion. I've actually been taking online-hybrids as I'm retaking prerequisites to re-program myself for nursing school, and I would say that is the best of both worlds. The material is the same, online practice quizzes allow you to really gauge how well you're learning the material, and labs and tests are done in the traditional "classroom" setting one time a week. Online discussion (like we have here) is an integral part of a lot of online and hybrid courses, and that's where you get the peer-learning interaction which also helps to cement the material. I would not advocate taking say, A & P wholly online (period) or hybrid (much better choice) if it is your first exposure to the material. Something like human nutrition, basic math, English, or ethics makes a lot more sense to take online. I'm hoping some of my nursing specific classes will be provided in an online or hybrid option; working night shift gives me ample opportunity to do homework, but it's easier to handle if I don't have to be awake in classes during the day. Clinicals are integral, and must not be skimped on or cursory. As long as you prove knowledge of the material and are cleared for clinicals, I would see no problem with a program like this as long as it is accredited. Wendy CO EMT-B

I'd love to see what you come up with. I think the presentation my SAR team has is pretty much along the lines of what you're developing, but fresh material is always good. --Wendy

I also recognized it without Google. What Kaisu said. Although, I will say it would have been nice for Bushy with the "DING!" jeopardy moment to go into what it is, how it occurs, prognosis, etc. Once you've had to read up on it once, it rings a bell when you see it again. I had to research it in my microbiology class as an adverse reaction to certain antibiotic therapies. Wendy CO EMT-B

Why would you bother with gloves for an IV if you're not going to bother with them when they *really* count? And sure, you're not supposed to deploy with known HIV/Hepatitis, etc... so, it's totally unheard of for someone to catch it after they're screened, right? Ignorant... Mm. You had potential here... shame. I'm done... Wendy CO EMT-B