Eydawn

You want to clue me in as to what "obvious" thing I'm "seeing"? --Wendy

It's a humorous word smash. Nurse-doctor = "Noctor"

Nasty hypertension. What's her blood glucose? Why did she fall? And how heavy is "rather heavy"? Are we lookin' at 200 pounds of grandma, or 400 pounds? If she's very obese, we could be looking at major tissue damage on the posterior side. Why was she butt naked? Incontinent at all? Breath sounds? I know you initially said not injured, but what does my physical exam reveal? Medications? Wendy CO EMT-B

Mental status? Health history- long term and short term? How old is "elderly"? Last oral intake? Last menstrual period? BP, SaO2, pulse, respirations, skin color, condition and temperature? Let's start with those... Wendy CO EMT-B

I beg your pardon! I must bow to the master, since I obviously don't know any of my orifices from various geological formations! Good lord, man... you obviously don't know me at all to come at me so strongly. I wrote that post at the end of a *very* long night shift that was also interspersed with studying for a final exam for tomorrow. Too bad you missed my tongue in cheek... and I'll be very honest, the word "noctor" just tickled my funny bone. My apologies for having a sense of humor. For your information, I already possess a Bachelor's degree. Nowhere did I imply that all Nurse Practitioners do not understand the delineation between an MD and a DNP. I am *very* familiar with the differences between PAs, MDs and NPs, having considered each of those options as a long term career goal. I am personally acquainted with several individuals who are PAs, MDs and NPs, respectively. I am also intimately familiar with a couple of individuals who possess a DNP who really and truly should never have obtained that licensure. To counter another of your points, nowhere did I indicate that I have a problem with someone who has a doctorate degree being addressed as "doctor." What I do have a problem with is someone who possesses a doctorate degree in a health field attempting to represent themselves as equal to an M.D. which they are clearly not. NP and MD are very different practices, with different ethical focuses and treatment emphases. They may accomplish similar goals, but the educational path is drastically different and I feel that those differences need to be recognized. For those of us in the medical field this is not so difficult; for the layman, who stands to lose the most in this game, it is very easy to confuse. There are a select group of individuals who are attempting to represent themselves as equal to the M.D. in petitioning for completely autonomous practice, and I disagree with this. I believe that a physician extender, no matter how competent in their field, is NOT a doctor. If this offends you, I am sorry, and I would like to know why. I have great respect for the vast variety of medical providers in modern medicine. I am in awe of what PTs can do. I admire those of my friends who have managed to make it through medical school, and have greatly enjoyed watching them develop both personally and professionally. I am immensely proud of my friends who have progressed to Paramedic (many of whom expand their knowledge at every possible opportunity.) Your comment about "piss poor opinion" of NPs is ludicrous, to say the least. I would really like to know how you gained that impression when I didn't really comment on the field of NP itself... As far as advancement of education for medical professions goes, you will find no stronger advocate for higher level education than myself. I became very aware of the EMS education shortcomings very quickly. I realized that I had been turned loose with next to no education on pharmacology, anatomy and physiology, pathophysiology, and so forth... it made me very uncomfortable, and as I have moved away from the initial 'Hooyah I got a cert!' phase I have come to the conclusion that EMS providers should at the very least have an Associate's degree, preferably a Bachelor's degree, before they are allowed to practice at the level that they currently practice at. This opinion, in part, has been formed through the multiple intellectual discussions that have taken place in this forum. It has also been formed from my personal experiences in various aspects of EMS. I am not nurse bashing (again, where the hell did you get that idea?); I recognize the shortcomings of EMS very acutely. Why, good sir, do you think I am pursuing a degree in nursing instead of EMS? To be fair, I also acknowledge the shortcomings that are present in the field of nursing. No profession is immune to failure. Nursing simply happens to be further along the "developed" continuum than prehospital care, as far as I can see. I also much prefer nursing ethics and the nursing approach to care. I intend to obtain my BSN as soon as practically possible, as I feel the ADN will not be adequate for my goals, even though it allows me to license as an RN. You know what I think you did? You saw that "EMT-B" after my name and lumped me in with the "we don't need no stinkin' degrees" crowd without even bothering to go through any of my posts to get a feel for who I really am and how I *really* think. You chose to judge me based on a single post without context. Shame on you. For someone who appears to be so intelligent, based simply on the quality of your writing, that was a pretty ignorant move. And for the record: Paramedicmike has known me since I was 17. That would be nearly 7 years at this point. He knows that I am not in any way anti-education, and was trying to gently clue you in. For you to lump him into that same ignorant mental mold was another ridiculous move. Yes, there are those who oppose education advancement on this forum. If you spend some time actually reading threads, you will see that those who advocate education are as vociferous as their ignorant counterparts (and generally spell better, to boot!) As far as the LPNs writing prescriptions, not a *single one* actually wrote a prescription. This NP in question sought advice on how to write the prescription, to the very drug and dosages, from our LPNs. This was deemed wholly ludicrous, and discredited this NP in the eyes of everyone who has become aware of these incidents (yes, they are plural). Stupidity is not limited to a profession. I think that's where I'll leave this for now. Wendy CO EMT-B

Speaking as someone who's looking to eventually become a NP, I couldn't agree with JPINFV more. You want to be a damn doctor, you suck it up and go to MEDICAL SCHOOL just like every other doctor. You want to be a nurse practitioner, you better accept that at the end of the day you will answer to a doctor. I am all for allowing NP's to prescribe, but under a doctor's supervision and final veto... ROFL @ "Noctor" btw... that totally made my morning!!! Oh my gosh. I'm gonna walk around the building this morning chuckling "noctor... snrk" under my breath... coz we have a nutty NP who comes in to see some of our residents who has missed several things but who also thinks sunshine comes from her every orifice... and then asks our LPNs how to write out prescriptions. Noctor. My new favorite word!! Wendy CO EMT-B (Future anti-Noctor)

Welcome from another Coloradoan!! Good to see you around. If Dwayne says you're ok, you must be! :-) Wendy CO EMT-B

I'm Wendy, not Annie, lol. I've found that the more restrictive we have to get with immobilization in the SAR world, the more they tend to freak out... just my experience though... Wendy CO EMT-B

The SKED is a useful tool and I would agree that it is not necessary (imperative) to use some form of spinal immobilization when you're utilizing the SKED. That said, I would agree that an immobilized patient moves around less and is far more comfortable for the ride out, especially if you transfer them to a litter on a wheel. For high angle and scree stuff we use high angle and scree specific baskets... I don't know that we really use the SKED much. I would suggest contacting Rocky Mountain Rescue Group (they put on advanced rescue trainings for people in our area a lot) to see what their take on it is- they're wicked smart as far as that stuff goes and I'd be more willing to go with their recommendation than with my own skimpy knowledge. As far as rescues go, I'm a stuff-schlepper, EMT and patient-schlepper. I can also run a brake and a belay. I can't set up systems, I'm rusty on my knots, and I'm not who you send over the edge because I lack a lot of experience with that. So... there's my knowledge base for you.. Wendy CO EMT-B

Aw man! You put my avatar's face on the ditzy tits chick!! And Dwayne is great... 'cept for the fact that his hands changed race lol. EXCELLENT photoshop funny... made me LOL!!! --Wendy

We always trained our kids to be First Responders. I cut my teeth in a Venturing crew that has EMS as its focus. We used to have a contact where we were allowed to ride along with the local EMS service, until it was deemed to be too much liability (we had a couple 17 year old whackers who got us in trouble, basically.) Now my crew does more event standby work and teaches Boy Scouts classes like Readyman and CPR. My primary concern is that when you are 14, 15, 16 you really don't understand the hazards associated with working on an ambulance- it's just cool and interesting and exciting. Know that any crew taking on a rider will have one more thing to be concerned with on the call. Make sure you have proper legal paperwork (parental releases, etc) before you let anyone ride. I would hold the kids to the same standard of vaccination as your employer does- if they require MMR, Hepatitis, Tdap, TB test, etc. make sure the kids have proof of this as well. Make sure you know where the kids fall as far as being covered by workman's comp insurance, etc. I might encourage making the minimum age to ride 16. Riding herd on a 14 year old is different from riding herd on a 16 or 17 year old, in my opinion and personal experience. I think this kind of thing can be both valuable and risky. Make sure it's worth the risk to your agency before you take on the underage riders. Also make sure that your kids are mature enough to safely ride with you- we had a few I really didn't think should be allowed to ride in my crew due to immature behavior. The last thing you need to worry about is a kid doing something stupid in a volatile situation. I think your outline for what to teach the kids is great; looks really similar to what my crew taught (sans the department specific stuff). I think you should dedicate about 4-5 months to teaching all of it and make the kids take written and practical tests before you let them on your ambulances... anybody who doesn't pass, doesn't ride. Good luck to you! Feel free to PM me if you have more specific questions. Also know that I came into Venturing as a youth and cut my teeth as a First Responder and loved riding, but that I have since changed my opinion on it as I have grown older and become more aware of the hazards, so if this post seems like it's negative with regard to letting the kids actually ride, there is rationale behind it... Wendy CO EMT-B

You cannot and will not change a negative, nasty department. If you can't bend yourself to shape to the status quo, you will be ABSOLUTELY miserable. Find a department that is worth working for and don't look back!! Get your good director to write you a letter of recommendation, and move onwards and upwards. It's not worth the fight. It really isn't. Good luck to you! Wendy CO EMT-B

If you're on a training that turns into a call, shoot the significant other a text as you leave saying you're gonna be incommunicado until it resolves. And take away the scanner. Absolutely what I would advise as well. I always worry more about my SAR team when I'm listening to a call that I'm not on than I do when I'm at work and don't have my radio... same damn call, but hearing voices here and there you start to worry... did they make it up the trailhead OK? Is so and so's knee going to go out this run because it's been touchy the last few weeks? Are they ok working this code? Will everyone process it OK after the run? I don't do that when I'm not listening to the radio and getting snippets of the call... weird, huh? Fortunately my husband and I are both EMTs. This definitely helps- we both know how this stuff works and not to worry unless you get a phone call from a higher up. I think teaching your wife that no news is really and truly good news will be the way to go. Wendy CO EMT-B

Anthony- They didn't deserve you and you didn't deserve their treatment. Someone with your intellect and talents will find a much better position that is much more gratifying than working for a $h!tty service like that. Chin up, dude. You did no wrong, you did everything you could, and they're a bunch of morons for deciding to force you out. Good luck on the job search!! Best, Wendy

"The Companions" by Sheri S. Tepper- excellent science fiction piece, future-overpopulation themes and animal activism stuff along with interstellar travel... it was actually one of the most complex storylines I've read in a long time and yet I managed to never get lost, which is pretty rare with multi-strand storylines. "The People Stories- Ingathering" by Zenna Henderson- collection of short stories about another race of human people not of Earth and their experiences after they get here... REALLY good stuff. Actually falls under the hat of Christian science fiction in my opinion (I know, right? Totally different than what you'd expect). The "Chanur" series: "Pride of Chanur" "Chanur's Venture" "Return of the Kif" "Chanur's Homecoming" by C.J. Cherryh... absolutely one of my favorite sci-fi series of all time. Character development rocks. Good interspecies conflict stuff. That'll do for starters, I think... Wendy CO EMT-B

I always report clipping a curb... I dunno man, with a policy like that it sounds like you may in fact be screwed, simply because you happened to get busted for a miniscule dent. Policies like that are absolutely stupid and do not encourage self reporting at all... just good cover-ups... The only thing you can say is that honesty and integrity are core values to you and that the curb brush was so slight that it didn't even occur to you that it might have caused damage, and that the crew who pointed it out got an honest response from you- that you thought maybe it could be from brushing the curb. The fact that they canned a guy for a minor fender-bender does not bode well, unfortunately. I'd start looking for new positions right now just in case... hate to say it... but better to get your ducks in a row and not have to use them, right? Wendy CO EMT-B

Volunteer service period is beneficial for people. Especially younger people seeking purpose and identity. I know my EMS focused Venturing Crew saved one of my friends. Literally- saved this kid from self-destructing. He's now a very successful paramedic. Glad to hear things worked out for your young'ns there!! --Wendy

Spenac: I'm sorry, friend... I think you're a very intelligent poster and usually have a lot to offer, but you totally copped out on this thread. If you have experts to support your position and opinion, please, put it out there so the rest of us can work through it too. Don't just say you have them and then claim that you're taking some sort of moral high ground by not providing the evidence that you claim to have... all that does is make you look SCARED to back up your claims. No, I mean really. I've never seen you do that before. What gives?? Wendy CO EMT-B

You know what, this show is starting to become pretty entertaining. Of course they're still making mistakes, but they're capturing characters a lot better now than they were before. Best line ever: "I was gonna let a doctor, or at least someone smarter than Bo, decide that this guy was dead..." That whole sequence just had me ROLLING because I've totally met EMSer's like Bo. TOO FUNNY!! If you know your partner is a writer, don't go to their readings... you don't want to hear how they write you, because you're just plain not going to like it. That goes for any profession where you've given your coworker permission to write about you... God, I hate to say it, but I think I like this show... it's got some decent character development going on even if it still isn't totally realistic. *ducks and waits for the negatives* Wendy CO EMT-B

WTF are you doing going out to Jackson Mississippi from Arizona? I'm sooo confused.... --Wendy

There's no evidence for a myriad of beliefs, traditional or non-traditional... (organized religion vs. individual perceptions of the world.) That's why they're BELIEFS. Someone posted a topic in the PERSONAL SIDE forum to explain their perceptions of empathy. You can disagree with it or agree with it as you choose, but to hit that post with a negative (and Dwayne's follow-up post, which I just corrected that on) is childish and severely unproductive. You don't have to believe in empaths, psychics, ghosts or anything else you don't want to believe in, but you also don't have to take a shit on someone for taking the time to lay it all out in a directed, logical and well-explained fashion. I believe some people are sensitive to things that other people are not. I also have funny theories about how time works. Does that mean you're going to hit my posts with a negative, too? I think that's as good an explanation as I've seen from pretty much anyone... I've had premonitions. I've sensed things that other people around me don't sense. Guess you can lump me in with the crazies. Wendy CO EMT-B

You DO realize that it's 3am EST, 1am MST? Of course there haven't been many views yet! Hang tight, let me find you some references. I'm kind of busy studying but I'll see what I can pull out for you. I think you're on the right track with the ETC shutting down and byproducts building up resulting in death on the cellular level... but I'm not entirely sure myself. Wendy CO EMT-B

Just wanted some general discussion on the issue of gender in medicine with specific emphasis (this time) on physicians. This was prompted by the fact that it gets really hard for us to function on the floor when some of our residents absolutely refuse care from a provider of a specific gender even though they know and like the provider. Thoughts? Does it matter to you, personally, what gender your physician is? I know I prefer male doctors because I've had more success in open honest communication with the male doctors in my experience and had a lot harder time getting female doctors to listen to what I have to say. Perhaps I have become conditioned by my selective experience and am now prejudiced against female doctors (with regard to choosing my PCP, for example...) On the other side of the coin, for those of us that are actively working in the medical field, does it bother you when a patient refuses you on the basis of your gender alone? How do you react to that? What do you do to be able to work around it? Should gender matter? Should a patient (assuming no history of sexual trauma) be able to refuse a provider solely on the basis of gender? Wendy CO EMT-B

It finally premiered!! Sweet. Will have to see if it's on demand for me... I missed it. I happen to enjoy Bruckheimer's use of storytelling and character development, so I have high hopes for this just from that perspective. That's me though... CSI junkie... Wendy CO EMT-B