Eydawn

I'm not talking full time clinic hours here... I'm talking making the NP's salary worth the rural area's time by having them fulfill a dual role. I'm sure it could be finagled appropriately. Maybe it would be beneficial to be a rotating system- have three that work under the auspices of the hospital who rotate in and out of the clinic/EMS role on a bi-monthly basis... I'm not talking taking NP's and PA's with no experience and chucking them in a rural clinic and expecting them to fulfill a role they're not prepared for... in a way, I think I'm envisioning creating a new dynamic position that people would be expressly educated for. That way, you bring two kinds of healthcare to rural areas where it was previously unavailable... I think it's very financially feasible as long as it's handled correctly. I'm fully aware that NP's and PA's are not MD's and must work under one. Hence why I think any NP or PA in that role should be affiliated with the hospital, rather than the fire department. They still have more freedom than a paramedic and the education to go with it... and are still able to do more in a clinic setting than a paramedic ever could, even with really liberal protocols. Who covers the NP? Well, there's usually only one paramedic on at a time in rural areas that have them... so the next patient suffers luck of the draw and gets screwed. Without a program like this, they *all* get screwed in terms of having ALS care available to them. As a community health model, I think the NP idea has more merit than introducing paramedics... and it has the bonus of drawing in people who really WANT to be NP's instead of what will happen if ALS is externally mandated... you'll get a lot of resentful fire folk who didn't want to do it in the first place who turn into half-arsed medics. Wendy CO EMT-B

I think DocHarris nailed it on the head. And I agree with Vent... and it gives me hope to see that she's not given up. I might still be young and hopeful, but to see a veteran who's also committed to providing the best that they can for the patient on ALL levels is very heartening. Makes me not regret turning in my nursing school application, and really makes me want to bite the bullet, get back on the horse, and head back out pre-hospital again. Don't get me wrong! I have no problems with being realistic. Realistically, you're not going to help everyone. Realistically, you'll see the same frequent flier and maybe never have an impact. I completely appreciate where people are coming from with this. But that doesn't mean you don't TRY. You never know when you'll be that random factor that makes the difference. Wendy CO EMT-B

Would you mind not cluttering, CB? Offer an actual response, or stay outta the pool! Crotchity, to address your two points as to why my proposal won't work... You already have EMT's. The PA is not going to be riding in that ambulance by themselves... they're going to need partners, just like everyone else, and I'm sure there can be some changes in licensing rules to allow a PA or NP to meet that requirement. In the volly system, the PA is arriving on scene with members of the FD... someone's gotta drive, right? And most of them are EMT-B already... I think we can find PA/NP types that want to work rural systems, and who are interested in pre-hospital as well as clinic settings; the trick is setting up programs specifically to recruit those individuals and adequately prepare them for those roles. I think the interest is there, we just don't have the structure set up yet to bring both sides together. Wendy CO EMT-B

I've been thinking a lot lately. Many of you know that I do search and rescue for my county... and as such, we often work with the smaller rural fire departments in our area. I know a lot of us have lamented the problem of volunteer EMS (whether or not it is attached at the hip to fire) as a major factor in holding back our profession in terms of respect and wages and so on and so forth. I've come to the realization that we will probably never be able to completely eliminate volunteer EMS. Many of the rural areas are simply just too small to make it financially viable to go fully paid and to acquire the number of paramedics that it would take to staff shifts 24-7. That leaves us with a bunch of volunteer FF/EMT-B types in the areas where we could best use ALS level care, which is frustrating for many of them and a disservice to many of our rural communities. Here's the idea I've been kicking around in my head. What if we changed the approach a little bit? What if we used physician extenders in these rural areas? The advantage to having an NP or PA respond on EMS calls is that they are better educated than paramedics and can do things that might be beneficial on a long transport (or in a situation where you know you can't get the patient out until the snow stops), and they can also operate with regard to certain procedures and pharmacology without a direct order from the MD they are working under. They can also easily take care of minor things, like sutures or prescribing antibiotics. An NP or PA could staff a clinic during "normal" business hours, providing a closer source of medical care and potentially eliminating some issues that would have been an ambulance call with the status quo in many of these areas. Someone who wanted to provide care in this setting would have to enjoy clinic work, and would have to be affiliated with the closest hospital, rather than being a direct part of the FD; for ambulance runs, they could operate just like everyone else, carrying a pager and responding when available (aka: not currently caring for a patient in the clinic). It seems to me that it would be far easier to convince people to pay for the salary of someone who would be serving the community to a much greater extent than just responding to "emergency" calls. From the sociological perspective, the FD would be able to retain its position and still be very useful, but not be solely responsible for medical care (which we can all see isn't working). I think a lot of FD's would be much more amenable to this arrangement than having a bunch of their folks (who don't want to be paramedics) forced to become medics, or have external medics integrated into the infrastructure. The NP/PA isn't as much of a "threat" since they're not there to completely change how everything is run and aren't interfering at all on the fire side. So what do y'all think? Am I way out in left field? Could it be feasible? We'd have to set up educational programs specifically geared to give the NP/PA prehospital experience, and candidates coming out of those programs would have to have a significant interest in working in rural settings. Let me know what you think. Wendy CO EMT-B

Vent is not holier-than-thou... she just is able to empathize with this particular population despite how irksome they may be in the short term to us as medical providers. She's also trying to show that no "population" of people is perfect-- we are all human, and we all have flaws. Without exception. I'm too blunt, for example... and it's not always a good thing. I can also box myself into being a little bit arrogant because I'm smart. It's something I work on. Herbie, don't be such an @$$hole! I'm serious, man. I'm sure you're an excellent medic. You're probably very intelligent. But you're sounding like one of those people who doesn't understand a holistic approach to medical care, and since you don't understand it, you scoff at it and go off on those who are trying to (at the very least) broaden your mental horizons a little bit. It also sounds like you've developed a prejudice against the homeless because you know they drain your system... but have you tried to think PAST your prejudices and get inside the problem? Or are you just reacting to it? Medicine is not just about being right. It's about communicating with your patient and determining what your patient *really* needs. Have you ever noticed that people who are upset respond better to treatments once they calm down? Sometimes patients need more than what we have written in our protocol books. Sometimes, a patient needs you to just *really listen* instead of hunt-and-peck for the pertinent parts. Many of the homeless are mentally ill, developmentally disabled, or otherwise combating something they may NEVER let you in on... and without addressing some of those underlying factors, handing them the information on a shelter is going to do nil point zippity... Just saying. Don't fall into the trap of arrogance- that you must be right since you're a good medical provider. Some of these frequent fliers may have been something you can't even imagine before they descended to where they are now. Show some humility! Wendy CO EMT-B

GOOD FOR THEM! While we were in Victoria, every time I saw a BCAS rig I sent good vibes their way. One thing I noticed... they all looked SO tired. I hope this gets resolved in a way that is fair to the paramedics... after all, they're the ones providing care... Wendy CO EMT-B

My two favorite quotes in this whole thread: -- CBEMT --tniuqs ROFL!!!! Y'all just made my morning... Wendy CO EMT-B

Bruckheimer's show has a shot. He's a really good writer/director. Hopefully he was smart enough to grab a LOT of consults to help him with accuracy! --Wendy

So a pedophile who is entertaining has value to society because they provide amusement, and therefore should be given free pass? *puke* That's exactly what I was getting at. America has sold its soul for a few good grooves and good times... Wendy CO EMT-B

You guys are *so* not alone. Welcome to the world of what I jokingly called "numeric dyslexia" until I figured out it had a real name. Transpositions are something I've always been HORRIBLE with, especially if there's a decimal somewhere in the number... I would solve chemistry problems completely correctly, but transpose digits multiple times throughout the multi-step solving process and come up with the wrong numeric answer. I switch digits on phone numbers. I have to write things down regarding dates and times, or I forget them. I can't visualize theoretical structures (like isomers in O-chem or forces in physics problems) to save my life. Failed Calculus (granted, it was only my sophomore year of high school) with a 37%. I was tested for dyscalculia in college, and did come up with that diagnosis, but it's never really been officially used for me in any capacity, as I am a decent enough test-taker to not really require extra time or anything like that. To deal with this, I've basically had to train myself to cross-check multiple times with any given set of digits (as that seemed to be the worst of it for me) and have now gotten to the point where I transpose or have errors much less frequently than I used to. Awareness and accepting that it is something for you to work around are the two biggest steps in adapting to having dyscalculia- once you quit denying it and heighten your awareness, you can train yourself to compensate. It seems to have worked for me, as I showed ABOVE average results on my dispatch testing with regard to digits and audio-visual recall of alphanumeric sequences... it's because I've had to force myself to be so careful. I catch mistakes AS they happen now. Of course, when I get to nursing school (which I'm writing my essay for right now) I'm going to have people cross-check my drug calculations until I'm sure that I can do them adequately, and then I'm STILL going to have people cross check them. Hang in there! If you think you've got it, definitely get tested for it. Accommodations for it in school are nothing to be ashamed of, and you may gain access to resources to help you overcome your issues with it!! Good luck!! Wendy CO EMT-B

If you've worked with sex offenders and have watched even 15 minutes of Michael Jackson television footage, you'd have to be an idiot to completely discount the rumors surrounding his scandals. No, I cannot pass final judgment... but I can't say that I argue with our system that requires several proofs of innocence... this is the protection of children we're talking about here. Several things about Michael Jackson, media fluff aside, have led me to draw the conclusion that he was probably sexually inappropriate with children. I agree with Anthony on the whole "if it walks like a duck..." idea. Body language. Reactions to questions. Behavior around children. The children's behavior around Jackson (including his own kids). Take some time to just watch different clips, and see what it all looks like. To me, it looks like a very smooth pedophile or pre-pedophile using a lot of misdirection... but then again, I've been trained to recognize grooming and to recognize the difference between "nice" adults and groomers... and it is a very difficult distinction to make until you've been educated... We know Michael Jackson was severely abused by his own father during his childhood rise to fame- that sort of thing is often a huge causative factor in developing aberrant behavior patterns in individuals... damage to the psyche can really lead to scary things. Of course, it's not a 100% causation, but it is a common bit of history seen in individuals with sex offender tendencies. Michael Jackson was a talented artist, yes... but chew on this for just a little bit. I'm having a bit of an issue with all of this media overkill and the canonization of at best, a decent musician... If someone accuses a priest of molesting a child, and the Vatican ponies up for it to "go away" regardless of guilt, people decry the Church and demand blood-penance and excommunication. People abandon their own parishes, because they feel they can't trust churches anymore. If someone accuses Michael Jackson of molesting a child, and he ponies up for it to "go away" regardless of guilt, people line the streets and hold vigils for his freedom and mourn him as though he had actually done something worthwhile, like curing cancer. Can someone explain this to me? Wendy CO EMT-B

Um, the grind is WORK and paperwork to change my name. I don't refer to my intimate life as the grind... lol. Don't worry. I'm not one of those women to declare no sex... or use it as a power play... that's retarded. --Wendy

We went hiking up the East Sooke harbor trail and did eat at the Sooke Harbor house! It was INCREDIBLE. We got plenty of outdoors and sun... and are now back home in CO. Off to the grind again... --Wendy

I didn't realize that the triad was often the sole justification for accusation and prosecution... there's about to be some lawsuits from this. Tragic no matter what... SBS or not, the children are still gone... Wendy CO EMT-B

For all who are concerned, there's plenty of naked. Relax. You gotta get out into the city to eat sometime... lol Dwayne, yes, we'll get together when I get home lol. Kaisu's in AZ, remember? Off to do more 'splorin... --Wendy

Hey there folks! I'm no longer single... (let the whining commence) and having a blast on my honeymoon with the Mr. Eydawn here in lovely Victoria, BC. Any locals want to come meet us for a drink? What should we do as a 'must do' while we are here? Oh yeah... and I almost ripped into someone in a restaurant tonight. They were blathering on about how "ambulance attendants" just open and close doors and the rest are automated, so the strike was silly etc.... took all my restraint not to shout! --Wendy

Sounds like someone is a cross-dresser who doesn't really seem to understand the line between enjoying one's getup and harassing those around him... I wonder if he approached women specifically? Or if he approached men as well? Really strange. I don't really think he committed any crime, to be honest, but the behavior is really strange and to me smacks of something a fledgling sex offender might do... Hm. I wonder if we'll get more info on that. Wendy CO EMT-B

I want to see the original source... I'm curious as to whether the author wrote it himself (by his own hand) or had it dictated. Wendy CO EMT-B

Tell me you're kidding. You're shatting me, right? Wendy CO EMT-B

Excellent. The student defended his friends with lethal force, as was apparently necessary. I'm glad none of the innocent parties were harmed. This is why concealed carry is IMPORTANT... situations like this. Wendy CO EMT-B

Holy thread resurrection, Batman! Easter was last month... Wendy CO EMT-B

Whoever you are, I just wanted to say that it is really really touching and you have no idea how grateful I am. I didn't deserve it... and I certainly couldn't afford it. Thank you!! --Wendy

Herbie, you hit the nail on the head. Crotchity, respond to Herbie please. Let's address the root of the problem rather than identifying the symptoms (lack of black supervisors etc. And FYI: Almost all of my supervisors at my current position are Latino.) Herbie... I challenge you this... WHY do you think these kids didn't value education? Do you think it is possible to teach people to value education when they are culturally reinforced to NOT value education due to its connotations (quit reading, you're acting WHITE) and due to the opinions of everyone surrounding them? How do we teach people functional literacy when they're being shot at and have no money for rent and food? How do we teach them that literacy and education are not betraying one's race, but rather the tools to fight inequality? Wendy CO EMT-B

Thomas A Swift's Electric Rifle. I've known that since I was a tiny kid. Remember... I'm a sci-fi reader! Wendy CO EMT-B

A relationship that is perfectly loving and intelligent would be one where firearms are a purchase for a special day... my fiance and I bought a Ruger 22 rifle for Valentine's day... I bet Mr. Taser was a Boy Scout. Sounds like something a few Scouts I know would do... Wendy CO EMT-B