Eydawn

ROFL! I love that website. It provides a mindless escape at times. I don't want to spend 40 hours a week playing with it, however. Wendy CO EMT-B

So I missed the thing about no helos, so sue me... I'm still calling dispatch and putting in a request in case we get a weather let-up. So there! We need to stop the bleeding... and get him out if possible. How stuck is he? Wendy CO EMT-B

Cut power to the combine. First step. This might be an appropriate place to use tourniquets, if his lower limbs are hamburger already. O2, wait for Fire with extrication gear, and get the helo on the way. Wendy CO EMT-B

Pro life, intend to have children, against doing a field C-section without appropriate training. Wendy CO EMT-B

Nuchal rigidity after a fever? College girl? Dude, this can't get any easier. I'll play nice though. Productive cough? Headache? Other signs/symptoms? Recent trauma? Wendy CO EMT-B

If I were trained to competency on emergency c-section, I would not hesitate to do so. End of story. Wendy CO EMT-B

Notice a trend? Anyone? It's like arguing with a potato! Except a potato is useful, tasty and nutritious. *facepalm* Wendy CO EMT-B

GET OUT OF THERE. The hospital sucks, the system sucks... you need to get out of there. Your hospital shouldn't be so sub-par that you feel like you have to step in to do effective CPR. You shouldn't have to accept a failed intubation just because the doc fails to do capnography and doesn't see that the stomach is getting bigger with ventilations. You shouldn't have a procedure as your only alternative for an airway that you haven't been trained on. Yes, there are things you could have done better... but everything was set up to cause failure in this case. And it doesn't matter how much progress you could have made transporting, nitro and lasix aside, that failed tube would have killed her no matter what. Hang in there, Kaisu. I know this can't be easy. Wendy CO EMT-B

Those of us who enjoy practicing medicine and not throwing away the investment of education generally care about not losing certification or licensure. Maybe if you're a renegade and feel it's appropriate to throw away that investment, or worse, you decide to practice with false certification or under false pretenses (like that paramedic here in CO not too long ago.. I think that guy should be shot!) it doesn't matter... Wendy CO EMT-B

Bogus, both hypotheticals. If I have a kid who tells me that he's using crack, I'm suspecting more than a skinned knee from the fall and I'm suspecting the cause of the fall itself. He goes to the ER for a full workup, and it becomes the doctor's responsibility to inform the parents that the kid is abusing an illegal substance. I'm probably going to tell them as well... but it makes a difference if it comes from a doctor. Kid says he's going to take a BB gun to school to "scare" someone, I'm telling the cops, because I could very well tell the parents, have them brush it off, and then have the poor kid end up in jail due to hyper-reactive school officials. If I tell the cops, the cops tell the parents, and it's legally documented. Plus kids are much more likely to listen to a stern talking to from the cop... and the cops can deal with the bully situation if this kid is facing continual harassment. I can't do anything about some asshat beating this kid up every day. But a police officer can. Yes, there are instances in which I'm going to tell parents what children have told me. But it is a difficult line to tread. What I'm saying is that discretion and intelligent thinking are your best bet- not assuming that you have to tell parents absolutely everything that their child tells you. I think that's what the doctor in the original article seemed to think as well. Wendy CO EMT-B

Funny... I don't see the word "reality" anywhere in my post. I'm not a fan of it, so I rarely use it. How long have you been out, what was the highest education you attained while in, and how long did you work for? I haven't seen many facts come out of you, just ideas about "good paragods" and "bad paragods" and the idea that "Mike must be a paragod because all his coworkers say so (with no quotes or real evidence to back that up with)." Like I said... refute the logic or concede to it. Someone who generalizes based on a single experience (or a single post for that matter) is not utilizing logic; they are using flawed extrapolation. Wendy CO EMT-B

I don't know of many parents who are competent enough in the medical system to even realize that we document things just like a hospital does... and what you document in your trip sheet and what you choose to verbally relay to a parent can easily be two different things. Your trip sheet is your legal documentation of care provided, assessments, and information pertinent to the provision of care to the patient. Sure, a parent COULD potentially access it... but how many realistically will? For example... how many of us have documented that we suspect a child's injuries are the result of child abuse in the trip sheet, but not said a word to the parents and simply reported it to CPS? Just as this article indicates, this is a GREY ZONE. Keeping something confidential in terms of your direct interaction with parents and putting something in your documentation because you are legally required to is not contradictory, or breaching confidence with your patient. Things that are directly affecting a child's well being and safety need to be brought up. But it doesn't mean one has to immediately run to parents with everything one finds; there is plenty of room for advising a teenager or tweener to approach their parents first and have it come from them. Especially in the case of pregnancy... and it's not like the parents not knowing for 10 more minutes while you counsel the lass and tell her that there's no real way to keep it secret is going to kill them. As far as the emancipation thing.... I was under the impression that any choices about prenatal care and the care of the underage mother's child was her right and her decision, but that her legal status remained as a minor and a ward of her own parents until she legally became emancipated or reached age of majority. AKA: Prego teen can say "yes, I want to have this ultrasound done and test for genetic problems with this pregnancy" even though her mother says no way, don't test. Prego teen cannot refuse treatment for chest pain if her mother says yes, treat my daughter for this. Perhaps I am confused, or maybe it's a local thing... time for me to go look it up again. Wendy CO EMT-B

It isn't about getting sued! It's about practicing medicine outside of your educational scope! I'm not advocating doing it or not doing it, I'm saying to be cavalier about it is akin to the "I'll rush into the burning building to save the children" mentality that we criticize so often in our firefighting brethren! It is a personal choice. Do you sacrifice your cert (not because you got sued, but because you obviously and intentionally acted outside of your legal purview) for one pediatric patient that has a low survivability chance? Your call. I say if your OWN medical director, your top kahuna, the doctor directly signing off on every action you do every day is on the cell phone with you and says you know, I fully back this, I hereby give you a temporary clearance to perform this surgery under my direction, then you should be ok or at least have some backing legally and it is up to you. If you can't get authorization, you should realize that you are risking your entire career and your future in medicine by taking this action. I say if you get positive fetal heart tones with your doppler, you have more of a case for doing it. If you can't find them, then you can pretty much figure that the fetus is already deceased and avoid surgery that is outside of your scope. Akroeze: I think that's more of an extrication consideration than a "medical procedure" consideration. The difference is that the person who's trapped isn't necessarily going to die if one waits for a surgeon to be brought to scene to amputate the leg of the deceased person who is entrapping the living person. And the living person isn't inside the dead person- just behind them. You may not be able to extricate them and get them moving, but you may be able to do interventions that will increase their survivability. And it's less scary to consider using a power tool to remove a leg from a cadaver than it is to consider using a scalpel to open a dead woman's abdomen in an attempt to save a fetus that is directly inside where you will be cutting... I tried *shrugs* not sure where you were going with it, but that's my response. Wendy CO EMT-B

CISD is something hotly debated here in the forum. Search for it and see the mess before jumping back into it? Many argue that CISD/CISM causes more damage than it helps, and that it has no concrete psychological basis. Many advocate seeing an individual therapist or counselor instead of participating in CISM. In any case, any CISM *must* be orchestrated by a psychologist in order to have any merit; if it is just your fire chief or your operations head running it, it's not a good thing... and it should never be mandatory to participate in. Wendy CO EMT-B

I don't know of any paramedics who were licensed in field OB surgery but who just kinda let it lapse and aren't sure they know how to do it anymore. They never knew how to do it in the first place, unless they were a Vietnam type doctor who decided to let the MD go away once they got back to the States! Never learning how to do it in the first place and learning it once and being outdated are apples and oranges. It's relatively hard to screw up CPR. Push on the chest until someone else gets there. All you gotta remember as a lay-person. It's VERY easy to screw up a field C-section. What if you cut too deep? What if you cut the umbilical cord while trying to get access to the uterus and the infant exsanguinates? Then you just killed the kid for certain! I'm sure there's more complications involved in that, and I would have no idea where to start because IT IS OUT OF MY ARENA. Wendy CO EMT-B

Oh, two different worlds is no joke- no insult felt or offense taken. That's become increasingly clear. I don't think it's an age or geography thing. How long ago did you leave, just out of curiosity? I haven't walked in your shoes either... but I have no problem arguing with anyone's logic, regardless of sole-swapping, because logic is just that- not based on subjectivity. Walking in shoes = experiencing personal subjectivity. Argue the logic, or concede to it- no hikes necessary. Wendy CO EMT-B

Does anyone in here carry doppler? We do at my service and we routinely use it to establish the presence of fetal heart sounds in pregnant females, and to try to find blood pressures that are harder to hear with the steth on rural roads. I think it would be a good tool for this situation. Squirt the gel on, use the larger head, see if you can hear fetal heart tones (since mom has no heartbeat, it's impossible to confuse hers for the fetal tones). If you can, you can relay that to the doctor you're talking to and that can factor in to the decision. I would say that emergency C-section on a corpse to remove a fetus is a very interesting grey zone. But if you can hear that fetal heartbeat, I think you can cover yourself legally a hell of a lot better. Yes, it's not in your protocols, and in many places, it is outside your scope. But sometimes scope can be expanded at physician discretion... if your medical director is on the phone with you and you paint the picture and he authorizes it, is it a no-no? I would be very leery of performing this procedure without a physician present. Working in collaboration with a physician is one thing... doing it with phoned in direction is very different. Is this one life with super low-survivability worth ending your career? That's a personal decision. Some will say yes, some will say no. But I would argue that we are faced with situations on a fairly regular basis with adults where we could exceed protocol because we could see benefit to that patient... but we don't exceed protocol, we follow it and take the patient to the hospital. Because this patient is an unborn infant, it is a much different emotional situation for many. I certainly wouldn't be doing this procedure as an EMT. And I'd certainly not want my medic partner to do it without being on speakerphone with the doc. Wendy CO EMT-B

Man, you had it going ok till you started saying "positive paragod" and "negative paragod." The term paragod ITSELF implies negativity. A good PARAMEDIC is one that people like to work with and one who advocates for and ensures the best patient care possible. That person isn't a paragod. A paragod is someone who thinks they are superior simply by virtue of having their medic cert, and who acts accordingly... As for the "people" vs "person" argument, that is absolutely the dumbest thing I've ever seen someone base an evaluation of someone's character on. As a matter of fact, Mike first began by saying a common phrase- "You can't please all of the people all of the time." So, logically, in keeping with the tone of that phrase, it makes perfect sense to follow with "There will always be people that, no matter what you do or say, will always regard you as a para-god." One could also read it as multiple people OVER THE COURSE OF A CAREER deciding you're a paragod when they really just can't hack medicine or having someone intelligent around them. And if your life experience involves automatically jumping to the conclusion that everyone at someone's work thinks they're a paragod because they indicated that some people will never get their heads outta their butts where interpersonal relations are concerned, it makes me wonder a bit. Sorry. A medic is superior to an EMT where patient care is concerned. An EMT should not be arguing with the medic unless it's a matter of the patient's life and long term well-being. An EMT should, if they're seeing something, bring it up with the medic ("hey... did you get the hx from the FD? He's allergic to peanuts... we good on that Atrovent?") but they shouldn't be quibbling over stupid stuff, which is what I've seen happen. When the paramedic is thinking about 6 different things and the EMT is bitching about whether they really need to disrobe a patient, the paramedic is going to get a little snippy. You may be the smartest EMT in the world... but if you aren't facilitating your partner's ability to provide ALS care, you're in the way. I think a lot of "paragod" crap comes from snubbed EMT's who don't understand why THEIR point wasn't important or why the medic had to be assertive to get things done. Wendy CO EMT-B

Crotchity-- Who said multiple people at Mike's work are calling him a paragod? Methinks you are reading something into a post that isn't there. And what I prefer to do is get to know someone myself before I judge them. I refuse to go with what people say... because different people have different agendas. Once I've interacted with them and worked with them a couple times, THEN I will determine what I really think of them. What Mike is saying is that no matter how much you sugar coat something or try to make nice with the person who has an issue with you, there will always be asshats with their heads up their bums who are CONVINCED that no matter what you do, you are a paragod or a know-it-all. And sometimes, asserting your knowledge for the benefit of the patient or indicating that something needs to happen ASAP for that patient's welfare will come across as short, arrogant, or otherwise unpleasant. Intelligent adults realize that these situations occur and deal with it accordingly instead of walking around calling someone names. They address the problem directly, or they suck it up and do what they have to do to get the shift done. Sometimes, with partners that suck, that's all you can do- suck it up and then bring it up with management. YOU pulled out of YOUR butt that "Mike must be a paragod" which is why I called you an idiot. I apologize- calling you an idiot was unprofessional. However, I am one to call it like I see it. Your approach to certain posts has made me much more reactive to what you post... so it spilled over into the public realm. I do apologize. I'm short on sleep, patience, and well-being at the moment. But I would invite you to re-examine Mike's post and then your own and see if you can't see the non-sequitir. Wendy CO EMT-B

Obviously someone hasn't taken the time to get to know Mike. Mike is absolutely right. There will always be people who are threatened by confidence and intelligence, and you will NEVER please everyone. As long as the majority of your coworkers don't take offense to you, you're doing fine. There will always be personality issues and clashing personalities, no matter where you go, and some people will just plain not like you for no good reason. Crotchity, you're an idiot. Sorry, it just had to be said. Wendy CO EMT-B

I much prefer Verizon. If you're looking for a rugged phone, the G'zone from Verizon is damn near indestructible and a reasonable price... Wendy CO EMT-B

In the interest of our collective sanity, I would echo Doc's sentiments... I decline to share, and I really hope everyone is helping to keep an eye on each other. Stay safe folks, and don't be afraid to ask for help. Wendy CO EMT-B

I hope you're planning to respond to my rather lengthy post from yesterday. Don't be scared! Speak! Wendy CO EMT-B

CB, you may wanna stash a box in your POV so you at least don't end up screwed by the moron brigade... That sucks, dude! Wendy CO EMT-B

Seriously, crotchity, you obviously didn't read my posts thoroughly, you pulled the *classic* and ever so popular move of selective reading by pulling out that one snippet where I said I don't care what someone does in the bathroom. Is it unprofessional to go into the bathroom with a camping stove and saute liver'n'onions? Yeah, I think so, but I'm not going to barge in and see WTF is taking you so long in there. That's all I was indicating. I think if you need to go masturbate at work, you forgot to bring something to keep yourself occupied, and you must be of lower intelligence so that's your automatic entertainment default. Sex at the station vs sex in the ambulance vs sex in the hose-bed... all seems to fall into the same category for many people mentally. Take a good long while to *think* about why that is. If you think there's a difference, by all means, show us. I don't think there is... I think it's *all* unprofessional and stupid. Just different levels of exhibitionism that have no place in the workplace. No one is saying that someone who was dumb enough to get their jollies at work is a bad person and automatically needs to be banned from EMS... what we're trying to flippin' say is that the ATTITUDE that you so clearly display of CONDONING and even ENCOURAGING nookie at work is UNPROFESSIONAL AND AN ATTITUDE THAT WILL HURT OUR PROFESSION. Is that clear enough? Do I need bigger font? *EVERY* person that we respect on the personal or professional level has screwed up and done something really stupid in their lives. We're all human. Screwing up when you're 18 and a new EMT and getting it on with your gf or your partner is a STUPID mistake. If it doesn't become a pattern, or one becomes aware of the ramifications that such actions can and eventually will have on your employment, AKA learns from the experience, one grows as a person and knows better than to condone such action in oneself or others. You're full of it, dude. You're not sorry that you've "upset someone by shining the light on something in our industry that *WE* are not proud of" you're pissed because people are countering your avowed approval of nookie at work with DISAPPROVAL and the statement that it is UNPROFESSIONAL. You're mad because we don't agree with you. And obviously, you don't want to "clean up our own backyard first" or you'd open your eyes and realize that multiple providers from different geographical areas and working environments have all stepped up to the plate and said NO, sex at work is NOT ok, regardless of the fact that it happens. You're sitting here clinging to the good ol' boy mentality that as long as the station's good and you're cool enough to be able to get your clothes back on in time to do a call, you should be able to boink whoever you want, whenever you want. That is CLEARLY your attitude towards sex in the workplace. As far as that thread that the other troll started goes, if you actually did more than skim the posts you'd remember that there was mostly a spirited debate about WHAT CONSTITUTES PORN. I don't remember anyone worth a damn advocating stopping by "Dr. John's Videoplex" on the way back to the station to pick up the evening's entertainment. In case you need a refresher, here's the link for you. Feel free to pull out how *ALL OF US* managed to say that any R rated movie was porno and that they should all be banned from work... with NAMES and QUOTES. BAN HBO AND PORN LOCKED THREAD Wendy CO EMT-B