Eydawn

Mike, I was more thinking along the lines of "how many incompetent hearing providers are there out in the field" -- we focus so much on this one issue, but the fact is we have a much larger problem than allowing deaf/hearing impaired providers with the drive and intelligence into the field. How many partners have you had that are truly dumb as a rock, but they meet all the physical requirements so there was no automatic exclusion? Wendy CO EMT-B RN-ADN

Isn't it a pity that we focus on "can this guy hear?" instead of "does this yahoo have a brain that works?" If we're talking about folks to exclude from playing due to risk of missing something or not being able to provide good care, I'd much rather let someone with a hearing impairment (not full deaf, mind you- you have to be able to hear enough to assess) work on me and mine than some asshat who doesn't care about the medicine and worse, doesn't care to learn. You can hear abnormal breath sounds... but do you know what to do with them? Let's say you can hear well enough to hear they're abnormal, but not exactly what's wrong. You smack your partner, throw them your steth and say "check me here- what are you hearing?" How is that any different than what a lot of us do- "hey man, I've got something here and I'm not totally sure of it- what do you see/hear?" I would think that someone who is partially deaf knows that they are at a disadvantage when it comes to situational awareness and would be working harder to make sure they're as close to "on the same page" as everyone else... now, if someone is full deaf, that's a different story... not only can they not assess, but they're not able to ensure their own safety, let alone someone else's. Before anyone says I'm being prejudiced, let me just explain that whitewater rafting with my cousin (who has to put her cochlear in the dry bag so it doesn't get fried) means watching out for her at least sevenfold compared to the rest of the folks in the boat. She can't hear instructions and needs a hearing partner to pull her down, get her to duck, change paddle directions, etc... when she got pitched, that was terrifying, because she couldn't hear our instructions. Now, am I willing to take the responsibility for keeping her safe when we're out rafting? Absolutely- she's a good swimmer, and does decently despite the deficit. Am I willing to take responsibility for a full deaf partner who has to have me do any hearing based assessments, radio comms, and maintain full situational awareness for all of us? Man, that's a tough one. They better be one hell of a clinician despite the deficit. If they have the attitude of entitlement that I've seen some folks with disabilities or disadvantages have, they're surely not welcome. Knowing you have a deficit and working hard to overcome it and prove your capabilities is excellent; expecting everyone else to accommodate you by default because you have XYZ is wrong. I don't expect my coworkers to pick up the slack when say, I have an asthma attack in the middle of my busy shift... just because I'm asthmatic. I don't expect to get an easier patient assignment. I feel bad, rather than entitled, when said situation above happens and I have to pass all my patients off in the middle of an already fubar shift... if I were an entitlement brat, I'd just take it for granted. Instead, I'm truly grateful... Wendy CO EMT-B RN-ADN

Holy crap, you mentioned lil' old me? Whoa! CONGRATS and GOOD LUCK!! You drink coffee, right? If not, I guarantee you'll start. I know an avowed non-coffee drinker who started during his intensive medical program... ;-) Wendy CO EMT-B RN-ADN

I think, in general, if you're the caliber of motivated personality that we see here on the City, your odds of doing well in a bridge program (either RN to Medic or Medic to RN) are much higher. Let's face it... the folks who hang out here seem to be by and large the exception, rather than the rule... I forget that sometimes, and run nose first into that wall out in the real world and wonder "how the hell?" until I take a few minutes to think about it... but I digress. Is a bridge a good education for absolutely everyone? No... Should you really be required to take both programs from scratch (and play the politics and bullshit twice) if you have the foundational education behind you? I vote no... (I also vote no if you can prove competency by challenge exam, in case anyone's interested.) If you are very "stuck" on "this is how I learned it in ______ program when I got my _______ license" or "this is the only way to do _______ because my instructor said so" you're going to have a hell of a time figuring out how to wear both hats. I have to pay for my BSN first (see: discussion RE no advancement without it) and then you can bet I'm finding the first medic bridge program that will have me. I think I am the right personality to succeed in that kind of program, and I think my experience as an EMT-B intertwined with my experiences as an RN will set me up to adapt to the protocol and critical thinking needs of the medic role. A paramedic I very much respect that's out here local to my area has said I'll do just fine, but he worries about his medic buddies trying to bridge to RN... they are very different (yet so similar!) and a lot of medics have trouble fitting into that integrated team/directly delegated MD approach to care. So sayeth my friend... and I happen to think he is a wise fellow! Wendy CO EMT-B RN-ADN

I've seen this... it can be a reaction to antigens left in the platelets or FFP (I've seen it more with FFP than with platelets, but it's a risk with any blood product I would think). Our protocol says for mild urticarial to give antihistamines and steroids... if she were truly allergic to Benadryl you bet I'd be calling for a stat promethazine order. The claritin PO is good to have on board, but we need the old school fast acting stuff here... For anaphylactic our protocols call for epi, steroids and oxygen (and a stat page for a rapid response team). For this chickie, steroids and a run to the ER, watch the airway, be ready to hop on the epi if it looks like she's becoming more compromised. For the fellow who said bag her or put 15 LPM NRB- dude, she just got a neb tx, of course her resp rate will be elevated (along with her heart rate). Ever had one? She's fine. Her sats are fine. She's compensating well. We just need to support her and watch her carefully lest she decompensate on us, in which case we've got a mess on our hands. Wendy CO EMT-B RN-ADN

We just had one of our Orthopods (whose patients are almost always heavy bleeders, go figure...) start it in his post-op regimen. We're giving it IV for total knees (that's the only one I've seen it with so far) about 4 hours after they come up from PACU. Pretty interesting stuff! Nobody's had a bad reaction to it so far. I still had to reinforce damn near all those dressings though... so.... we'll see lol. It's like the data on ketamine... everyone says yeah, it's fantastic! It's amazing! And my personal experience with it in our setting has been "holy shit! It turned my patient into a fruit loop and now they're on constant observation! That's expensive!" Pretty cool idea! Wendy CO EMT-B RN-ADN

It's hard because many nursing instructors don't understand what you're doing when you're trying to synthesize past experience and education with the new material you're being presented. If you come in excited, ready to work and apply new things and you don't seem "scared" enough, sorry to break it to you but you have the BIGGEST bulls-eye painted on you for some reason... I agree with put your head down, do the best you can, bring the stuff you *really* want to discuss to the City, and go from there. Nursing is a different world from EMS, but there is a lot of overlap and I really do enjoy both. Once you get through school you can appreciate that you really did want to do this and that you're good at what you do. If you look back, you can see that I had some of the same struggles. I learned to just shut up and sit in the corner and occasionally ask something prefacing it with "sorry if I'm going too in depth with this, but does ______ have relationship to _____ in this context?" or "Can I ask a higher level question here?" On the plus side, in the senior simulations where you're supposed to "rescue" your patient, I was dead on there... that was nice. Sweet revenge is I think I was one of the very first to have a job... in the hospital system... even though I wasn't the instructors' little darling. Wendy CO EMT-B RN-ADN

Chief- it's called superglue. Got the husband patched up (again). Lawnmower blade sharpened, tightening it down... Let's just say that him busting in while I was just falling asleep for a nap yelling "I need the superglue" was NOT a great experience... should've stayed at work instead of taking the get to leave early option! Oh, on the note of get the party started- some of the shithead college students here should learn that when there's hundreds of you in the street partying and the nice men in blue uniforms tell you it's time to go home and turn off your music, the appropriate response is "yes sir!" and stumbling for home, not "Fuck the police!!" And they wonder why they got some tear gas lobbed their way.... stupid... "wahh, my eyes burn, the police are fascists...." DUDE, you don't even UNDERSTAND fascism. If they were really fascist pigs, you'd be full of lead, not lightly seasoned with cayenne.... Ok, on a totally ADD note, you guys have GOT to listen to this song. -- Death Valley Fall Out Boy... it's AMAZING.

Loved seeing Orcas when we were up in Victoria. Would love to go back again! Scubanurse, what's the secret? Let'r rip!

Rawr. Bridezillas suck- the only time I ever pulled an "I'm the bride" moment was on my wedding day, because my aunt made my cousins late, and I wasn't gonna hear for the next 20 years about how she made my cousins miss my wedding and how horrible etc. So we waited for them to get there. (My family is crazy- trust me this was indeed the better option). Beer thirty indeed! Yum. (Defying my choir director's explicit instructions I might add... lol we have a dress rehearsal and performance yet to go this week and alkyhol isn't so good on the old vocal cords.) Any good weather around anywhere? It's finally raining here...

How you perform on CBT has no bearing on your potential as a provider. That goes for any level, from EMT to Paramedic to RN to PA... CBT is a tricky bastard, and you really have to learn to play the game by the rules they set for you. You have to learn what the best answer FOR THE TEST is, and answer accordingly. I'll give you an example from the NCLEX: You're a school nurse out with the kiddos on field day. Kiddo falls out of the tree, and is complaining of leg pain. What do you do? A: Send someone for help; B: Give the kiddo a Tylenol; C: Instruct the kiddo not to move and stay with them until help arrives; D: Tie the kid's legs together. C seems like a no brainer, right? Well, with the info given in the question, there's no indication of any trauma other than to the leg, so you do D to provide splinting and protect CMS. (I know. I was SO PISSED...) The answer is not always airway... the test is adaptive, so you have to pass a certain number of a certain level of difficulty questions in each category to pass... if you're answering right but you're at or below the pass threshold, you still fail. Prep courses are good; I used the Kaplan book to prep for NREMT and I used the Kaplan computer based prep for the NCLEX. If you know the material, and you brush up on the critical topics, and you can pick out the "correct" "critical thinking" answer instead of the quick, obvious common sense answer, you'll do better on CBT. Do you have any test anxiety? Dyslexia? Dyscalculia (dyslexia with numbers)? Need extra time? Do you take the entire time to take the test? Do you get bored/lose focus? How'd you feel after taking your previous exams? Good? Failed? Knew you failed? There's more to it than just sitting for it again. The game doesn't change, your approach to the game has to change... Wendy RN-ADN CO EMT-B

I find it difficult to explain that intuitive synthesis of information that one begins to acquire as a healthcare provider. That a patient's condition is more than the sum of the pieces (BP, respiratory effort, labs, psychosocial situation, etc). Some folks understand that concept, but others look at you like you have three heads or imply that your "spidey sense" or "intuition" is useless in practicing medicine... I beg very strongly to differ... I usually have to draw lots of parallels to non-healthcare related things to get someone to understand it that's having a hard time with it. That's the hardest thing I find to explain... Wendy RN-ADN CO EMT-B

They kept it on the downlow pretty well as far as media went. The individual in question that I know was working in the ER at the time of occurrence... basically, the patient was OD'd, got nasally intubated and they used Narcan to restore responsiveness and thought it'd be hilarious to have the patient walk in, bagging self... they were extubated post-haste and the medics in question were disciplined (but I don't really know about fired.) The story spread amongst the EMS folks of CO... but I know someone claiming to have borne direct witness, and have no reason to mistrust them. Denver Health is also famous for the "backboard sandwich o'death"- combative patient? Smush 'em between two backboards! Except that one stopped breathing. Those guys DID get fired from what I understand. I didn't realize there was goofiness with the Polyheme study- I never did hear any much more about it other than Denver Health was participating in the trial... have to look that one up! Wendy RN-ADN CO EMT-B

Holy bejeezus. That's a major mayday moment for sure. Glad to hear he's expected to recover well and that he's already home. Wendy RN-ADN CO EMT-B

Defuse, seek exits, look for weapons that can be used to defend self if you have to make a dive for it... I agree with Dwayne's post about the comparison of "drunk"- how violent is this guy? Oriented? Deranged? Twitchy? Likely to shoot by accident? In control of self? Responding to internal stimuli? Making demands/expressing needs? Personally, I'd probably sit on the floor (harder angle to shoot at) and be ready to crawl for a window/door at the first available opportunity. In an active threat situation, I have to safeguard my own safety first, then my partner, then the individual making the threat... if I can get a door/objects between myself and the psycho, I'm going to try to... If he looks like he's escalating, use any object near to hand and try to incapacitate, before I get shot. Ugh. Nightmare scenario this. Final answer: Do the best you can, and hope you make it out alive... Wendy RN-ADN CO EMT-B

This expat too dumb to invest in using proper protection? Or just thinks it's cool to capitalize on ignorance and ditch the rubbers? Don't let me know who it is, or they'll get a MAJOR earful. Not only risking their well being, but the well being of every partner they have and will have... what a pig. This kind of behavior is inexcusable in someone who knows better, and makes me just plain angry. "I get tested all the time"- sure they do. SUUUURE they do. Even so, what damn good does it do you? You're still infected... Wendy RN-ADN CO EMT-B

We tried to feed our doctors... there was lots of leftover pastry. It was pretty fun! Wendy RN-ADN CO EMT-B

That story is in fact legit, about walking in the guy bagging himself. Oops! Haven't heard of anything that sketch in quite some time. It was several years ago. I know people who did in fact witness the act. Denver Health is a good service. I know medics who work for them. If you're set on the Denver area, they're a better option than Rural Metro, AMR or Action Care... Northglenn Ambulance is good, smaller company, less in the toolbox as far as protocols go- some folks I know started working there and moved up to Denver Health once they had enough education and field experience. If you're willing to go outside of Denver proper and head north, PVHS EMS (Poudre Valley Health System) is a great agency. Lots of growth right now due to taking over part of a response area from another agency (voted on by the residents of said response area.) Good protocols, good involved medical director, lots of evidence based practice, good hospitals in the area to transport to (I'm biased, but I work at one of them and I'm so, so lucky to work in such a good place, even with all the shakeups going on from massive mergers and healthcare reform.) Lots of resources due to the PVHS/University merger. TVEMS (Thompson Valley EMS) is also excellent. Great medics, don't know much about their medical director but know a lot of folks who enjoy working there and have never had a problem interfacing with them either on the hospital floor end our out in the field on the SAR "let me give you my patient now" end... Wendy RN-ADN CO EMT-B

You could be held legally liable if she got in and killed someone, no? I'd never do that... and I'd call the cops if I saw anyone else doing it! Yikes. Wendy CO EMT-B RN-ADN

Very much a difference between a tranny and a transvestite! Lol. Transgender, gender neutral, dude who wears makeup, chick who binds, etc. etc.... as long as they adhere to corporate dress code and treat patients with respect and their care doesn't suck, welcome aboard! I'm a very open minded person. I don't care who you sleep with (or want to sleep with), what gender you identify with, what chromosomes you have, what parts you have/want... you're a person, and that's all that matters... as long as your partner of choice is of consenting age, have at! Wendy CO EMT-B RN-ADN

Pacific Northwest is gorgeous if you're looking for more of a drive around, do your own thing kind of vacation. Where are you coming from? Driving? Flying? Moab is also awesome... --Wendy

Man! Lots and lots of bridge-dwellers creeping out lately. Lol! Seems like the City's perking up a little! Wendy CO EMT-B RN-ADN

Yeah, if she won't talk to male staff? We'll find some kind of female. PD, MD, RN, paramedic, anyone who's available. I would be highly surprised to find no female of any kind in an OB office... my MD/GYN won't do a pelvic without a female present with us (protection for him and for me.) With this kind of dissociative/trauma reaction, you just take it slow, at the patient's speed, and you FIND the resource you need to ensure the patient's comfort and safety. If you can get them to come back to planet Earth, and they're appropriate/safe, you can release them as above... if not? You do whatever you need to do to ensure the patient comes to a safe location for appropriate treatment... Wendy CO EMT-B RN-ADN

I've already told my boys, we're registering for it the second it opens next year and we're road tripping it out there. Me, the hubby (an EMT-B as well), our best friend (volly fire and EMT- and our other best friend (runs fire equipment around the country for the forest service, EMT-. It's gonna be AWESOME. I hope everyone had a blast! And didn't drink too much tequila. I never did admit this, but between us, Dwayne and I split an entire bottle of Jose Silver... I couldn't look at tequila for MONTHS after that! Wendy CO EMT-B RN-ADN Student