Eydawn

If you're in the state of Colorado, you can get your First Responder. At least in the Boy Scouts. Until I know where you are though, I can't offer much in the way of help. Good luck! Wendy CO EMT-B

Don't you mean *I M P E R A T I V E*? You flunked your own test! Wendy CO EMT-B

Oh damn! Not good. *_* Wendy CO EMT-B

Headed for Denver? Colorado rocks, I have to say... Did you ever look at in-state programs here for emergency management? I know I've heard of a few good ones. I'll see what I can dig up. Wendy CO EMT-B

Welcome to the City. What state are you in? You may want to look for a Venturing or Exploring program that has a focus on EMS or Fire in your area. (Part of the Boy Scouts of America.) What about taking a CPR and first aid class, and going for your lifeguard? Wendy CO EMT-B

I'll take my chances with a community that's got better EMS response than fire response... at least most of the time I can get myself out of a burning house. I can't get myself out of an asthma attack... that would be an out-of-body experience... Safe to live is a subjective measure. Just keep that in mind. Wendy CO EMT-B

So what do you do when the Samsonite positive turns out to actually be having a massive MI and dies in the holding tank while the cop is writing up his civil summons? Guess what... medic crew is fried. I'm not saying that hating fire is the way to fix the EMS system. I'm saying that fire based EMS in many areas is not a happy system. People fight over medical control because it means contract money. Fire systems force employees to get their paramedic's license, which means you have a lot of paramedics with no desire to actually be paramedics in the field (a.k.a medic mill produce), who have no capacity to transport in many cases... yet there are still arguments over who has scene control; the transporting agency, or the fire department. I'm all for having Fire on scene to help me lift the land whale, or to cut my patient out of the tin can formerly known as a geo... but having them redundantly respond every time the tones drop, (especially responding hot) puts the fire folks themselves in danger as well as the general public. If fire wants to come help with medical calls, they should be waiting for EMS to request them- on standby, aware of the call, waiting in the station. Or responding cold if they know they'll be needed soon. I will not argue that we need fire personnel in large quantities to be ready for fire suppression at a moment's notice. Fires can escalate quickly and sometimes, need way more resources than people would expect. But I will argue that the public is best served by those who specialize in paramedicine by choice, rather than those who become jack-of-all trades through force. Wendy CO EMT-B

Way to go, Kaisu! Congrats!!! --Wendy

PTSD can develop at any time from any stimulus given the confluence of factors in someone's life. PTSD doesn't hit n00bs because they're young and unprepared, and our elder sages haven't failed in some way if they develop PTSD. You can be the most experienced person in the world, emotionally well adjusted, have dealt with several horrendous incidents and processed them without issue, and still develop PTSD from what seems to be a more minor incident. Think about your normal day and the stressors you experience. You spilled the coffee and the dog got into the trash. You forgot to fill your gas tank up and now you're going to be late for work, and damned if the gas price hasn't gone up again! Your boss is chewing on you for no apparent reason... and your spouse is mad that you forgot *something* important, whatever that may be. Then, someone drives like an idiot and *nearly* kills you (literally) in traffic. That sucks. On a normal day, that's just a crappy day. Now, let's imagine that you've been running on 2 hours of sleep a night for the last week, you've had a family member die recently, you're struggling with different things emotionally (whatever that may be, we all have phases like that) and have some cumulative stress that you haven't been able to dispel... that crappy day culminating in the near-death traffic experience could be the *perfect* trigger for PTSD. All of a sudden the traffic near-miss isn't just a near miss... it's a focal point for all of the stress and emotional distress and cements itself in your mind in a way that no-one, even you, could have expected. Make more sense? Wendy CO EMT-B

My condolences to those who knew him. Thanks for all of the hard word, and Godspeed friend. Wendy CO EMT-B

Mateo... (good discussion, by the way! ) If a doctor fails to initiate necessary care, again, I will be taking it up the food chain if I feel the situation warrants it. I won't do it WITHOUT authorization from someone higher up from me, but I will do my damndest to make sure it gets done. Yes, you default to a superior in a critical time situation-- unless you know for a *fact* that the act is wrong. I accept that I may not know the reasoning behind a treatment order, in which case, I will perform that order to the best of my ability. If an order falls within the realm of things I absolutely understand, and I feel the order is wrong, I will not obey the order. End of story. Or, I will do as told and document everything, including my objection to the order. I believe that ccmedoc's opinion is not that you are an inadequate provider due to your age... I think he's referring to his opinion on the leadership style you indicate you have based on the posts above. I think he's saying that (as all of us do) you still have growing to do in order to become the absolute best paramedic and leader. It's not a personal thing. It's a professional thing. I think it has to do with (as I have gleaned from the posts above) your portrayal of everyone on the team with you as being automatically subordinate because you are the paramedic, and only capable of action delegated to them, and as such they should not be deviating from said action to question any of your treatment decisions. Wendy CO EMT-B

Oy frickin' vey. It's called HIPAA, and we don't need to "ham it up" for anyone. There was a show that did exactly that on the Discovery Channel; it was called "Paramedics" and showed a good mix of crappy and cool providers. Big deal. Besides, media types with cameras make me mad. They sit there and get in the way and try to get an angle on their story... instead of helping in a crisis situation where all hands on deck would be absolutely amazing. The *only* exception I can think of happened in Denver a long time ago, where a news helicopter pilot intervened with his chopper in a hostage situation after a long police chase and standoff, saving the hostage and helping the cops. His name is Mike Silva. Focus on becoming an educated professional who can express yourself in multiple arenas. I know I'm planning to take these typing fingers way further once I get my BSN... I have a feeling that good quality writing about our field and the elements that are lacking in it will do a helluva lot more for our profession than "Lookit! We do schit in the back of the ambulance! I not are Amboolance drive!" We aren't in this for the recognition and glory. You want to meet some under-appreciated care providers? Go apply for a direct care job in the developmental disabilities world. Paid less than CNA's, many are hated by families, attacked by behavioral clients on a daily basis, exposed to volatile body fluids on at least a weekly basis... and the list goes on. EMT's have it cushy... you treat the patient, you do the paperwork, you turf them to the ER or back to their house. Try a 12 or 14 hour shift in a group home with *maybe* 2 bathroom breaks if you're lucky... So quit bragging about prehospital medical care and start learning. If your communication becomes more sophisticated, all of a sudden you appeal to wider audiences than just other EMT's... and as we've all noticed, the power balance isn't exactly sitting in the truck with us. Make sense? Wendy CO EMT-B

The *one* thing that will make the difference for every patient, every time? My brain. Can't do crap with all the junk that's made in China hanging off my person if I don't use the brain first... Wendy CO EMT-B

I ended up with an emu in France eating Ugli fruit. Woohoo! Wendy CO EMT-B

Mateo, I said *inevitably*... not *every time* which indicates a probability at some future point... maybe it was kind of unclear. Regardless, the attitude that you *always* know what is best is a great way to paint yourself into a corner. In any aspect of life. As for the nurse doing what the doctor says or getting out, I'm not planning to risk *my* license after graduating nursing school if a doctor orders something that I know is *not* in the patient's best interests, and I will take it up the food chain if necessary, as well as refusing to carry out the order. Doctors make mistakes. There is a reason malpractice insurance is mandatory... You missed my point. I am emphasizing that each provider at their level has just as much of an ethical and legal responsibility to provide excellent care as the doctor does. Therefore, we must act accordingly, so that our superior doesn't take a fall needlessly... instead of just relying on the fact that "they're in charge, so they must be right." One would hope that the people you work with are able to work as an effective team, in an environment where a superior trusts your judgment enough to take into consideration points that you raise. If you're in a situation where your partners suck so bad that you absolutely have to take on the bad-ass commander role all the time, you need to find better partners or find a way to help your current ones improve. Just a comment on leadership styles... I have infinitely more faith in the leader who comports themselves with a quiet demeanor. This kind of leader's authority is so implicit that it doesn't need to be illustrated in any fashion, save to the most imperceptive dolt. The leader who is brash, obviously in charge, loud, and re-iterates that at every turn hasn't mastered leadership yet. There are always situations where the sage has to raise voice to accomplish things... we can all think of several. But if that is the norm for leadership? The leader is still learning... Wendy CO EMT-B

Hm. I've flown on a buddy pass before and received great customer service from this airline and all of its employees. Except for that bit where they scheduled my return flight from Florida to land after my connecting flight in Boston left for Denver... But they did put me up in a nice hotel, give me a meal voucher and find me a flight on another airline for the next day (which I had to pay for, as I was not a paying JetBlue customer because of the buddy pass). I've been mostly impressed with the airline, much better service than some of the horror stories I've heard. I'll see what I can find out. Wendy CO EMT-B

What I'm trying to say is that many sets of eyes means different input and perhaps a way to catch things that might kill your patient. You might be the best friggin' whatever in the world, be it nurse, medic, basic, doctor... and if you're wrapped up in "It has to be this way because this is what *I* see and to hell with everyone else's input" then you *will* inevitably miss something vital and kill a patient. If paramedicine is an individual sport, and each and every decision should be carried out by a paramedic because of what they're seeing and their analysis of the situation, WTF are you proposing we run dual medic rigs for? If it's just playing along to get things done, with you as the final "buck stops here," what are you going to do if your partner is ALSO a paramedic with the same constraints and responsibilities as yourself? If he/she sees something different and is *sure* that the treatment needs to happen their way, what do you do? Throw your equally certified/licensed partner out of the truck so you win? If that's the way paramedics have to operate, it completely kills the idea of dual medic rigs. Might as well just have EMT's as partners. Now, if medicine *is* a team sport, which I firmly believe it is, then the situation changes. The doctor, in hospital, is ultimately responsible for a patient's care. But each nurse assigned to that patient and each tech assigned to that patient is also personally and professionally responsible for the patient's care. It is the responsibility of a nurse to challenge a decision they think is detrimental to a patient, rather than just saying "I was following orders" and doing something they are unsure of. If you administer the wrong medication just because you assumed the captain (the doc) has it all under control and you kill the patient, you're still liable for your actions. The paramedic, in the back of the ambulance, is akin to the doctor. Ultimately responsible for patient care decisions. But if a partner challenges the decision, and the paramedic immediately dismisses the input because they are numero uno and what they say flies, and the partner happens to be right and the patient is adversely affected, the paramedic's arse is fried. Now, this isn't to say that you absolutely have to listen to everything your partners are saying and consider each possibility that they present and change your treatment based upon it. You do have to be aware that they might be seeing something you're not. I guess my take home message is that I think it is extremely foolish to assume you know everything when you're treating a patient and to proceed without paying attention to those who are also working with you to provide patient care. Yes, you are ultimately responsible. So do the responsible thing and keep your mind open. Don't get tunnel vision just because you're on a new level. Wendy CO EMT-B

Medicine is a team effort dependent upon the individual competencies of the practitioners. Yes, you must be the absolute best practitioner you can be and assume full responsibility for all of your decisions and treatments... but no, you are not the end all be all of medicine for this particular patient. As PREhospital providers, we work within a larger picture. In the field we must be autonomous and make all necessary decisions for the patient's well being. The second we enter the hospital, we must integrate into the team in order to continue providing the best care possible for the patient. We can't just say OK, now it's the nurse's responsibility to figure it all out... we share information and enter the dialogue for a reason. I personally think that people who enjoy team-building exercises benefit from that sort of learning environment. After all.. you're going to be in class with these people for two years. You might as well start learning how to get along with them. Will it make them better medical providers? If it creates a more positive learning environment in which people can blow off steam and study in healthy proportions, then absolutely. There are far too many practitioners who see only the individual pieces... and miss the whole... and medical schools are starting to give preference to candidates who are well rounded, rather than illustrious bookworms who can regurgitate biochemical processes at the drop of a hat. Wendy CO EMT-B

Also try taking an antihistamine consistently... I've found that the drowsiness seems to drop off the more you use the medication. I find Claritin to be a godsend... benadryl to be naptime OR wired (depending on the time of day) and chlor-trimeton to be instant 4 hour sleep. You could also try adjusting the dose... taking half-doses throughout the day to buy you some relief... or taking 24 hour antihistamines, where you're sleepy for the first couple of hours and then fine thereafter. Lots of options! As to the turpentine allergy... dayum! Never heard of someone reacting anaphylactically to airborne turpentine. That had to be scary! But at least now you know, right? Wendy CO EMT-B

But there *are* crocs that are fully closed shoes! That's the thing... and many people wear those on the job, giving them full coverage... Wendy CO EMT-B

Neither are tennis shoes, which are commonly seen in the HOSPITAL environment, which is what I believe was being discussed here.... If I've got a choice between getting my nice tennies puked on where the puke soaks in and can't be cleaned easily, or the equally lacking in protection Crocs that can be dunked in bleach quickly, I'm going for the Crocs... Wendy CO EMT-B

Depends on how far forward you go... take it a ways up, and you won't put yourself in the optimal staging area. Better than parking right behind el smush... Wendy CO EMT-B

My first questions for red nasty pussy skin thing are as follows: "Are you currently being treated for this? Have you seen a doctor yet? Are you taking antibiotics? If so, what kind? Multiple rounds? How long has this been like this? Is it spreading? How long has it taken to spread from the initial boo-boo to this ugly nasty monster we see right now? Have you been exposed to anyone with MRSA or other contagious disease that you know of? Is this from a bug bite?" Being treated, on antibis, still getting worse and quickly, yes, I'm going to take more precautions. Anything that's moving fast, yes, I'm going to take more precautions and move more quickly. Known MRSA exposure/colonization, yes, I'm going to take more precautions. Unknown? Well, I guess I won't rub my scraped knee against it... Wendy CO EMT-B CO EMT-B

Calling 911 is the absolute best thing you can do. After that, yep, your options are limited... so C-spine, airway, and support are all you can do. But it's better than doing nothing! I've stopped at accident scenes before. Actually, I stopped at a pretty gnarly one on my way home from work last Friday... at 10:00pm. Shan't give details, but let us just say that the dude who got nailed by the drunk driver was exceedingly lucky in that he only had some minor glass lacerations and minor bruises. From the way his car looked, and the kind of intrusion into the passenger compartment, I expected him to be way worse off. As a matter of fact, seeing the vehicle was what prompted me to stop... Hazards? Definitely dark. I parked a good 400 yards up from the accident scene. Broken auto glass *everywhere.* Traffic at 50mph driving next to us. But the guy got knocked back into a dead end driveway, so the vehicle was fairly removed from the flow of traffic. Some other people stopped as well... and one of them beat me to the cell phone. So I got the driver to sit down (he had self extricated) and let him borrow my cell phone so he could call his folks... and then I explained what was going to happen next as the cops, FD, EMS etc. began to roll up. You know what? He calmed down significantly when he learned how the process was going to work... and as soon as the cop came over, I identified him to the cop and left. That's it. Did I contribute much by stopping? Nah... Did I put myself in danger? No more so than walking along that street on Friday night normally entails... and I certainly didn't neglect other responsibilities in order to stop. I got to reassure a pretty shaken dude, keep my eye on other bystanders so *they* didn't get hurt, and bail as soon as the pros got there. The take home message is that you can't do much when you stop, but if it is a severe accident and you're willing to take the risk, do what seems right to you. If it's really gnarly in a rural area and you *know* it's gonna be a while, stopping might be a valuable idea. Wendy CO EMT-B

Congratulations Dwayne! I knew you'd do it! --Wendy