Eydawn

This individual is biologically female, having undergone "transition" to "male" via hormone therapy and masectomy- not penile construction. Thus, having retained the correct parts.... this individual is capable of becoming pregnant and bearing children. I believe the article mentioned artificial insemination, which to me implies donor sperm. Since the individual identifies with male, they are referred to as "he" but remain biologically "she"... God, when did this all get so confusing? Wendy CO EMT-B

The native groups who view this herb as a religious element need to get the legislation moving now to legalize it for their practices... lest they end up with the rastafarians and be barred access to it. Hope there's good lawyers for em! Personally, I don't dig anything that screws with my mind or body. I hate painkillers... too much caffiene... etc. Wendy CO EMT-B

No no no! I'm not trying to accuse you of anything. I guess I'm still confused as to what you have been saying. Yes, I see the legal precedents for excluding HCW's from direct patient care... what I don't see is your jump to "ergo, anyone with HIV shouldn't be a HCW due to legal precedent" which is what I'm reading. I'm trying to reconcile calculated risk and employment status with what you've been saying and I'm missing it. Blond moment perhaps? What I'm saying is the actual facts that I've been looking at are the stats that Vent gave us from different sources, and I'm not seeing you incorporate those with your legal precedent stuff... which is what *I* am trying to do to fully formulate a position on the issues... ? Wendy CO EMT-B

Dusty, your fact seems to be more opinion to me... because the only *facts* with numbers to back them up that I've seen have been produced by VentMedic. What am I missing? (I sound like Dwayne! :shock:) Wendy CO EMT-B

Ok. Here's my attempt at this. You know that muscles contract due to nerve impulses, correct? The nerve impulses are a result of depolarization and ion shift, which is essentially the same thing as an electrical impulse. Ergo, with these motor nerves, if you flood the system with high levels of electricity, the nerves are going to fire. Now, even dead muscles have residual ATP, which is the energy unit by which things are done. With these muscles, with this store of ATP left, the ATP can still be used by the tissue, and the muscles can contract. Make any sense at all? Wendy CO EMT-B

The patient always has the right to choose his or her HCP (unless they are unconscious or otherwise altered) and what I fail to see is how a HCW having HIV infringes upon the patient's right of choice. There are many laypersons who do not understand infectious disease *at all* let alone HIV or Hepatitis. My position, based upon the solid figures that VentMedic supplied, is this: the patient is benefitted the most by having access to the most intelligent, most educated, ethical and compassionate provider possible. What is being pushed as the correct position is that a provider who meets the above requirements only does so if they are not infected with HIV. I disagree! There are many things that people find "awful" and "scary" when it comes to other human beings. Satanic worship, mormonism (no offense!), homosexuality... the list goes on. Should a homosexual male nurse disclose his sexuality to a patient because he is in a higher risk category for contracting HIV, so that his patient may decide if he is totally comfortable with this provider? I for one am much more worried about maintaining the cleanliness of our blood supply and medical instruments in terms of disease transmission. I'm much more concerned about the HCW who indavertently gets TB without realizing it. I've looked at the numbers... and it looks to me that the risk is so astronomically small, that I can't understand why people are stating that it is to the patient's benefit to keep HIV+ or non-infectious Hep+ providers out of the field. It looks like throwing the baby out with the bathwater to me! I am all for giving the patients the best possible care and taking care of their psychological and emotional needs while doing so, especially when it comes to long-term care. I do not think that stigmatizing those individuals with HIV and barring them from practice achieves that aim. I see what Lone got out of your statements, Dust, and yes pulling snippets out of context will often remove some of the associated interpretation. But it is human nature to look beyond the printed word to see what is behind, and I still disagree with your statement that you haven't taken a stand. Your statement that the facts have taken a clear stand... see what I mean? Wendy CO EMT-B

Really? Dust isn't taking a stand? I don't quite buy it... and here's why.... (no offense, Dusty, you know I love ya and respect ya...) Here's what I'm going to do. I'm pulling quotes from multiple posts, and analyzing the language you used, and the effect it had on how I interpreted it. Feel free to show me where I read it wrong. I know this is in response to the statement of "if your loved one lay dying wouldn't you accept care from someone with HIV" but the way you say "prefer and demand on a day-to-day basis" indicates that you, given the choice, would prefer a HCW without HIV over one with HIV, regardless of other qualifications. Since you didn't clarify that other factors might play in, this is what I see here. Here, you seem to be indicating that our weakest and most vulnerable are getting less than they deserve when they encounter a HCW with HIV. And you state that it is morally repugnant! Tell me that "repugnant to MY moral reasoning" isn't claiming a position on HCW's with some sort of transmissible disease. Not quite sure where you were going with this quote, but you seem to be implying that by accomodating healthcare workers with diseases like AIDS and TB we are merely pandering to their emotional states, rather than evaluating risks, and thus endangering the individuals themselves and their patients. Looks like a position to me! Here you seem to clarify and crystallize what I was seeing inferred before. Your stand is quite clear. The public health should not be a secondary or other lower concern; in your opinion, since the rights of infected HCW's are apparently being prioritized, it is a bad thing. Because that's not how you roll. Ok. So here you're saying that only people with a poor understanding of microbiology would even question the issues being raised here, and that to debate the issue is silly. Therefore, it is cut and dry. And you're also inferring that someone who's taken microbiology who disagrees is also silly.... see how tricky language is? Ok... so what did I misread? The nature of internet communication is such that we must infer what we cannot get from vocal inflection or other communication, so we interpret based on what we know about a person and how they phrase things. Wendy CO EMT-B *edited for a syntax problem*

So the idea of a reference thread to throw at the n00bs appeals to no one save myself and Moby, huh? Friggin' AWESOME. Glad to see that people are interested in just silencing it so they don't have to see it anymore, rather than attempting to do something productive about it! Sorry... too many carrots. I'm kind of rabbity at the moment. AKA in a kicking and thumping mood! Wendy CO EMT-B

A dictionary, medical or otherwise, is a great resource to have available. Google is also your friend, as is dictionary.com... Try those. If you don't understand the answers you get, PM me and I'll walk you through some of this basic terminology. Wendy CO EMT-B

Dwayne, varicella = chicken pox. Bad for pregnant women and adults, may lead to the development of shingles as well as having (as I recall) teratogenic effects on the developing fetus. Kind of like Rubella (german measles) is bad for pregnant women to get.... Wendy CO EMT-B

In response to many of the common statements below, here are my thoughts. Paramedics are thinking about things from a much different perspective than EMT-B's. As an EMT-B, I was trained to look for obvious signs and symptoms and taught simple, quick, important skills that would presumably allow me to follow the adage of "do no harm" in most cases. However, what I was not taught was how to see past the obvious. It is much easier for me as a Basic to care for a broken arm... to provide chest compressions to a pulseless patient... to place oxygen on an elderly woman with shortness of breath... for this is what I have been taught. When the paramedic looks at the broken arm, he (used for simplicity... not excluding female paramedics) may be thinking of hemodynamic compromise from severed vessels. He may be thinking of long term nerve damage, of how much pain medication may be appropriate for the patient dependent on a whole host of factors, or of what he might be missing in terms of other, more serious life threats secondary to the trauma that caused the broken arm. When the paramedic sees the pulseless, apneic patient, he knows that he must rule out a whole host of things and is thinking about physiology and pharmacology that we cannot even begin to understand at the Basic level. Is the patient in asystole? V-fib? A-fib? What drugs are appropriate? What continuing care can I provide enroute? Is it possible to ensure this patient's airway remains patent? Are there comorbid factors? As a Basic, the most we can think to do is start the IV for the medic (in certain areas), and provide BLS airway support and chest compressions while the medic does the *thinking* work. Same deal for the elderly woman with shortness of breath. We are taught the magic 15LPM NRB spell... but when that is not enough to fix the problem, we are left empty handed until the woman reaches the point where we must physically force air into and out of her lungs for her. The paramedic's brain engages and runs through the complexities of the human respiratory system, searching for the answer that may save the woman from being intubated- or from dying. The key difference here is that yes, the physical supports that we provide as Basics are very important... but the mental toolbox we work from is much smaller. The paramedic may leave the physical skills to you because he knows you can handle them... but a good medic would never dare ask you to find the solution to the problem, because he knows you haven't been given the right tools. It's like having a kid's carpentry set, and having a basic idea of how to hammer a nail into two boards to fasten them, and then being confronted with building a new wing onto Buckingham Square Palace with just your kiddo sized tools. It's not a personal affront to you, nor the medic being lax in what you've been trained is important... it's them using the most important thing they've got-- their education and assessment skills. Paramedics are important for every type of call. There are always hidden subtleties. Ok, maybe not on the stubbed toe... but there's an exception to evey rule. Medics may seem arrogant because some have arrogant personalities... but others seem like "know it alls" or "paragods" simply because they're busy thinking at a different level and don't always have time to break it back down to the level where you, the Basic, can completely understand it. Them telling you just to do whatever they told you to do is because they're focused on the patient. Helping you learn and helping you to understand the complexities of the human body is best done off scene, where there is actually time to dissect what was going on. A paramedic may choose to spend more time on scene because doing so may give them time to figure things out that speed up the in-hospital process. Starting IV's, when the patient is more stable, may save the trauma team valuable seconds in-hospital when the patient decompensates. Although we as Basics may not always understand what the paramedic is doing, or why, we have to trust that their higher level of education means they have some competence and our job is to do our best to support them. We do the same for the doctor or the RN in the ED, right? We know they've got more education and think about things differently than we do. The same goes for our medic partners. I hope this helps clear some things up. Knowledge without explanation can seem like arrogance... and may be, but give people the benefit of the doubt and realize your own limitations before attacking Paramedics. Wendy CO EMT-B

Having had a medical microbiology primary literature based course, I find plenty to debate here. Infectious diseases are influenced by so many variables in terms of their contagion level and deleterious effect on the host; so much so, that as with many other isses, putting out a blanket decree in terms of who is and is not allowed to continue working as a HCW is a rather stupid idea. While there may be legal precedents for excluding contagious individuals from certain activities, or even restricting their physical and legal freedoms (to wit, the arsehole with antibiotic resistant TB that's locked up in a hospital in Denver somewhere... who flew around the world *knowing* he was contagious), it does not mean that any indication of disease status is an automatic signal for the appropriateness of said restriction. I disagree with Dust. I would not rather see Varicella OR HIV transmitted, as both have dangers to specific populations that can be equally lethal, and I would like to see precautions taken that cover both. Those precautions may involve a period of isolation, or extra PPE measures, but do not necessarily have to include banning the person from being a HCW ever again. I believe it comes down to the issue, again, of infection vs level of contagion. You may just have been infected with HIV and just found out about it, but your immune system may not weaken for years to come. If you take the precautions that we all take in terms of not exposing one another to bodily fluids, why shouldn't you continue working? I'd much rather see employees who come down with illnesses that are spread in an airborne or other highly contagious fashion be given a forced leave until they are no longer contagious (kind of like how I couldn't go to work until I had been on antibiotics for 48 hours when I had strep throat a couple weeks ago). I think this is much more pertinent to protecting our patients than forcing an HIV+ nurse to quit just because she carries HIV in her body. Same with Hepatitis... if you've had it, but are no longer contagious, your history shouldn't preclude you from the employment of your choice as long as you meet all the requirements. As a side note.... those who don't want to see a zing in Dust's direction, jump off the thread here. Dust, would you knock off the holier than thou for I am educated bit? It's starting to get rather irritating. Just because we would like to debate this highly pertinent issue and tease out the nuances doesn't make us ignorant. I think blindly accepting everything you're taught and never questioning it is much dumber... and that the best way to learn is to challenge something, examine it from another perspective, and then return to the issue to see where you really stand. Perhaps it is much easier for someone with your lengthy experience to automatically know where they stand on the issue... but it doesn't necessarily automatically ensure that you are correct, nor that others' opinions are invalid or "silly." Also, I feel that there are many who have contributed to this discussion that *have* taken microbiology.. yet there are still things to discuss. Just my honest opinion. If this gets too hairy, let's take it to PM Wendy CO EMT-B

Refuse to falsify any documentation whatsoever, and if they press you to, get a lawyer. I will not falsify my trip sheets or any other pertinent documentation for any patient interactions I have. That's a good way to lose one's job long-term. Wendy CO EMT-B

Ah, the point I'm trying to make there is that they're BOTH stupid. The pretty girl who drinks a crapton and puts herself in a bad situation, and the fratarse who chugs the keg. It just seems to be that when the pretty one croaks, from her own stupidity (not referring to any GHB involvement here, we'll get to that next) that it's a tragedy, and she's turned into a martyr. For example! The lovely instance from the school I'm currently at... Samantha Spady. Drank a crapton, wandered from party to party, passed out in a frat house attic and died. EVERY YEAR on the anniversary of her death, her picture is paraded around... the "tragedy must not be forgotten".... and no one comes out and says that she *killed herself* through stupidity and associating with stupid people. Now, take your average, unshaven, unwashed "general education major" frat boy, and place him in the same attic she was found in... oh well... another frat boy died of stupidity. I'm trying to say that if we don't care about the frat boy, we certainly shouldn't care about the dumb broad, either. Either the fact that they die of stupidity is to be blown off, or it really is a tragedy (and I think loss of any younger life is a tragedy... there's always the potential for turnaround). Now, another thing I can't stand about certain fraternities and sororities is the sexual social culture. I have no issues with anyone who chooses the one-night stand lifestyle. Your body, your emotions, your choice. When that lifestyle is added to a drunken, disease riddled, contraceptive free environment, it becomes a societal problem. Not to mention the fact that some fraternities still operate on the "boys will be boys" mentality, where sexual assault on women is not only expected, but encouraged. Lots of date rape, party rape, GHB use and coverups. Hell, one house up here, Sigma Alpha Epsilon, is known as Sexual Assault Expected. They even are loud about it- they repaint the lions outside the house red whenever a member sleeps with a virgin. I'll bet there's lot of upset ex-virgins who were drunk and didn't realize what they were getting into.... The sororities should be educating their women on how to avoid these situations and how to keep themselves safe.... but no! The sororities PLAY INTO the mess, encouraging girls to look as attractive as possible and frequent drunken frat parties. When a girl goes home with a frat boy, it's a *good* thing and discussed ad nauseum the next day. As always, this is a general observation. From two physical locations- Michigan (WMU was right next door to K College, where I went) and Fort Collins, CO (CSU)- I have observed the same kind of behavior. Ergo, I make generalizations about fraternities and sororities. There are a few notable exceptions, but most of them don't live in houses together. For example, the Eagle Scout fraternity is completely a social service organization. They do things for the Scouts and the community... and don't live in a party house. Alright. Back to the thread. I agree, this is pretty straightforward; airway, history, IV access, be ready for seizures, transport and reassess continually. Get him to the hospital so they can try to fish him out of the alcohol sodden mess he's currently in. Wendy CO EMT-B

I hate the binge drink, "let's phuck with our passed out frat brother" mentality. Unfortunately, I've seen a LOT of it. We're lucky (or genetically unlucky as the case may be) that more of these arseholes don't croak themselves or their friends doing this stuff. Notice that when it's a pretty young lady who dies, it's a tragedy? I know of several unsung frat boy deaths... because it's *expected*..... but no less tragic or preventable in my opinion. I will never join a fraternity nor sorority. They're usually either caught up in politics, or *really* into the puke'n'whirl gig on weekends. Wendy CO EMT-B

Without watching the entire video (perhaps a few clips if there's anything more interesting further along would be better... I don't have time to watch these guys screw around, to be honest!), my first requirement is police on scene to get the guy's arsehole drunk friends out of the way. Second, with the fixed pupils that I noticed in the vid, we're transporting this guy emergent. Protect the airway. Prepare to be puked upon. Figure out what they ate, what they drank, how much, when, and if any other drugs are involved. Figure out how long he's been unresponsive and snoring. Figure out if he's puked at all, and if he's had any other fluids besides alcohol recently. Get whatever kind of medical history I can from his drunk friends. Start moving. Get an IV enroute, be ready for seizures, and hope to god I've got a medic who can tube this guy. It's going to be a long night for him. Without more info on what actually is going on, I'm not writing a PCR narrative. I can describe what I'm seeing, but not any other information... so if you really want, let me know and I'll describe my initial impression of the guy as I see it on the video. Wendy CO EMT-B

Ah, a "Skeptical Inquirer" fan! While I do enjoy some of the things they come up with and analyze, and find the rag to be a rather entertaining read, I'd like to see another source quoted with actual numbers and statistics that are more current than 1972... Their citations are good, don't get me wrong... it's the superficial interpretation that makes me nuts. Got anything? I'd love to see it! Not that I'm defending acupuncture or accupressure, nor discrediting it. I'm still out as the jury goes as to its benefits... but I don't need a study to tell me whether or not my patient is feeling better after an accupressure treatment, a massage, listening to a good CD, etc. If it works, placebo or not, go for it... Wendy CO EMT-B

Go for it! Just learn your limits and how long it takes you to quit bleeding etc. once you start the warfarin. I know a nurse who's been on it for 30 odd years who just joined the search and rescue class I'm in... she's doing fine, and has been doing fine as a wilderness EMT and nurse for ages. As she said... "Hurray for living on rat poison!" :rabbit: :rabbit: Wendy CO EMT-B

Look. I won't name names here, but how many other users do we have that are as blunt as this guy was, that we make excuses for or even encourage? Sorry... I smell hypocrisy! Don't get me wrong. I luvs Ruff! Ruff is incredibly intelligent and very articulate. I don't think anyone should jump all over him for not wanting to further discuss the issue, since he's given his reasons for his standpoint and now chooses to back off some. I didn't see anything particularly derogative or inflammatory in smallfry's post. Didn't see him label ANYONE in particular as being small minded or living in the dark ages. Was it a polite post? Certainly not. Was it an invalid post, lacking complete credibility? Not as it stands. Should he choose not to come back and further discuss the topic, then yes, it seems pretty minimal. How many folks have we had with small post numbers and a lack of experience/contribution on this forum turn into articulate, valuable contributors? How many had the potential, but chose not to remain? Back to your regularly scheduled thread... Wendy CO EMT-B

Many lurk before posting. Smallfry may well be versed in common opinions from certain users. And one could argue that firing someone for a Hepatitis or HIV diagnosis is in fact discrimination if they are still able to perform their duties. Wendy CO EMT-B

Someone who chooses to put their opinion forth and defend it has credibility. This poster said he/she perceives prejudices, and thinks some people need a pathology refresher. They were just a smidge blunt about it- bluntness that we tolerate and make excuses for in other posters with "more credibility". Just because there's only 9 posts behind the name doesn't make the poster worthless. Low shot, Ruff. So, since again this topic seems to come back to education, who's had a sociology course recently? Or a nursing ethics or healthcare ethics or philosophy class? Anything relevant in there that would add to this discussion? Wendy CO EMT-B

Agreed... Ruff's position is clear, for his stated personal and professional reasons. Ya can't change him, so let him be. I'm thinking a little more deeply about this than I had been previously. For example, I was under the impression that a resolved TB infection and subsequent drop-off in antibodies would then lead you to have a negative skin test. At least, that's how it was explained to me by a nurse, when I wondered why I had to get 2 of the PPD tests within 2 weeks of each other (being "two-stepped", as it was referred to) since if I tested negative then, I would theoretically test negative 2 weeks later. Still have to go read more about that one. If someone is negative for HepB or HepC on a blood test, even though they've had a previous infection, I don't think it precludes them from working in the healthcare setting. I do, however, think that anyone who's "active" should be very careful. We all know it's a long shot and much less likely for us to transmit something like Hepatitis to a patient than it is to transmit something like the common cold... but in the majority of patients, Hepatitis transmission would have much longer lasting and more severe repercussions. That would be a life altering event. As for HIV? I'm still on the fence. Not because I fear being infected with HIV from one of my healthcare providers, but because of the stressors involved on the person with the HIV infection and the secondary infections they tend to get. If someone comes in with bad pneumonia, and my HIV + coworker gets it (whereas most of us didn't), it's going to be around us for longer than it would have previously, and now it's more likely that I'm going to get it too. No? Not saying that all HIV+ people are disease-mongers; far from it. Just saying in the work environment, it will increase chances of us being exposed if a susceptible coworker gets it. I would think that someone with HIV would want to spend time living life, not working, but then again for some work is life. I think if you do have something extra nasty hiding in your system, you had better be extremely aware of risks to you and those around you, and take precautions. If you do, then sure, keep working as long as you're able to satisfy the job requirements. Still pondering, however! Wendy CO EMT-B

Dude, maybe it's just him operating the needle! I have known folks who are fine with getting stuck, they can handle it, they can watch others get stuck, but sticking a needle into someone else is very difficult for them. Dunno what this guy's issue is, but if that's the case, again... sucks to be him. But yeah, any phobias or wierd dislikes are going to get you razzed no matter where you work. Yay for the workplace lol... You know what I hate? Cleaning up warm puke. I can watch someone vomit, hear it, smell it, help them out while they're puking... but if I've gotta clean it off the floor and I can feel through my gloves that it's still warm? *BLARGH* :tongue6: :puke: :pukeleft: :pukeright: Wendy CO EMT-B

Check your inbox- just in case Durango isn't your best option. Wendy CO EMT-B

PM me. Someone up here in Fort Collins just recently became a PHTLS instructor and may be able to help you. Wendy CO EMT-B