Eydawn

Rofl! That's pretty funny. My whole take on crazy hair (having grown up around musicians) is that ok, it's well within your rights to express your individuality however you see fit... purple mustache and checkerboard neon buzz cut and all... but it is also well within my rights to laugh at you when I see it! To each his own... Wendy CO EMT-B

Ooh... with those three minds working on it I think the next contest will definitely be a challenge! I can't wait! Sorry I didn't post my idea in here... I was waiting for the go ahead. Since it's not purely EMS related, if you want to know what it is, PM me and I'll send it to ya. Wendy CO EMT-B

When I come home at the end of the day, I tell my significant other about it. The little things. The big things. The boss things. The achy "We both really didn't expect that one client to go limp while we were helping him walk and now my back is killing me" stuff. And he listens! Then I do the same for him. Just being able to share your day with someone else helps you to put it into perspective. I also absolutely love food. I love to cook, I love to bake, I love to eat meals that have been prepared by various chefs; when I'm thinking about food, it's hard to think about anything else that's going on. When I get the opportunity I love to get outdoors and go hiking or walking. Just being in the sunshine helps (boo to winter... I hate this part of the year where it's so dark!) and watching different critters is really nifty. While I'm on shift, if there's a lull, I read science fiction... just that temporary escape into a world that isn't my workplace. Wendy CO EMT-B

ROFL! That was pretty darn funny! I also liked the picture of the hammer screwdriver set... the shoe and butterknife... so true! Been there! Wendy CO EMT-B

Huh? Hey, ventmedic, what are you thinking here? Spell it out for the undereducated basic? Wendy CO EMT-B

I've got a few ideas kicking around. What is this kid's BP? What do his mucous membranes look like? The pulse ox says he's saturating at 85%... but do the physical indications back that up? How do his pupils look? Are his extremities cold? What's his respiration rate now and is there any change to his breath sounds? Does he have a family history or personal history of ANYTHING? Cancer, diabetes, sickle cell, asthma etc? Is he taking any herbal supplements? What home remedies has mom tried for the kid if any? How about OTC's? Prescriptions? Any funny smells in the house or anything that makes you think "uh oh... perhaps we better get out into the nice fresh (if brisk) air"? How much spray did the doc use? Did he get any into his bloodstream from the puncture perhaps? Is it possible that he inhaled some of the local anesthetic, numbing or otherwise interfering with the normal operation of smooth muscle tissue in his lungs? I know this is a long shot... but is there cardiac involvement due to this kid being hypersensitive to the anesthetic? Could he have an arrhythmia going that is causing the SOB? I never did see EKG results... or is the Lifepak/Zoll busted AGAIN goldurnit? The reason I'm thinking cardiac is because lidocaine, the first anesthetic that came to mind, inhibits the ion fluxes involved in neuronal impulses... hypersensitivity to this could mean a tiny bit in the bloodstream could be screwing up the cardiac conductivity... and administration EENT tends to act more like intravascular administration if adverse effects are seen from what I'm reading. Also another zebra... familial malignant hyperthermy in its early stages. Tachycardia and tachypnea with labile blood pressure... I know it's a long shot... I want more information. Since I'm assuming that I'm as screwed as if I were out at summer camp, isolated, no doc on the line, I want to puzzle out as much as possible while I'm waiting for assistance. Wendy CO EMT-B

Wow, Michael! You really *do* know everything!!! Holy crud! Wendy CO EMT-B

I *was* a homeschool kid. We *are* weird, especially when we first enter the real world and have to try to figure out social cues. The parents have relinquished control of their children to the "experts in child education"... think about all the parents you know who don't participate in the PTA or even vote in the elections that put school officials in power (at the higher level). Ask any average parent what their kid's teachers' names are, and I'll bet they can't name 50% of them. Yes, the school systems suck.. but they are enabled by ignorant parents who just accept that "that's who's in charge at the school and that's how the rules are." I know parents are busy. But it's a lot less time consuming-- and much less costly than challenging the juvenile courts system and finding a new school for your kid a year or so after it all clears up-- to challenge the system BEFORE this shite happens. Wendy CO EMT-B

Schools are moronic. Children get arrested to assuage the fears of adults who do not live in the real world... Those of you who know what happened to my brother this spring know what I'm talking about. PM me if you don't know. I swear to God... the fact that kids can be arrested for bringing EATING UTENSILS to school astounds me. Let's be honest here... if I go off the deep end and really want to kill you, I can accomplish that with my pencil. Should we now ban pencils from schools because they're dangerous? I wish I could take a clue bat to every school administration official in America's head... and if I expressed that desire anywhere within 100 feet of a school property, I could be arrested for it... Wendy CO EMT-B

Every scientific study is flawed. You use what data you have, you try to take into account your detracting factors, but at some point you have to make a conclusion based on what you're seeing. I dunno. I've been dubious of scientific studies in general ever since I figured out how they calculated the world's species number in order to estimate extinction rates. You ready for this? Some guy put tarps down under a rainforest canopy on an island, and fogged everything with poison gas... then counted the dead critters. He counted a certain number of species in this area, then extrapolated that area based on the habitable area estimated on earth. Presto change-o we have X number of species and we've counted X number going extinct so our extinction rate is.... My whole class looked at each other like "is our prof serious?" and then accepted the numbers to work with in the class. My point is... every study, no matter how well it's done or what it takes into account, will have errors in it. Such is the nature of the beast. You work with what you deem to be acceptable error levels, and you draw conclusions and work with what you've got. Otherwise we'd still be sitting here playing guessing games. Wendy CO EMT-B

Unfortunately, we didn't get to cover this specific problem in my neurobiology class. We did cover a lot, especially regarding what levels of the spinal cord will present with deficits/pain in which areas of the body... but I had never heard of Cauda Equina Syndrome until zzyyx posted it. And I didn't JFGI because that would have been cheating! Lol... Ok, maybe I did hear it someplace before... but not enough about it to have it come to mind. The only thing I could think of was lower back pain due to a lift injury: compression of the cord from injury to the vertebra (osteoporosis, anyone) or a disk moving and putting pressure on the cord. Didn't think about it being low down enough to involve the cauda equina. Wendy CO EMT-B

If you're talking about the three glass globes on the light out in front... Dust's house has 3 big balls! Wendy CO EMT-B

Ah hah! Ok. That makes sense. So how would you advocate transporting this fellow and what could we do other than palliative care prehospital? Wendy CO EMT-B

This is ridiculous. I wouldn't explain anything I'd just hand over my certs then and there and go hide under a rock. Wendy CO EMT-B

Sounds to me that he may have fractured or otherwise injured a vertebrae in his lumbar region, causing a compression injury (from movement of the vertebrae or from swelling) to his spinal cord. That would lead to the radiating pain (compression or injury of the pain and temperature sensing neurons) and the progressive weakness (compression or injury of the motor neurons) AND the numbness (touch and proprioception neurons). Wouldn't backboard this guy, but I'd definitely get him seated as comfortably and stably as possible on the cot, padding to make sure he's nice and snugly held. Then it's off to MRI and X-ray land for this fellow! Provided I can articulate my concerns to him well enough to get him to go with us. I'd be very very careful in moving him... Do I get a cookie? Wendy CO EMT-B

I'm all for going to continuing education... but the way it's set up here in Colorado is kind of screwy! For example... I took the refresher course this semseter. It's something like 54 CEU's. To recertify at the National level, you need 70 CEU's. Unfortunately, my employer doesn't pay for my EMT CEU's, just requires me to go to 40 million other trainings... even though I use my EMT skills while caring for my clients. Great! I'm short nearly 20 CEU's. So I could pay to go to a conference and pick up the remaining credits, or I could subscribe to JEMS and use their CEU program... or I could challenge the NREMT exam and recertify my national that way. Then once I've recertified the NREMT, I provide documentation of that to Colorado EMS and lo and behold, they renew my Colorado EMT-B as well. Seems like a much more feasible option to me. Not knocking continuing education or my refresher class, but they're so minimalistic at the EMT-B level that it's pathetic. It's "the bare bones needed" all over again. There were a lot of topics in my refresher class that were skimmed over, or places where a good more in depth dialogue started and we had to move on to "hit the next topic." It's *not* continuing education! It's re-training. Let's be honest. I was frustrated in that class (as my innumerable text messages to a paramedic friend will attest) and felt like I learned more by zoning out and trying to puzzle out some physiology concepts in my head. It's good to have your skills re-covered. But don't tell me it's education if it is a lower level review than my original class was... I didn't learn anything new, except that Northern Colorado apparently doesn't treat flail chest in the field (????). Don't get me wrong- I needed the review of Colorado protocols... but my ability as a medical provider and my critical thinking skills were not challenged in this refresher class. Due to financial constraints and the lack of availability of good con-ed (to me personally, not in my state) I am challenging the NREMT-B test. Probably on December 21st. I'll let you know how it goes! Wendy CO EMT-B

My bad. The Combitube is a strange ALS device that is written into the EMT-B protocols in Michigan. I couldn't even get my license there (and yes, it IS a license in Michigan) until I had "remedial training" and learned how to use the damn thing. I don't necessarily like the Combitube. Blind pseudo-intubation in the hands of someone like me? I'm smart, but I don't feel educated enough to use that device... hence my statement about I'd much rather use OPA/NPA until a medic can drop an ET tube, or, failing that, use one of their backup devices. Wendy CO EMT-B

Since I currently work for a CCB and provide care for adults with developmental disabilities, do I get to attribute this $1,000,000 to my current employer? Or do I use my camp EMS job? Wendy CO EMT-B

Well stated points! In MI, where I still hold current certification, the Combitube is a BLS device... I'm just leery of it due to studies finding increased necrosis to the esophagus and higher incidences of airway trauma due to having to PULL the Combitube in order to drop an ET tube. Ergo, the way I see it, I'm glad I can't do it in CO because in the long run it may do more harm than good. But that's just me! Wendy CO EMT-B

Can't emphasize the body language and tone of voice stuff enough. If you're frustrated with the patient, let them know that your tone of voice and body language are coming from your own stress, that it's not something that is directed negatively towards them. If they're with it at all it will help. Acknowledge what's going on with them! I know that in my field, working with people who are developmentally disabled and who have a host of psychiatric conditions along with the DD, it can mean the difference between a shift from hell dodging blows and a calmer shift if you just acknowledge what they're experiencing. "I can see that you're frustrated... if you'd like, I'm willing to listen to what's bothering you" "I can see that you are angry about what your roommate just did... would you like to talk about it?" "I can see that you're upset... could you tell me why? Maybe I can help!" Too often I've seen staff go "Oh, you're exaggerating this. Stop it right now" and have their shift turn into a full blown physical and verbal power struggle. You know what? It seems like BS to you... but to your patient it doesn't. Same goes for psych patients in the back of the rig... pay attention to how your words and actions are affecting the situation. If things are getting worse, change something. If things are getting better, continue doing what you're doing. Of course, you will *always* get the person that is hell bent on kicking your arse for whatever reason... that's what restraints are for. EMS is lucky... we get to physically restrain our folks with more than our hands... no such luck for the field I'm currently in! No chemical restraints, nothing more restrictive than a standing 2-person control hold which must be released after 15 minutes by LAW... even if they're still bent on getting you. Count your blessings that you have Kerlix! Wendy CO EMT-B

Clarification: DWAYNE was the one with opinions regarding reducing FF numbers... just don't want that misquote to stand, Dusty, lol! Not that I disagree with him but I didn't say it. Wendy CO EMT-B

Oh oh! Here comes round 2 for n00b reorientation.... (no offense intended!) Don't take any comments that say "firemonkey" as insults, they're not directed at you personally. And be aware that your perspective may not be agreed with, and that the types of responses you give will affect the types of responses you get. I do agree that early defibrillation is key... but a First Responder with an AED/CPR cert can do that very easily. As for the Combitube, there are many schools of thought on that particular airway adjunct... and many people have expressed a preference for trying to get the ET tube *first* and using the Combitube as a backup device. Personally, I think I'd rather see my cardiac arrest patient being managed with BLS only airway devices (NPA/OPA) and good BVM technique, rather than a medic having to pull the Combitube to establish that definitive airway. The less we screw with the inner workings, the lower risk of trauma to that airway. Just my opinion, however! I'm a little confused about your statement regarding "more manpower... and dropping the silly requirement that all EMS providers have to be firefighters"... are you advocating combining the two departments permanently, but having the EMS be their own thing within the fire department? So would you then drop the requirement that all firefighters have to be EMS? Not sure where you are going with this. As for the need for fire personnel... I am not a FF and will probably never be one, so I will not venture to comment on what could be considered adequate staffing for a several alarm fire. Don't know enough, gonna keep my mouth shut. I will say that I've seen a lot more overstaffed kitchen and dumpster fires and a lot of very bored extra fellows on scene when I've been at a fire scene, but again, I don't know enough about how the fire side works. A comment on the aggressiveness of Dwayne's fire-medics and theories as to why: I don't necessarily think that just because they're FF/Medics and therefore more "aggressive" due to being in the fire field that they're more aggressive MEDICAL providers. Perhaps they know the inadequacies of certain transport crews and choose to try to make that difference in patient care before they have to transfer care? I would argue that aggressive patient care is motivated by education and caring, not by balls o' steel and the willingness to risk personal danger... because I've seen many fire-medics who were avid firefighters, willing to wade through the lava and rats, who just plain SUCKED at medical care and were not aggressive enough with treatments. I do believe that stating they were more aggressive because they were firefighters was a bit of a non-sequitir there. Alright, Wayne... your turn! Just remember that no one hates you here, it's not a personal attack, and yes, people ARE going to tell you that you're wrong and not paying attention in the next few posts. Be ready for it- don't knee jerk react and think about how to COUNTER it in discussion. Welcome to the City! Wendy CO EMT-B

Very good points, lfdcaptain! In response to the term "Professional EMT" being an oxymoron... there are many of us here who believe that EMS providers are undereducated, having only a bare minimum of training (the 120 hour course sound familiar)? Ergo, until we have a professional level of education akin to those that many RN's receive, EMT's cannot be considered to be professional providers. Trained providers, kind of like a CNA has training, but not educated because we don't have the anatomy/physiology, pharmacology, cardiology to back up our treatments etc. I think the problem that some people have (myself included in Colorado) with fire based EMS is that there are many guys who are *excellent* firefighters, who really just got into this for the fire side of things, who are "brute forced" through an EMT class that is designed to get them to bare-minimum pass their National Registry and State exams. There are many firefighters who just do the EMT thing "because they have to" and really don't do a lot to try to further their education afterwards. Ergo, they provide sub-standard or mediocre medical care when they're on scene, and there your feud begins... I can attest to the "brute force" tactic because unfortunately, with the way my schedule worked at the time, I ended up in a summer EMT class. 10 weeks, only 3 of us in there really wanted anything to do with EMS as a career. It sucked. If I hadn't had some good foundational A and P from college and learned the physical skills as a First Responder, I'd probably have been $h!t outta luck. Oh, we all passed the NREMT (eventually in some cases), but it wasn't a class that was trying to EDUCATE good providers. It was trying to train these guys so they could get hired on with the local FD. A lot of us don't know what to do to solve the problems that we see, both with education and poorly run Fire/EMS systems. But the first step is acknowledging that there is a problem and trying to see what the roots of it are. Personally, I'd like many fire departments to drop their EMS requirements, or at least step it back to the First Responder level, especially in urban areas that have adequate EMS-only coverage. I think the benefits of them getting to scene faster would still apply... doing CPR on someone in cardiac arrest or putting O2 on the asthmatic goes a long way, and unless you are a transport agency, that's about all you'll end up doing plus some history, vitals etc... all First Responder skills. That's where some of the issues lie... hope it made sense! And, well written post and way to see through Dust's vinegar to the actual issues. Most folks take about 3 weeks before they get to that point! Wendy CO EMT-B

Sirrah, I suggest you do the same.... until you've ridden Spenac's bus and he your engine, do either of you really have a good frame of reference for what the other's professional life is like? Really... I promise not everyone hates you because you're fire based EMS. Some of my best friends and a couple of the men I trust most with my life are fire based EMS. Lfdcaptain, you're committing the serious newbie sin... think back to your probie days and how folks treated you when you were uppity at the new station... that's what you're catching here. Chill out, no one is out to jump your bones, but you're posting kind of antagonistically and about something a lot of us have seen before. Now, everyone take a deep breath, open your mind and realize that there may be validity in critiquing any system, INCLUDING YOURS whether it's wilderness, scouting, or fire based.... Wendy CO EMT-B

Fire/EMS is an olllld argument here on the City. Relax, take the time to lurk and see who really seems to hold what opinion, and then argue with the ones you see fit to rumble with. It'll be much less frustrating and more productive... and you might just have some insight that no one's come up with before! It does happen occasionally. So tell us more about yourself? Where do you work that Fire/EMS works for you? What rank/cert are ya and how long you been in the field? Wendy CO EMT-B