Eydawn

Debate remains flowing on this issue because there are too many factors involved to definitively pin the weather pattern flux we're now experiencing on the effect that emissions have on the atmosphere. The overall temperature increase we're seeing may not be entirely caused by human activity. Now, I'm not saying "global warming is a lie" or that we *don't* need to reform our pollution policies and reduce our emissions, but I'm saying that you can't 100% support the idea that human activity is the SOLE cause. Even the top scientists and researchers are still debating this one. The primary literature is where you can see what we really know about this issue. You know, after we reduced the amount of particulate being emitted into the atmosphere, the rate of temperature increase actually accelerated, according to some researchers, because some of the light energy was being reflected by those particles... This problem is much more complex than people give it credit for. Yes, you should reduce, reuse and recycle... that's part of being a good steward for the land you live in. But you shouldn't just automatically point the finger at all SUV drivers and say "they're evil and they caused Katrina." Just my thoughts on the matter. Wendy CO EMT-B

Quote: "In people with otherwise stable liver disorders, hepatic encephalopathy may be triggered by gastrointestinal bleeding, eating too much protein, infections, renal disease, procedures that bypass blood past the liver, and electrolyte abnormalities (especially a decrease in potassium). A potassium decrease may result from vomiting, or treatments such as paracentesis or taking diuretics ("water pills"). Hepatic encephalopathy may also be triggered by any condition that results in alkalosis, low oxygen levels in the body, use of medications that suppress the central nervous system (such as barbiturates or benzodiazepine tranquilizers), surgery, and sometimes by co-occurring illness." http://www.nlm.nih.gov/medlineplus/ency/article/000302.htm There's your answer as to how it maybe came about... Wendy CO EMT-B

So... when I was in my 3rd rider days, we got toned out to a working fire at a pallet factory out by I-225. We get there, and this industrial sized dumpster is VERY on fire, and it's wedged right up against this steel wall, which is starting to look kind of unhappy. The FF's kind of need to put this out. Surprise: This is a difficult angle to work the fire from! The side that drops down is wedged against the wall. The dumpster is full. So we have FF's standing on top of the truck, shooting down into the fire... not much good being done there. The EMT I was riding with went off in search of something, so I went with him... and lo and behold, "Fred" as we shall call him finds a forklift! The first thing I did was dive for cover. Fred, having never driven the forklift before, gets the forklift to the scene, puts a pallet on it, and they put a firefighter on the pallet. Better angle to shoot from! Still not working. Fire still going. Bummer. So one of the owners/employees of the factory shows up. They decide to hook a semi up to this recalcitrant dumpster in order to pull it out where the side can be dropped and the fire broken into better. Semi burns rubber. Bummer! By this time, Waste Management shows up with 2 large pickup trucks- the industrial tow-truck cousin types. So they hook up to this dumpster. Now, looking at these fellows... I decided, along with most of everybody there, to hide behind the fire trucks. (Side note... there was a beautiful brand new truck out there... this was its inaugural run!) So they rev up, drop into a low gear, and start pulling the dumpster. Friction decreases, it breaks loose and starts sliding... and genius in truck # 2 hits the brakes. Here's your sign... dumpsters DON'T have brakes!!! So the flaming dumpster collides with the back of moron's truck and sends him hurtling at a wierd angle, RIGHT AT the brand new firetruck. Eliciting a collective "AW, $H!T" from everyone and a mass exodus! Fortunately, he missed. Also fortunately, no one was injured. But it still remains burned into my mind (pardon the phrase) as the "flaming flying dumpster incident... also known as Here's Your Sign." I was pissed off! We missed a respiratory, a seizure and a cardiac arrest while we were stuck there (and I really could have used the experience) but at least it's a good story. Wendy CO EMT-B

Working fires and CO detectors: Absolutely. Pull stations? Nahhh... why do you need EMS to reset the freakin' Silent Knight panel that fritzed again? Until they confirm smoke/fire etc. it doesn't make much sense for any medical folks to be there... now, when it's confirmed, we definitely need to keep tabs on folks and be prepped for unexpected victims. I had a standby for a dumpster fire at a pallet factory once... I asked the EMT that I was shadowing why we needed to sit at a dumpster fire, and he told me that out in the industrial area, very good chance a victim had been dumped and the fire set to cover tracks. Never thought of that one before... On the plus side, it was one of the most hilarious "Here's your Sign" calls I've ever been on! I think I'll post that in Funny Stuff so as not to get too off track here. Wendy CO EMT-B

Jeeze how utterly "special".... If that's how they treat a candidate testing, how do they treat patients? Wendy CO EMT-B

Let's make sure the airway is taken care of and she's well oxygenated. Then I might consider a couple of things. Recent history of some fairly major surgery + woman grabbing leg and screaming in pain --> unconscious/AMS... makes me suspect DVT with a clot that busted loose headed for stroke/MIville. What does a 3 lead or a 12 lead show? Pupils? The other thing I'm wondering.. how many of those narcotics were prescribed, and has she been taking them recently? Did she take a lot initially, then not take any, and then take too many? Might consider Narcan slowly to see if you get any reaction at all, then stop short of completely waking her if you've got control of the airway. Regardless, she's prolly gonna need an MRI to really figure out what's going on. Any change in pt presentation? Get her in the rig and we'll continue as we move! Wendy CO EMT-B

Dad owns a Sprinter. My immediate first thought was "Man, I wish I could turn this into a camp ambulance..." Sprinters are huge on the inside, and I think they'd make great ambulances here in the US. They handle very well too for a tall vehicle. Oh yeah, did I mention that my 6'1 fiancee and 6'2 father can stand up inside of one with no problems? I am pretty sure they get better gas mileage than the boxes we currently schlepp. *shrugs* to each department their own... Wendy CO EMT-B

There's nothing wrong with remaining a basic. There's something wrong with remaining a basic only at the level of training and education recieved in one's EMT-B school. Unless you pursue more education and challenge yourself to soak up information so you can think about what is *really* going on with your patients, you will remain a cookbook reading protocol technician and stagnate as a medical provider. You don't necessarily have to go to medical school or P-school; but you do have to have a willingness to learn. Many people, once they begin learning more, hunger for the understanding that P-school often affords them and become medics. Many do not, including a friend of mine who is an EMT-B with multiple bachelor's degrees and several minors. He's very well educated; he just doesn't really want to be a medic! Wendy CO EMT-B

No. Have your partner check anything you're unsure of and you should be good! And make sure you can operate with stoplights... Wendy CO EMT-B

Although you may have had bad experiences with counselors, you have to realize that not every counselor is bad or a pill pusher. It may take some time to find the one that's right for you and that works well with your personality. It's just like any other doctor... if the communication isn't there, it isn't going to work. Don't give up on the counseling field as a whole... try to find someone who you work well with and who is leery of throwing antidepressants or other drugs at problems. They exist. Good luck! Wendy CO EMT-B

You know what? The 15 year old doesn't look a helluva lot different from the 18 year old in a lot of cases.... Like I said, it all depends on the situation and the individual involved. Fortunately, most of my guys are restricted to go-fer duty and quiet observation. You know where they come in handy though? Calming down scared pediatric patients... Wendy CO EMT-B

I think the big questions are as follows... why remain in this environment where you don't feel safe? The working environment should never make you feel uneasy or like there's only one or two people you can trust. I know it may be difficult to do, but perhaps you might consider reporting this to your employer, as well as the employer of the other individual. If they're going to do this to you, who else might they hurt? If you can't bring yourself to do it in person, a letter or an email would be good to start with. If not for yourself at this point, for the protection of someone else. You don't want another female to be hurt by these guys. It sounds like you have a great friend in your partner, and I'm very glad you have someone you can trust. Let him support you... but don't rely on him or your father as your sole source of emotional/cognitive support right now. Because you've had a trauma in the past that's been repeated, you're not only dealing with the emotions from *now*, but you're also reliving the emotions from *then*, especially if you didn't get a chance to fully process the previous event or seek psychological help at that point. That's too much weight for you, or you and your partner to bear alone. Let someone with that professional distance help carry that with you. I know it may be difficult to bring yourself to a counselor or psychologist's office. I know many people (including myself at one point) feel as though "I'm a freak... there's something wrong with me... I deserve to be treated this way, (whatever that may mean), if I was smarter I could just figure this out and get through it, I just need to tough this out, it'll go away soon..." when they first think about going to get professional help, or when someone brings it up. The fact of the matter is that emotional trauma and all of the physical and psychological things that go along with it is an illness just like many of the things we treat on a daily basis. Look at Rid's example of a diabetic... many diabetics are ashamed that they have to inject themselves every day to be "normal". Many asthmatics have to carry medications and suffer the humiliation of not being able to keep up with their friends, or have to take time off of work due to the illness, which feels HORRIBLE. But you can't treat diabetes or asthma with "toughing it out," because it will kill you or severely damage you in the end and make things harder. No one here can tell you what to do, and you shouldn't feel obligated to do anything. But out of concern, many of us are giving the best advice we feel we can to you. My personal suggestion would be to seek out psychological help, because the nature of the illness warrants that as a treatment. If you feel too uncomfortable going alone, you could ask your partner or your father to go with you. I would also suggest reporting the incidents to the perpetrators' employers, so that you get some closure and so that others may be protected from their attacks. I also think you might want to consult with your boss, and perhaps take a temporary medical leave of absence. You don't have to live with this, and you don't have to struggle through it alone. It doesn't always have to be this way. If you don't get help, you will never learn that you are valuable enough to not be treated poorly or assaulted by men, and you may compromise your ability to do your job. What will happen the next time you and your partner run on a sexual assault patient? What will that bring up for you? Please, see someone professional. For your sake, for the sake of your partner and your father, and for the sake of your future patients. You have an illness- not a defect, and it can be helped! And there is no shame in seeing a psychologist. I freely admit that I have seen a psychologist before to help me process some difficult and painful things that happened in my life. I'm not crazy, and seeing a psychologist hasn't labeled me as such. Feel free to PM me if you just need someone to vent to, or someone to bounce things off of. Good luck with whatever you decide, and thank you for opening up with something so painful and reaching out for help. Wendy CO EMT-B

I always always *always* verify narcotic/controlled substance drug counts MYSELF. Do not *ever* sign your name to a drug count or check that you didn't do- if something goes wrong, it makes you complicit. If you see a problem, report it to your supervisor immediately! Otherwise, when the crapola finally rolls down the mountain, you will be completely buried along with the rest of your coworkers. Honestly! How long does it take to count/check the drugs or look at the seals? At my job, working with developmental disabilities, we physically shake out the client's pills and count them (wearing gloves and not touching the meds) or count them in their blister packs, and double sign the count. That's been the majority of my incident reports so far... funny controlled med counts. You wouldn't believe how many people just take the last shift's word for it, or just subtract whatever they've given to the pt. from the log sheet. BAD idea.... So, to re-iterate... check the box, count the vials or check the seal, and don't sign the paper until you do! It ensures your job safety, and helps the industry keep folks from abusing the narcs! Wendy CO EMT-B

Now here's an interesting concept... if my patient is confused but has a patent airway, and I have to call for glucose but he's got a jug of orange juice in the fridge, is it kosher for me to give him a glass of OJ? I always thought so... Easier than making them eat some nasty goop or things that taste kinda like tums... Wendy CO EMT-B

Why so close in? Branch out a little! Might do you some good! Try some California, Colorado, Michigan, New Mexico, upper East Coast... don't limit what you look through by its geography. Start looking for what kind of school you want... small liberal arts, huge state university, somewhere in between, all male/female etc and go from there. Also look for fields you're interested in, like, biology, English, etc. Good luck! Wendy CO EMT-B

Chas, it's called Venturing... and through the Venturing, you can gain valuable experience while still being in a controlled setting (aka scouting events), rather than on an unpredictable emergency response call. 3rd rides are a double edged sword. On the one hand you are providing 15+ kids with valuable experiences as well as a better look at the profession. On the other hand, you're exposing them to all of the occupational hazards we face. Speaking as someone who's been a minor 3rd rider.... I think it depends on the mental and maturity level of the individual. I know plenty of 16 year olds who have their act together, and plenty of 21 year olds who don't. But I would say, basing things on the population in general and my experiences WITH MY OWN CREW, that the dangers outweigh the benefits of experience in 90% of cases. I'd much rather see most of my guys in the ED, because you can duck into a room if things get hairy... and you stay in one place, so you can be fetched by your folks easier if necessary. Unfortunately, when you let a 15 year old into the back of the ambulance, you expose them to that "I know it all, I'm perfectly competent exactly where I am" mentality that we're trying to fight in EMS education... and it just gets reinforced and makes it that much harder to advance the profession. There are always exceptions to any rule. Chas, you may be an exception, and if deemed competent enough to handle things I have no problem with the idea of you being a 3rd rider. I wasn't nearly as smart as I thought I was back when I was 3rd riding... and fortunately, even the slight advance in age has allowed me to figure that out. No minor should ever be completely responsible for patient care- ever. Not in an organization; wilderness and family emergency stuff is different. No minor should be allowed to enter a burning structure. There's a reason we don't let folks into the military until a certain age, and that reason applies in the fire service as well- judgement and legal competence. Chas, PM me with where you live... I'll see if I can find some venturing links for ya! Wendy CO EMT-B

I never quite understood what dilaudid was... isn't it a morphine derivative? Or is it a different class of drug altogether? My only knowledge of it comes from having received it for a badly infected wisdom tooth abscess last Christmas... and it worked very well. Does dilaudid engage with the same opiate receptors that morphine does? Wendy CO EMT-B

If you can't lift the patient, don't try. You'll only hurt yourself and your partner. Not fair to anyone. This applies to males and females. As to everyone out there who's indicated that women are, as a generalization, physically weaker than men and must take extra steps to achieve the same level of competence, you are absolutely spot on. There are some women who come to mind who could bench press some of you menfolk out there... but then there's women like me, average frame. Do I have to work harder to lift the same amount? Yep. Do I have to use compensated lifting tecnhiques to make sure my joints are stable? Yup! Do I cop out and say I can't do it? Nope! Do I try to lift something I can't adequately lift? Nuh uh! I got one pair of knees to last me.. and don't plan on buying new ones. Wendy CO EMT-B

Racism is not a cut and dry topic. There are no concrete answers to it, and while exploring the subject of having been called racist, it is perfectly acceptable to explore the idea of racism as a whole. Unfortunately, racism and politics seem to be intertwined in America. Ergo, we are discussing politics now. As a side note, I think everyone pitching a fit every time a thread meanders into some different discussion is getting really old. How many conversations have you had where you talked about the same thing for the entire time? I think the only way to learn and encounter new ideas is for tangents to occur. Not everyone is a completely linear thinker, and we've seen that starting a new thread for every little ramification of a conversation is a bad idea. -Rant off- Wendy CO EMT-B

Since when did mental illness become something EMS shouldn't have to deal with because it's difficult, dangerous and uncomfortable? Psychiatric patients are just that: PATIENTS. One thing I think we should differentiate between here is the interfacility transfer of a psychiatric patient who has already been evaluated and the emergency response to a behavioral episode somewhere in the community. Looking at Case A, the interfacility transfer: If this individual is not suffering any other medical complications and does not have meds on board with a high likelihood of sick-making side effects, it should be acceptable for someone other than EMS to transfer them. If they're suffering any other sort of medical complication and/or the meds are very powerful with a high likelihood of side effects, then one of our old favorite EMS transfer units and adequate resources should be utilized. Emphasis on the adequate resources. Looking at Case B, the emergent behavioral episode occurring in the community: How do we know for sure there isn't some underlying medical factor eliciting this behavior? How do we know that our favorite frequent flyer schizophrenic isn't having a delerious episode brought on by a high fever? How can we be sure it isn't a BGL issue? I guess the big question is, how do you know this person is ONLY suffering complications from their mental illness? Is that mental illness known to you and bystanders and DOCUMENTED? And regardless, they are going to need to be evaluated by a doctor upon their arrival to... the ED... so how could it not be safer for the patient and the responders to have them four or six pointed on a cot? Seems to me that taking away someone's power base by having them restrained horizontally lessens the chance that they're going to work loose or be able to injure me, my partner and any LEO's I have with me. And remember... even though someone may be having a severe, violent behavioral episode due to medication imbalance, blood sugar levels, mental illness etc., they are still a human being deserving the best care we can give them. There is a distinct difference between the individual who is intentionally violent or uses illegal drugs causing such a reaction, and the individual who is having an episode of mental illness. But we still care for everyone who is in need of our care, no? As long as you can find a way to safely do so... Wendy CO EMT-B

Gotta love improv! Having auditioned for an improv team a few times, it's pretty difficult stuff to do under pressure. I have to admit.. I just thought that was funny. Not gonna hurt our reputation any more than some other shows I could name... and well worth a laugh. Wendy CO EMT-B

Just on the single parenting thing... there is a distinct difference between a family that ends up in that situation, for whatever reason, and accepting single parenting as a parenting ideal. Not saying that single parenting is bad, or that a single mother or father can't raise a child correctly, lovingly and more than adequately, but most single parents that I know have attested to the fact that it would have been nice to have a significant other to help with child-raising. We know that it always helps to have 2 sets of eyes on a situation... and I can't imagine that the care and well-being of one's own child is a situation where that is not important. In some areas of the United States, single parenting is the cultural norm because one parent is assumed to have the responsibility for the children. Ergo, you get a culture where fathers just take off because their dad didn't stick around to help raise them, and everywhere they look it seems to be acceptable to bail on the child you helped to conceive. Sometimes mothers bail too, but by and large most single parents are women (I'll try to find some stats on that). I don't think captainstandup was trying to attack those individuals who end up as single parents or say that they're bad people or don't raise their children well. From what I can see, he's trying to point out that in many cases, the optimum is a dual-parent household, and that the cultural normalization of deadbeat dads is not a good thing. Sometimes it IS better to have a single parent household, especially when the other parent is abusive, totally emotionally absent, etc. But one would hope that both parents could take interest and invest in bringing up their children. We all make do with what we've got. No one is criticizing a single mother or father who works their butt off trying to support their children. It's the idea that single parenthood is wonderful and should be encouraged that scares many people. And the fact that it happens all too often for no good reason (again, especially in certain areas, especially where ignorance and poverty are rampant). Just my 2 cents on the matter... as always. Wendy CO EMT-B

There is a distinct difference between the PALS league and the HS arena. If your school district has the resources to contract with a private and ensure that an ambulance will not be taken out of service where it is needed, then that is fine. The little guys usually don't need much more than first aid, fortunately. If you're an inner city high school that can't afford textbooks, you certainly can't have that as an option, and it is foolish to try to force the local EMS (public, 3rd service, etc) to stage there for free because it is a "requirement" that your league has. Unless the school district has something worked out with EMS, it isn't going to happen. No one is saying that our children are less precious than professional athletes... it just simply isn't financially feasible and pretty much overkill to have an ambulance, BLS or not, at every sporting event they attend/participate in. Professional teams can afford to contract with private companies, ergo, it has become their standard. If you have a good athletic trainer or intelligent coach there to provide interim care while waiting on an ambulance (hopefully there in less than 30 minutes on a call of 'loss of feeling' subsequent to any kind of trauma... sounds like there are greater issues at hand with that one) you don't need an ambulance waiting on scene. As long as the trainer etc. knows how to hold C-spine, splint musculoskeletal injuries or do CPR and the refs can do crowd control... you see where I'm going with this? Look at it this way... you have a group of kids playing capture the flag in the local park. There's obstacles they might trip on, they're not wearing helmets, and being kids, they're going to climb trees. All dangerous and could potentially cause a C-spine situation like you mentioned. Should parents insist that ambulances be available in every park? Similar kind of thing here.... Wendy CO EMT-B

For this one I don't necessarily think there'll be huge crowds watching- just from the description given. Sounds like something that participants are more interested in... and no way family will be there for 18 hours. Even the cuckoo ones who are devoted support the family types will be out in smaller numbers. That's a good one I didn't think of... who is feeding participants? How likely is it that you'll get hypoglycemic issues? As for treating the crowd at events... tell me about it... having done first aid at the Bandimere Family Fun 4th of July weekend a couple of times (drag strip racetrack in CO) you definitely see many more injuries/problems from the crowds. Standby at youth sporting events is the dumbest thing I think I have ever heard of. If your coach or assistant coach or parent can't treat minor stuff and is uber-paranoid about the kids getting seriously injured, something is very wrong with the team/organization. I was the assistant coach for my brother's soccer team when he was 11, and did all our first aid stuff (and that was BEFORE I was an EMT...) It really isn't that hard. If you've got a major problem, you call 911 just like anyone else. Just some more ideas! Wendy CO EMT-B

ROFL! That's great. Imagine that conversation in the ER though.... "Ok, sir, how did you get injured again?" "I was robbing a house and Moses told me to watch out because Jesus was watching me and then Jesus bit me in the arse." "???" Wendy CO EMT-B