Lone Star

Ok, before I get crucified for being a 'heartless bastid', this needs to be said.... In my opinion, the 'take away lessons' here are: 1. ALWAYS be aware of your surroundings! Unfortunately, the officer in this case didn't have all the information available. This led to his 'tunnel vision', concentrating only on the victim on the ground. Since this was anhydrous ammonia, the victim was probably already deceased by the time the officer arrived on scene. Yes, we're trained to mitigate a whole host of 'bad situations' and the general public's opinion of what we do includes rushing blindly in to 'save the day'. As the video clearly shows, this course of action can have fatal results. While the officer attempted to 'save the victim', he was unaware when he rolled up that he'd only succeed in a 'body recovery'. 2. It's been said many times in many different ways that the rescuer is of no use to the victim if they have to be rescued themselves. As calm and collected as the officer appeared when he rolled up on scene, I'm surprized that he just ran into the vapor cloud without checking to see what it was, and how potentially dangerous this action would be. 3. In EMS, we're educated and trained to save lives, not sit idly by and watch people we're supposed to be helping die. Unfortunately, this video clearly shows that when you do not pay attention to your surroundings, and take the appropriate precautions; all we're going to end up doing is increasing the body count. 4. As Ugly pointed out (from the standpoint of someone who routinely works with hazardous substances), the firefighters did things as they were supposed to do. Bunker gear and SCBA were the appropriate safety gear for this situation. Since the airway was protected and the risk of exposed skin was minimized as much as possible, any exposed skin (neck, upper chest, ears, scalp,etc) could be decontaminated by hosing them down on scene with a full shower upon returning to the station. 5. Routinely, in EMS we are not equipped to rescue the victim. As much as this sucks 'the big one', we HAVE to wait on the sidelines until the appropriate personnel can get them out, or until the victim can come to us. Scene safety doesn't end just because we've walked off the scene. This could have been any number of substances that could have been carried back to the hospital, station,...home... There is a myriad of 'evil stuff' out there. We HAVE to pay attention and take the appropriate response actions, otherwise we're becoming part of the problem instead of part of the solution.

What is this 'multitask' that you speak of? ROFLMAO

INT- Intranasal Tube. I'm guessing that it's different than a NG tube? LS

I came across this the other day and decided I'd play. Sadly, I got most of them right.... How many can you properly credit? Who said it? I Family sitcoms: "Dy-no-mite!" "Aaay" "Stifle!" "Oh, my nose!" II Other sitcoms: "Baby, you're the greatest!" "I know nothing!" "How YOU doin'?" "No soup for you!" III News catchphrases: "And that's the way it is." "Good night, and good luck." "One small step for man ... " IV Cop show catchphrases: "Book 'em, Danno." "Just one more thing ..." "Let's be careful out there." "Who loves you, baby?" V Sci-fi catchphrases: "Resistance is futile." "The Truth is out there." "Beam me up, Scotty." "You've just crossed over into the Twilight Zone." VI Catchphrases from cartoons: "D'oh!" "Heh-heh." "Don't make me angry ..." VII Game show catchphrases: "Is that your final answer?" "Come on down!" "Once you buy a prize, it's yours to keep." VIII Sports catchphrases: "Do you believe in miracles?" "Let's get ready to rumble!" "Know your role, and shut your mouth!" IX Comedy catchphrases: "What you see is what you get!" "Mom always liked you best!" "Sock it to me!" "We are two wild and crazy guys!" X Variety show catchphrases: "Here it is, your moment of Zen." "Now cut that out!" "We've got a really big show!" XI Ad catchphrases: "It takes a licking ..." "I can't believe I ate the whole thing!" "I'm not a doctor, but I play one on TV." XII Reality show catchphrases: "The tribe has spoken." "You're fired!" "Smile, you're on 'Candid Camera'!" XIII Political catchphrases: "Oh, the vision thing." "They misunderestimated me." "I didn't inhale …" "I took the initiative in creating the Internet." XIV More political catchphrases: "Senator, you're no Jack Kennedy." "I'm not a crook." "There you go again." "Ask not what your country can do for you ..."

I seriously hope that this is nothing more than confusing 'upwind' and 'downwind' in your post... Never, never NEVER approach a suspected hazmat incident scene from the 'down side' (down wind, down hill, down stream')!!! This will only serve to bring the hazardous materials TO you. By your statement, approaching from the 'downwind side', you'll have to cross that scene to get to the safety of the 'upwind side'. By doing this, you've just contaminated your vehicle, your equipment and all personnel on board. As you stop a safe distance from the scene, you should use binoculars to locate the placards on the container, and either reference them in the DOT Emergency Response Guide (ERG) or call CHEMTREC and have them reference it for you. The information that they can provide will be things like reactivity to water, compounds formed by flame impingement, safe distances, eveacuation distances..... Once your minimum distances are set, you'll establish your 'hot zone', 'warm zone' and 'cold zone', begin to set up for decontamination and safety areas.

My apologies, Ruffles. I've got my head warped by 'finals week' and apparently misread your post. LS

If y'all had paid attention to the lead-in on the video, you'll notice that Fire and EMS were aprised of the situation being hazmat and that it was an anehydrous ammonia spill. This information was not given to the police. Being that it was in a rural area, he should have suspected that it MIGHT include farm machinery, or chemicals. Upon arrival, he should have seen the placard on the oveturned trailer and figured that it was a hazmat scene. Upon realizing that he may have a hazmat situation, he should have backed off the scene and used his binoculars to get the numbers off the placard. If he didn't have a DOT hazmat book in his vehicle (I think they're required by federal law for first responders, police, fire EMS), he could have had the information relayed to the dispatcher who would have been able to call Chemtrec (1-800-CHEMTREC) and had the numbers translated to english.

Ask and ye shall recieve... I reposted your initial post as well as my response to it, so it made sense.... LS

In response to a request that I move this here, here's the backstory and the response to it: I guess with the last name of 'Cum'mings, used in the context of the whole rumor should have been a 'tip off'.... Although, this isn't doing much to convince the women that we're not all that 'quick on the trigger'.... Even though this turned out to be a 'load', you just gotta shake your head at the 'spunk' of some people! I guess I'd better quit before I have to roll over and go to sleep.....

I guess with the last name of 'Cum'mings, used in the context of the whole rumor should have been a 'tip off'.... Although, this isn't doing much to convince the women that we're not all that 'quick on the trigger'.... Even though this turned out to be a 'load', you just gotta shake your head at the 'spunk' of some people! I guess I'd better quit before I have to roll over and go to sleep.....

I watched a program called "America Now" just a little while ago and saw something that caught my attention. It seems that in this age of electronics, online sharing and whatnot, taking pictures with your 'smart phone' may be revealing too much information about where you are. For those smart phones with cameras and are GPS enabled, every time you take a picture with your phone, that GPS information is recorded. When you post the pictures online, if someone knows what they're looking for, they can get the GPS information. Obviously, if you're taking pictures at home, your home address will be revealed through that metadata. The program listed a website that proves what I'm saying. That website is icanstalkyou.com There, you can find more information about this topic, how to 'fix it' and you can see what I'm talking about. Just thought y'all might like to know....... LS

Congratulations on being picked for the honor of this occasion. The WTC, and anything associated with it will always be an 'emotional event'; especially for those that are participating. Since you recognize what an honor it is to be included, I'm sure that you have the right frame of mind; and will do your best to help shed a positive light on not only EMS itself, but the members that make EMS work.

Congrats bo! You have just increased the group of minds I plan to pick apart when I get into medic class! To all my Medic friends: I hope y'all are prepared to have me make a royal pain of myself! We've all heard horror stories about the child who will ask a question, and then follow your answer with about a million responses of 'Why?', no matter what you say to them. I'm already planning on doing something similar.... Even with the comparatively inferior knowledge I now possess, I’ve got at least a half million questions that I’m working on being able to ask correctly……

Would you have any medical procedure done by someone not affiliated with the medical community? I know I wouldn't! Even though the person is on death row, doesn't mean that he's forfeited his right to have medical procedures performed by medical personnel. I doubt anyone would allow their car mechanic to replumb their house or rewire it. We would call in a person specifically licensed to perform that type of service. The same applies here. Whether or not you can teach your child to start an IV isn't the issue. You wouldn't let them start an IV on anyone, mainly because they're not licensed for that task. As far as the guards 'throwing the switch', I don't think it works that way. Usually (at least as far as I know), the state hires an Executioner to speciffically perform that task...

First off, stop listening to those that don't know what they're talking about! Second, it's your body, and you know whether this 'rice krispies feeling' is 'normal' or not. If it's not, then it only stands to reason that you should get it looked at. There is a big misconception that 'if it's broken, you wont be able to move it'. That's bull puckey! Crepitus is the sound of the two broken ends of a bone grating against each other. This is not a 'normal sound'. Alternating between ice, heat, nothing for periods of 15 minutes each should help with the inflamation. Be sure to place a barrier (like a small towel or washcloth) between the source of cold or heat and your skin. NSAIDs (like motrin, aleeve, ibuprofen) have been shown to inhibit fracture healing (this bit of information came from the orthopedic doc that treated my broken wrist). If you feel you've broken a bone, by all means rely on your education and training, then have it looked at. LS

Doctors say that Nordberg has a 50 - 50 chance of living, though there's only a 10 percent chance of that.

"I’m doing everything I can… and stop calling me Shirley!"

And people wonder why there is such an outcry for a standardized national scope of practice.......

It's been my experience that BLS is 'basic life support'. This includes O2, CPR, bleeding control, splinting and basic shock control. This does not include invasive procedures such as IV, BGL and doesn't include cardiac monitoring. ALS is Advanced Life Support, which includes the invasive procedures, cardiac monitoring, advanced airway management, and pharmacology. Just because ALS isn't initially dispatched to the call, doesn't mean that the patient isn't in need of ALS treatment. Therefore ALS can be dispatched after patient assessment. It's my understanding as an EMT-B, that certain patients couldn't be transported by a BLS crew. This included central line IV, PIC lines, IV's other than NS and INT, ETT, vent patients and patients that required a monitor to name a few. There was even some question about whether or not a BLS crew could transport a PEG tube. The rationale behind this ruling was that if something went wrong, it was out of the BLS scope of practice to be able to mitigate the situation.

When I had my motorcycle wreck last November, I tried to tell the ER staff that I thought my wrist was broken. They assured me that everything was 'just fine' even though there was heavy edema and obvious deformation of the wrist. I'm pretty sure I was being dismissed as not knowing what I was talking about, but when I returned to the same ER a few hours later, it was confirmed that the wrist was broken. There's this misguided notion that "if I can move it, it must not be broken". That isn't always the case. Just because the patient was up and walking around is not a guarantee that there were no spinal fractures, and once those 'unknown fractures' were revealed by x-ray; the only acceptable treatment at that point was to immobilize prior to transport. It's no different than the splinting of my wrist once it was acually confirmed that it was broken. In addition to Richard's story about the football player, there's also the undocumented anecdotal story of the MVC patient who is up and walking around the crash scene, when someone calls their name. The patient turns their head to see who is calling them and instantly becomes an instant quadriplegic. As Richard also stated, it's better to overtreat than undertreat.

Having been through the EMT-B twice (12 years apart) and in two different states, I can see where the entire EMS program needs to be revamped. My first course turned out to be 240 contact hours plus clinical rotations. While the second time through was about the same amount of time, the information passed along was far inferior. In my considered opinion, it IS all about patient care. The more education we get (as opposed to training), the better care we can provide to out patients. It shouldn't matter what title is on paper, it should matter though about a standardized national scope of practice, a shift of focus from the minimum hours required to a solid knowledge base in order to understand not only WHAT we do, but WHY we do it. If EMT-B is the 'basic building blocks of EMS education', then there should be more focus on Anatomy & Physiology, psychology, pharmacology, and cardiology at the basic level. This will give the EMT students a more solid footing as they progress through EMT-I and into Paramedic; rather than watch them crash and burn when things like acid/base, basic cardiology and pharmacology are introduced. There is far too much reliance on 'the book says' in EMS. We need to be able to separate ourselves from 'the book says' and be able to think in terms of what evidence we are presented with on scene. EMT-B is far too reliant on regurgitation of catch phrases and acronyms without actually understanding what they REALLY mean in the grand scheme of things. THIS is where things need to start changing. Before we can begin thinking of increasing our scopes of practice so that they overlap and there is a seamless integration of the levels of EMS, we need to concentrate on increasing our knowledge levels.

If the whole purpose behind this campaign isn't to be able to provide better patient care, then just what IS the purpose of the restructuring of NYS EMS? The whole purpose of EMS is to provide the BEST emergency care that we can until we can deliver the patient to more defiinative care than we can provide. Changing the names of the providers ISN'T the answer, better EDUCATION is! If I went solely by that line I quoted, it looks like nothing more than an attempt to look more impressive on paper, and thats all. Titles aren't what keeps our patients alive. It's the skills we develop through more and more education.

Ok, let's all take a step back and take in a few deep breaths.... This isn't a thread of whether or not capital punishment is justified, or whether it's right or wrong. In order to have a healthy discussion on this touchy topic, we need to be able to separate our personal feelings from the question at hand. We can all agree that there are some pretty evil bastards on death row. They have been convicted of some pretty heinous crimes. Again, this isn’t the issue at hand. We talk about ‘patient advocacy’, morals and ethics; but are we ALWAYS following them? We have taken an oath to preserve life wherever and whenever possible. Yes, capital punishment flies directly in the face of that. But in the situation where the outcome is inevitable, then certain moral and ethical guidelines must still be adhered to. Regardless of what the condemned has done, they still deserve to be treated as we would treat any other human being. We cannot let the alleged crime dictate what level of care they receive based on the crime they have allegedly committed. We are not the judge, jury or executioner. Even though they have been convicted of a crime and sentenced to death, then it could be argued that they STILL deserve to have medical protocols adhered to while initiating venous access. This IS a medical procedure, and the inmate DESERVES to have it performed by trained medical personnel, like it or not. The AMA and NAEMT and other organizations that have established the ethical guidelines we adhere to has taken a stand by saying that participation in the execution process violates the ethical guidelines they have established. How many are willing to withhold treatments on patients that have been driving drunk and just killed a family of four that were returning from Grandma’s house? Or just shot a cop? Or was accused of raping some woman? How many find satisfaction in slamming home an I/O, just because the patient appears to be drunk and violent? We talk about morals and ethics, yet we’re more than comfortable of making that ‘no good son of a bitch’ suffer for what they’ve done! This isn’t your decision to make. The condemned is still a human being and still deserves to be treated as such. Prolonging what may be a painful death for nothing more than your own sadistic glee is considered ‘cruel and unusual punishment’ and is prohibited by the United States constitution.

Ok, I've just got to chime in here.... I was taught (by an amazing instructor) many years ago that you place the B/P cuff about an inch above the antecubital region (the 'front part' of the elbow), and the palpate the brachial artery, and place the diaphragm of the stethescope over it, and lightly press on the stethescope. Begin to inflate the cuff until you cannot hear any 'thumps', and then increase the pressure 30 mm/hg. S-L-O-W-L-Y start to release the pressure in the cuff. As the pressure is being released, you will hear the pulse return, this will be your systolic pressure. As you continute to release the pressure, you'll end up 'losing' the pulse sounds. This will be your diastolic pressure. I will defend the use of the Sprague type stethescopes. I find them easier to hear with (especially in noisier situations). It is my personal choice. If you ARE using the Sprague type, remember the head of the stethescope will turn. I use the large diaphragm for lung sounds and blood pressures. Remember that there is a 'flat side' of the head fixture. This indicates which diaphragm is 'turned on'. This 'flat side' will be toward your patient. When using a stethescope that is 'single lumen', remember to keep your fat little thumb off the back of the head. I've noticed that those stethescopes are notorious for picking up YOUR pulse sounds from your thumb. Also remember that if you take a blood pressure in the left arm and aren't sure of what you heard, if you inflate that cuff again, you'll get a different reading than you initially had. I've seen people who inflate the B/P cuff to a minimum of 250 mm/hg or more rather than the correct way, and I want to auscultate a corotid B/P on them! It's not the proper way to do it, and causes the patient undue discomfort. As has been stated before, the earpieces should be comfortable and fit the ear canal, and the 'arms' on the stethescope shoud be angled slightly forward. This directs the sound into the ear canal, and you don't try to rush though the process because the ear pieces make your ears hurt. Practice is the key here. As you start practicing, do it in relatively quiet places, and then start to work with more noises (television, radio, other people talking; etc). This will help you hone the skill and be able to work in environments that are less than 'dead quiet'.