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I fully agree nothing takes the place of personal responsibility. The point I was making is that I think unhealthy eating is just as much of a public health concern as tobacco smoking is. Whether you agree with it or not, basically the current consensus is that marketing an unhealthy product to a vulnerable population is wrong. We legislated against tobacco advertisement for just that reason, alcohol too, and while I do NOT believe that there should be legislation against fast food marketing, I do think that McDonald's, PepsiCo, Burger King, et. al. should take into consideration the real, clear health effects their products are having. This isn't someone who ate one two many cheeseburgers and got fat. This is a real epidemic, and I think fast food advertising is a big part of that.

Really only one patient springs to mind who I could say honestly would have benefited from the use of a tourniquet. He was a male in his mid 20's who had gone through a 1/4 inch think pane of exterior glass, and not the tempered kind. His right arm had a circumferential laceration approximately halfway down the humerus which transected all of the structures down to the bone. He was in stage III hemmorhagic shock and we were on scene only about 10 minutes after the incident. There was absolutely no way to hold direct pressure on this wound, it would have been like trying to hold Jell-o into place. Unfortunately our system was in the "off again" portion of the "on again off again" battle over tourniquets and they were contraindicated. Lucky for him it was a very short transport time to the hospital. I do think he would have benefited from a tourniquet. The vast majority of cases of hemmorhagic shock cases I have seen have been due to internal injuries, and just about every other extremity injury I have encountered has done well in sealing itself off, even complete amputations. I'm not sure what it was about the glass injury that prevented the vasospasm that helps to control hemmorhage. This is also why I am skeptical of Quikclot devotees. Its not that I doubt its efficacy, its just the times I have had someone exsanguinating from a small, clean wound of a major vessel have been non-existent.

I point the problem of obesity squarely to the marketing done by fast-food companies. Ever notice how fast-food companies use urban vernacular in their advertisements? Well the rates of diabetes and other nutritional related diseases amongst those same populations are through the roof. McDonald's and Burger King and all the others can do all they want to make "healthier" options. But when one meal of theirs contains half of your caloric intake, and you try and get people to eat those meals three times a day, they will get fat. Really fat. I try to avoid fast food altogether. The only time I eat fast food is when I am absolutely starving and I have absolutely no other option. I would like to commission a study of which is over all worse; smoking cigarettes, or eating fast food regularly. I am actually starting to lean towards the former. But don't smoke. Cigarettes are still bad for you.

I think I don't have cojones big enough to suggest a discretionary order of SQ Epi to the tongue to online medical control. But its interesting to know that in high enough doses epinephrine will alleviate bradykinin mediated angioedema.

Also, in almost any SIDS/Pediatric arrest scenario, you should not be on scene long enough to have much meaningful conversation with anybody. Scoop, run, drive.

Thanks everyone. I'm doing better. I still have a few moments of regret for missing out on time with Rob, but I'm coping. Plus my wife bought me a new set of skis and politely informed me that if that doesn't do something to put me in a better mood she's going to mail me to Peru.

PCP, oleoresin capsicum spray is by definition an inflammatory agent. It works by causing localized inflammation. Imagine in people with hypersensitive airways this can cause problems with bronchoconstriction. On the other hand, I don't think a good amount of OC spray is actually inhaled directly into the lungs. But I wouldn't rule out increased secretions or laryngospasm to cause shortness of breath. In the long run, I would say that Ventolin is a good choice for anybody who has a history of COPD and is complaining of SOB. That's my best guess.

FNG, I'm glad you came back and hope you'll stick around. I think you need a word of caution about this site. This site is fairly unique in that it has a high level of standards for EMS. Its really a collection of prehospital professionals, and we like to try and keep it that way. Our friend and colleague who recently passed helped to set that high standard. You can Google a million and one EMS sites and find the same old pat on the back war stories that everyone has heard and everyone is sick of. They'll be the ones with the cool gear and the latest patches. This isn't that site and its why its the only EMS site I belong to. I even canceled my subscription to JEMS because I got tired of the nonsense on that site. I read back the responses to your post and I really didn't see any name calling. Yes the responses were a bit harsh, but this real life. Every single profession in the world treats its subject matter with the same degree. If you don't believe me, go try arguing a point about structural steel with a group of ironworkers. It won't go well. So you won't find anyone here who will tell you everything is okay when it isn't. But if you have a question, you'll get it answered. It may not be the answer you wanted, but I can tell you it will be right answer. So good luck and again I hope you'll stay.

Hey, I was with you on the two pens and a Sharpie. I like Listerine strips but I found they're so small they fall to the bottom of my pocket and then I look like an idiot trying to find them. A nice blister pack of Dentyne ice is my preferred breath freshener. Wrigley's Five is good too. Cinnaburst was good too but its hard to find. As you can see I chew a lot of gum.

It's 4 a.m. and I still can't sleep. I feel really bad inside, and given the stuff I've gone through, that is no easy feat. I feel bad because as any regular knows, I was out of communication for a while.... like over a year or so. The truth is I simply had a ton of stuff to deal with in my personal life and I had to push everything else to the side for a bit. I don't regret putting those things ahead of EMS, but I do regret so much not getting to talk to Rob again. After I started posting here I would wait everyday for him to jump in so I could say hi again. That's one of the really awful things of life, one day something happens and now there is something you can never do again. I used to tell myself that one of these days I was going to experience one of the express elevators up to the top of the World Trade Center too. Its true. Then one day, you can't do that. Now I'll never get to say how I really missed talking with him and tell him about all of the stuff I was doing, and how I actually did it and got it done. It really, really hurts. A lot.

You are a gay rights activist. Your tag line says so. A gay activist, to me, is someone who wants to break down stereotypes about people who are homosexual and have them accepted without prejudice. I am all for that. Your avatar is of a character called Big Gay Al (who incidentally has a Big Gay boat ride) who speaks with a stereotypical lisp and has effeminate mannerisms. I find those two points to be somewhat counterintuitive. And not counterintuitive as in ha-ha its ironic, I mean counterintuitive like shooting yourself in the foot and being partly responsible for the continuing prejudice and stereotypes against gay people in modern society.

I am still on the fence if you are for real, or say, crochitymedic or someone in disguise pulling a grade-A troll job. If its the latter case, on any other day in existence I'd find it kinda funny, but not today. If its the former, I'll advise you it is a really bad idea to irritate me today.

You know what the saddest thing in the world is for me right now? This is the first post I read today. My first thought was "Oh wow, Dustdevil is going to have a field day on this guy..." The second post I read was the one about his passing. I think its time for me to go log off and take a walk.

Wow. I wasn't expecting to read that today. This is really hard. Even though I never had a chance to meet him in person, I counted him as a true friend and colleague. After so many years in the field it takes a lot to make my heart sink, but this definitely is one of those things. Rest in Peace Rob, and my most heartfelt condolences to all of your immediate and extended family.

Fireman 1037, like I said before, my list is what I used for urban/suburban response. If your area's needs are different, then you probably need other things and maybe not some of the same stuff I suggested. The duty belt works because I like to have a normal belt on for a neat appearance, and as wolfmanHarris pointed out, its a lot more comfortable to slip on and off when its not needed. In addition with a little practice you can slip it off and around a pair of turnout gear, rain gear or other PPE when necessary. I personally went through a roll of adhesive tape almost every other week. I used it for everything from making a label on an IV bag to securing two lines together to holding a tube in place. If your service is nice enough to provide purpose built equipment for everything, then its probably redundant. I tried putting adhesive tape on my steth but I liked the 2 inch kind better and that was a little two big. Plus it doesn't look as sexy. But if you need a lot of adhesive tape like I did I found the cotter pin set up worked really well once you got over the similarities in appearance to a roll of toilet paper.

Things you did wrong: Operationally: Freelancing a response. Entering an unstable scene without proper back up, PPE, or radio communications. Rendering medical aid while not appropriately trained. So when it comes to the first chapters of EMT school, you failed, in order, Well-being of the paramedic, medical-legal issues, communications, and operations. You failed the most major point of failure points, scene safety. Entering an entrapment scene without fire/rescue on scene really should only be done if there is a life threatening condition. Secondly, he hit a telephone poll. Unless you have a scanner for the local power company too, you are now in the realm of not entering the scene even if there IS a life threatening condition. Powerlines with power are bad. Patient was alert and talking. Chest pain and SOB are indications of an unstable patient but I would not say to the level of risking entering a confined space as a lone rescuer. Now lets move on to the actual medical stuff. Medically: Holding C-spine when technique not appropriately assessed by state-certified examiners. C-spine is a delicate thing. Holding it wrong can mean really bad things. And for the nitro: Chest pain and SOB with a bent steering wheel are indications for a high index of suspicion of a significant chest injury. Without going into too much pathophysiology, an injury to the chest can produce a whole bunch of life threatening internal injuries, and just about the only thing that can make them worse is giving someone a vasodialator, which you did. Also you shouldn't really throw around nitroglycerin unless they're on oxygen. I wouldn't treat someone for angina after the mechanism described until I had a couple of sets of vitals, a 3 and 12 lead EKG, and an IV. If I could swear beyond a shadow of a doubt that the chest pain was ischemic rather than traumatic in nature, then I would consider administering nitro. After I consulted with on-line telemetry, that is. Otherwise, I would assume the patient has suffered a significant chest injury and do the rapid transport to an appropriate facility thing. I'm still not sure if this post is real or if this is someone on EMTCity's version of Punk'd or Candid Camera. Seriously. Is this a set-up?

Its not an allergic reaction. It's a medication reaction, and a fairly common one, not a weird nor esoteric reason. Benadryl isn't going to work. Epinephrine won't work either. I guess you could use them to rule out an allergic reaction, but I still get the willies about giving high dose epinephrine to 97 year olds. I like to have them hooked to a 12 lead monitoring capable EKG machine before doing so. I found an article relating to airway compromise from ACEi mediated angioedema, but all it really tells me is that it happens most often in African-American women. http://chestjournal.chestpubs.org/content/126/2/400.long I've had a couple of cases of ACEi related angioedema. I have seen severe edema of the face and lips, but have yet to have one where the airway was in significant danger of being compromised. My suggestion is that if the person is presenting with S/S of upper airway compromise and you have a significant transport time to perform conscious sedation or RSI and place an ETT or supraglottic airway. But from what I've read, none of our toys tools for treating angioedema in a histamine or inflammatory reaction such as epinephrine, albuterol, or diphenhydramine will have an effect on bradykinin induced angioedema.

Angioedema secondary to ACE inhibitor usage is different than angioedema secondary to an allergic reaction. In an allergic reaction, an antigen binding with a B lymphocyte stimulates the release of IgE, which in turn stimulates mast cells and basophils to release large quantities of histamine, which when bound to H1 receptors produces vasodilation and increased capillary permeability. Epinephrine's alpha effects can mediate this by causing vasoconstriction. In an ACE reaction, the bradykinin that the ACE inhibitor has prevented from being degraded accumulates and causes increased vascular permeability by acting on bradykinin receptors. Why does epinephrine's vasoconstrictory effects not work on bradykinin mediated angioedema? I don't know. Ask ERDoc. This is rapidly moving beyond my pay grade.

My suggestion for stuff to carry on your person 1 pair trauma shears 1 pen 1 back up pen 1 black Sharpie (Used for more things than you might imagine) 1 small notepad (pocket size) 1 pair sunglasses and a way to store them on your person 1 glove pouch with gloves 1 stethoscope 1 pen light 1 watch with second hand 1 pocket knife, preferably serrated, and easily opened 1 squirt bottle off hand sanitizer, pocket sized 1 duty belt that fits over normal belt and can easily be fastened/removed 1 pack breath mints or gum (to be used or offered discreetly to partner) 1 roll adhesive tape (if you can find the cotter pin assembly for a trailer hitch of the appropriate size, these work great to attach a roll of tape to your belt) 1 cheap cell phone that you won't cry about losing/having run over/getting some sort of body fluid on and has big stupid numbered keys to mash quickly. If you bring your iPhone don't come crying to me later. You might want to invest in a prepaid phone just for this purpose. 1 pair goggles and a way to store them on your person 1 radio (I mean bring your radio with you from the station. Don't go buy one.) 1 pair sturdy boots. I like the kind with a zipper on the side. 1 pocket sized protocol and/or field guide. If you keep looking at it then you might need to review a little more often. For in the truck: A water bottle. The bigger the better. Fill it only from trusted sources. Some snacks. Nothing smelly. Inclement weather and PPE should be provided. Jump packs and what is stored in them are generally in your outfit's SOPs. This list is what I've found useful in an urban/suburban environment. If you work in the great outdoors you might need things like bug spray, suntan lotion, bear mace, etc.

FlamingEMT, if I was ever to refer to a coworker who happened to be homosexual by your login or avatar, I would be brought up on EEO charges, and rightly so. The fact that you do, when you claim to be an activist for homosexuals, is very ironic to me.

Only somewhat.

Sorry, but EEO has come down pretty hard in the humor area. No jokes. Ever. Same thing with TV. Someone might take offense.

That's pretty well covered in PALS and PEPP texts, if I recall correctly. Go check them out and get back to me.

Do you think its at all ironic you're decrying homophobia with a blatantly stereotypical homosexual character as your avatar?

I see the old "don't treat pain because it interferes with the exam" line a couple of times and in modern practice it usually is met with some guffaws. Personally, when I have several titles after my name and I get to have an input into practice (it'll happen some day... stop laughing), I'm going to suggest modern prehospital care move towards inducing amnesia in multi-systems trauma rather than try to achieve anesthesia or analgesia. Having under gone two procedures where the only medication I was given was midazolam, I can tell you first hand that it is very effective for mediating painful situations. I realize it doesn't have an analgesic effect, but I ask you, would you rather remember being in not so much pain when being extricated with bilateral femur fractures, or just not remember the situation at all?