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I would pray to the gods of EMS that this was not some odd drug reaction that was going to have a synergistic effect with a benzo, and give the peds dose of diazepam for sedation, if necessary.

As a service to those of us who live here in the United States, allow me to explain what is going on here. Mr. Acosell is referring to a popular contest in the Great White North, also known as Canada, whereby at Tim Horton's Donut shops, rolling up the rim on the paper coffee cup can reveal prizes. At least, that's what they say. Tim Horton's is a large, popular doughnut chain named after a hockey player (surprise surprise) who played for the Toronto Maple Leafs, the New York Rangers, Pittsburgh Penguins, and Buffalo Sabres, then died in a car accident after drinking too much vodka. They also sell some decent chili, pretty good sandwiches, and doughnuts which have an insane amount of caramel in the middle which is physically impossible to eat without becoming irreversibly stuck to the steering wheel when you're done. 98% of traffic accidents in Canada are caused by people trying to unstick themselves from the steering wheel or roll up the rim. The other 2% are caused by being a hockey player and drinking too much vodka. The number of traffic accidents can thereby be expected to rise significantly in Canada after the New York Rangers win the Stanley Cup and Canadians are left with nothing more than Tim Horton's and vodka to drown their sorrows.

Guns don't kill people. That's a fact. Glock is no more responsible for this tragedy than the people who failed to see the warning signs for this person. That is also true. Its also an indisputable fact that a modern firearm makes it extremely easy for a single person to inflict a horrendous amount of damage in a very short period of time. This is why I have the stance on guns that I do. If law abiding citizens want to own guns, fine, so long as they are fully cognizant of the risks, and they take responsibility for their actions. However, I will always be a firm believer in the fact that owning a modern firearm is a privelege, not a fundamental right, and if we have to place restricitions like increased penalities on gun vendors for infractions, increased waiting periods for purchases, and increased scrutiny on the purchaser, than I say SO BE IT. My question to gun proponents is this. How far does the right to carry a firearm extend? Does it extend to high capacity magazines for pistols? If a person is only going to use a firearm for self defense, does one need a magazine that carries an excessive number off rounds? I don't think restricting civilian ownership of high capacity magazines will have a particular effect on crime or shootings or pervent tragedies like this. I do question, however, why people vehemently defend things like high capacity magazines and high powered semi automatic rifles in the name of self defense. To me, it seems like asking for trouble. Unless you regularly travel through, say, Mogadishu, the need for a handgun with 33 rounds in the clip or a semi auto with 7.62mm ammunition seems to elude my grasp.

Got you to notice the newspaper and watch CNN, respectively, didn't it? Why do they resort to such tactics? Because it works, and it gets people to read the paper and watch TV. Now stop complaining, watch the news, and pay attention to the commericals when the TV tells you to. I turned into the news on the radio when it first broke. I wanted to hear if it was an isolated incident or not and how many people were killed. After that, I haven't read any news articles or watched the news at all on it. What more do I need to know? Until the American public stops confusing entertainment with information, it will be round the clock bloodbath coverage with big flashing graphics and talking head 'experts'. You only have yourself to blame. By the way... I hear they found new Jon Benet Ramsey evidence.... Or maybe it was something about Scott Peterson...no, wait it was definitely something about the girl who disappeared in the Bahamas. Definitely. Or maybe it was OJ. I'm not sure now. Whatever it was it was an exclusive, shocking, provocative, piece of expert journalism.

I suggest that you might want to check into social services for some of your frequent fliers, especially in the case of children. For instance: You are dispatched for a 10y/o with difficulty breathing secondary to asthma. You have been to this residence many times before. You ask the mother if she had the prescription for her child's asthma filled from last time you brought them in. She stated she had not, because he was fine when he came home from the hospital, and she knew if he got bad she could just call you again. In this case, filing a report with your respective child protective agency is the appropriate thing to do. Not having a child's prescription filled if the means are available is a form of neglect. Another time to have them involved is in the case of the poor grandma who lives alone with a billion cats and is skinnier than a runway model. If someone does not have the means to take care of themselves, they should not be living on their own. EMS more than anyone else can see the "big picture" when it comes to these situations. The police, who may accompany you on the calls, may not be able to understand the living situation as well as you do. The ER staff will not be able to see the residence like we can.

10-6 for the voice. One of these days, one of you is gonna kick the door down and there is gonna be an angry, mean, hungry dog with teeth filed down to razor sharp points and reinforced with titanium on the other side of it. Then I'll say I told you so.

I'd like to say, and I mean this from the bottom of my heart... HA HA HA HA HA! YOU GUYS ARE MORONS! I'M GLAD YOU DIDN'T GET HIRED! AHAHAHAHAHAHAHAHAAAAAHAAAAAAA HA!

There are a bunch of people on this scenario who are going to be writing "I will not think zebras" on the blackboard 100 times if they don't knock it off. Venomous fauna??? Woodland creatures? Anybody ask if there is a strong odor of alcohol or how his pupils look? No gold stars for anyone. Maintain C-spine precautions, board and collar, BVM with OPA. If he tolerates an OPA, prep to intubate in the truck. Otherwise go with an NPA and BVM. Check pupils. Strip to look for other injuries, get vitals. EKG, why not? Is there a car with a person sized hole in the windshield anywhere in the vicinity? I say the odds are: 33% Drunk 33% Stoned 33% Smacked on the noggin 1% Cardiac/mystery plant/critter

Welcome to capitalism. Supply and demand. More baby boomers hitting the age of cardiac problems means more people required to have ACLS certification to care for them. However, the number of people who actually have the skill, education, and determination to pass an old school ACLS course remains the same. The solution? Dumb down the skill set. Rid, Medic, for guys like you and me, the thought of walking into a cardiac scenario half cocked is horrifying. The though of watching someone succumb because our skills and knowledge are not what they could have been is absolutely horrifying to us. But guess what? We're the exception, not the rule anymore. People don't want to go to ACLS class so they can come out and be confident of themselves and their skills, they want to go so they can get their card so they can work and make money.

Anyone know how many people were wounded?

Tniuqs, A couple of points I could give you to add to your letter. ---In my neck of the woods, currently a court battle is up to its last appeal on the uniform status of EMT's and paramedics. In short, the City Council of New York, and several lower courts have ruled, and been quite clear, that they consider EMT's and paramedics in line with police and firefighters given the nature of their work, and should be recognized as such, rather than being considered simple civil workers in line with teachers and janitors. I can PM you with the specifics, if I can find them, lol. ---The old adage is "Its not how these people died that we remember them, but how they lived." Your name isn't on a memorial because of the fact that you died in a fire or were shot on duty, its because you gave your life protecting and serving others. No, the rates of line of duty deaths is not the same as firefighters or police officers, and that's a good thing, but it does happen, and when it does, its because someone selflessly gave their lives trying to help their fellow man. That's my $.02. Let me know how your letter goes.

Every April Fool's Day a phony release written by unknown miscreants in FDNY EMS is put out. If you're not in the system, you may not get all of the references, but still its pretty darn funny. http://www.ecnalubma.com/images/flatline-2007.pdf

Look, EMS is never going to be a brotherhood. We're never going to be on par with the firemen, because they've been around longer than us, when they actually have to do their jobs (it happens now and again), its far more dramatic and exciting than ours, and they die more than us, and sympathy is a powerful thing. That's because we don't require a team to get the job done. We have individual competitiveness that's a hold over from medical practice, and we are trained to think for ourselves. That's why we have problems with the whole team thing. On the the other hand, EMS does its job well because it can be fractured, chewed up, spit out, and still pull off its job. After 9/11 hit, EMS was first to regroup, count heads, and get back to work, and somehow we got through it with out sleeping with anybody's widows or smacking each other with folding chairs or driving drunk. To get back to yoru original question, well, you've already answered it. The reason some FDNY EMT's and paramedics give the cold shoulder to others is because of the perception of them as being 2nd class citizens. When NYC EMS was around, there was a sense of pride, of individuality, of being part of something. Being a paramedic WAS a career in and unto itself, something to be proud of, to identify yourself with. Now, its just a job, and worse, what's very worse, a stopping off place on to being an exalted and worshipped fireman. Yes, when you are proud of working for EMS, it gets a little annoying when someone comes along, working for a company that likes to decimate all you hold dear in terms of morals and values for a buck, so they too can be a great big hero macho fireman person. As for me, my pride in the work I do comes first. Take my FD patch off and I'm still a paramedic. Take my paramedic patch off and I'm still an EMT. Take my EMT patch off and I still know CPR, and if you take away my CPR card, I'm still a darn good guy. That's why I don't get upset when the firemen get all mushy about their brothers and how I'm not one of them, or why I don't get upset when my sorry excuses for chiefs make more boneheaded decisions, because for every person with a white shirt and gold on their collar who has given me a hard time, I have someone with "MD" after their name who has given me a slap on the back and a hearty handshake. I generally don't give the vollies a hard time, because honestly, I don't care. People need to grow up and do their damn jobs, that goes fore EMS, police, and especially Fire. Get over yourself, do some good, get your paycheck and go home.

2nd rate citizens? Then how come everytime I hear someone acting like an f--ing moron on the radio, its a vollie? Would you like my Lieutenant to come down and give you his laundry list of vollie shenanigans? Not being 89, not having proper equipment on standbys, but what can the lieutenant do? Nothing. There is very little oversight of the voluntary system, and the lack of discipline and standards in it is an ongoing problem. Yes, you do get better pay with the vollies. Then again, you also have to kiss up to your supervisor, can be fired on a whim, and if you get injured, well, workman's comp is your friend. Me, I'll take LODI and sit at home making full salary recovering. But I guess if you're just in it for the money and don't really care about your future, you can roll the dice with the vollies and make some bling. Yes, FDNY EMS has its problems. But the vollies are like Russian Roulette. Depending on where you are you might get some first class medics and EMT's, or you might get someone who's sole purpose is to drag you back to their rinky dink ER in a desperate attempt to keep their hospital open. Giuliani really f---ed over NYC EMS by letting Zakheim and the rest of the scum into the system. In that vein, I'd like any of you buff/whacker types out there who get misty eyed over the "9/11 Mayor" to listen to me and listen to me good. If you at all value the system you work in, or if you value EMS as anything more than a means to bilk Medicare, you will NOT vote for Giuliani in the 2008 election. If you do, don't come crying to me when Transcare or AMR or whatever mega-transport-pick-em-pack-em-bill-em corporation pushes you out of your area.

Let me clarify here. Having grown up in the country and having some libertarian tendencies, I am not for out right banning gun ownership. Personally, I don't think gun ownership is a fundamental right, but a privelege that rationale, responsible individuals can enjoy. However, having a good knowledge of violent crime and I think a better understanding of human nature than most, I am against notions of using firearms as a means of day to day protection. You can mock my scenario all you want, but chance of someone acting out violently because of a medical or emotional disturbance is far more plausible than being, er, ummmm, the bad guy terrorist who is going on a rampage at Home Depot. This is my entire point. When we start enacting laws that allow lay people to make these decisions with firearms, I believe tragic circumstances will proliferate. Also, statistically speaking, you getting shot after pulling out your gun is a fairly common occurence. Carrying a firearm drastically INCREASES your chances of death or injury from firearms. That's why I get a little indignant when people start talking about "Make my day" laws and "double taps to the chest." Am I getting through to anyone here?

Everyone, look, quick! It's my point! It's right over there! Look quick! Oh, I guess you missed it. Anyway, to reiterate, anyone who says they are a volunteer EMT because they want to serve their community can also be out there picking up trash, which has a much greater affect on the community overall. Anyway, when someone shows up wearing a T-shirt that says "TOOLS OF THE TRADE" and has like a litter bag and one of them sticks with the nail on it, then we can start talking comparisons

Okay, so the general consensus here is he is swinging a knife, shoot him. Double tap to the chest. Completely justified. Boom. Dead. End of story. Now lets back up. Lets say you retreated. Walked out of the store with everyone else. Then the police came and subdued him with beanbags. Then they found out his blood sugar was 20. Oooops, that crazed man swinging a knife was really just a hypoglycemic who skipped a meal. In this case, retreating was the right thing to do. I didn't say he was advancing on you, I said he was yelling and swinging a knife. You were the one who advanced on him, and now you just killed a guy because he skipped a meal. This is exactly why I am against these whole right to stand your ground BS laws, because they leave people dead. Nice shot though, I'll tell his wife and kids how well you grouped the bullets. Double "tap" to the chest, oh, wow, that is so cool. Stop watching CSI Miami. Oh, and just one more thing. Lets say that during this disturbance, after you have your gun out, I come around the corner. Up until this point I had my headphones on so I was unaware of what was happening. All I know is everyone is screaming about something in Aisle 3. Now I'm also armed. I come around, and I see you, pointing a gun at I'm not sure who. Will I be justified after I put a few rounds through your vital organs? When you yourself are laying on the ground, bleeding to death, will you forgive me?

Actually, Dick of EMTCity should be Richard Nixon, hands down. Anyway, you what I was reading about the other day? In Germany, in some areas, local communities get together and get little roving bands together who go out and pick up garbage off the streets, to keep things tidy. So, next time a volunteer starts running his mouth about how its all about serving the community, ask them how come they don't do like the Germans do and have volunteer trash collection squads. I'm guessing it has something to do with lack or flashing lights and T-shirts. I mean, in America, despite the fact that picking up litter has tremendous benefit for the ecology, property values, and overall hygiene of a community, if you are on the side of the road picking up garbage, then usually you have a bright orange jumpsuit on. Any "Its all about the community" types out there want to jump in on this?

I've always been suspect of grown men who wear cowboy hats.

First of all, Mike, I'm not a gun prohibitionist. I'm just against gun proliferation. As I said before, I don't have a problem with individual gun ownership, its when we start talking about using it on your day to day person and self defense and right to stand your ground that I start having a problem with. Yes, I can think of many situations where a legally carried gun could have made a difference. Just look at 9/11. That doesn't mean I'm for the right of passengers to carry firearms aboard a plane, though. I guess I'd rather have 100 innocent, law abiding citizens on their way to work mugged than one innocent person shot to death. I base my opinion on my knowledge of not only firearms and the law, but also human nature. Now I have a scenario for anyone with a concealed weapon permit who routinely carries. Lets say you're at Home Depot. You have your gun on you. You hear a commotion in the next aisle, and see a man screaming and yelling, holding a knife and swinging it at others. Several people come very close to being cut. You live in a state with the whole you don't need to retreat thing. What do you do?

When I'm feeling up to it, I'll look up the violent crime rate in NYC, but with a 70% drop in the past 10 years, its a lot safer than a lot of places, and if you took the per capita crime rate, it would be a lot lower than most. When was the last time there was a school shooting in New York? Its been quite a while. Sure, knifings, they happen, beat downs, yep, but shootings, really honestly, that's more of a Colorado phenom. The thing is, which is my point, you'll have a much better chance of walking away from a knifing or a beat down than a shooting. A shooting, at least, you're gonna lose function of something before the day is over. You know, on a side note, the Justice Department is really starting to piss me off. I'm trying to download some stats and they want me to order their products. Hey, I pay my goddamn taxes, make with the figures already. Maybe they're too busy firing non-good-Bushies. Oh, snap... One interesting thing I found out though, did you know that NICS background checks for the purchase of firearms only apply to non-licensed gun owners? Yep. So, if you have a carry concealed license, you can buy all the guns you want, and not even have your background checked. Sure hope you haven't commited any crimes in between getting the license and buying the gun, because, who would know, eh? God Bless America! YEEEEEEEEEHAAAAAAHHHHH!!!! BANG! BANG! BANG!

Yeah, you know why its so hard to find a good basic? Because the very best are called paramedics, that's why. Anyway, lets not quibble over who can figure out how to put the NRB on quicker. I'm not going to quibble with your statistics. I would say that the 80% of workplace murders occuring by outsiders is probably about right, because if you think about it, a lot of convenience stores are workplaces, and a lot of them get held up and Achmed takes a few rounds to the chest. What exactly this has to do with people having guns in their cars is beyond me. Anyway, you really need to start with proper punctuation and spelling before moving on to beating your chest over what a good basic you are or how guns really save lives, and not get people killed.

The NRA, fighting hard to keep guys like this armed to the teeth. Thanks a lot, fellas!

What is the equivalent of OSHA in England? Probably something like Her Majesties Right Royal Earls of Well Work and Non-Hazards or something.

For the record, I'm going to have to agree with ambman that putting in your time in transport does have its benefits and rewards. It does give you a glimpse into the workings of the healthcare system, and if you use your time wisely, you can learn a lot about different illnessess and medications. Sure, doing the dialysis shuffle doesn't exactly prepare you for running a code, but getting your bum to work everyday, even when your job sucks, does prepare you for being a professional. I guess I'd rather have someone who has been doing transports for a few a years with a clean employment record and a good aptitude rather than the guy with the lightbar on Chevy Nova and the star of life tattoo. At least I know the first one isn't gonna crap out on us when the boredom hits.