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The reason I wouldn't take the money is because its wrong. End of story. Done. Its not my money so I shouldn't take it. This is plain, simple, non-religious old fashioned values that have served me well throughout my life. Its simple and it works. Don't do things that are wrong. Taking money that isn't yours is wrong. I am amused by some of the justifications of those who admit they would, trying to make it seem like what they were doing is somehow different than shoplifting or stealing from the church collection plate. There is no difference. It doesn't belong to you. However, I'll at least commend you on your honesty, most of the people who sat they wouldn't are full of crap. Most people don't really care about right and wrong, so long as they don't get caught and/or embarrassed and they can justify it so they don't feel bad. Its sad, but its true. We can sit here and debate back and forth what we would do, but given the situation, when no one was looking, or worse, when say it was your group of close knit friends who took the money and then handed you your "cut", most people, including many of the ones posting would take it and not think twice about it. If your really want to learn about the dim side of human nature and ethics of the common person, read about the Milligram experiment sometime. Basically, after WWII a scientist wanted to learn about the effect of authority on people, and so he set up a device whereby a person believed they were delivering progressively increasing, and possibly lethal, electric shocks to a "subject". Only a select few did not deliver the last and what they believed would be almost certainly fatal shock to the "subject" (actually an actor), despite the "subject's" screams of pain, reporting of a medical condition, complaining about pain in the chest, etc. Ethics are what you do when no one is looking, and unfortunately, human nature is not as rosy as you might think.

Sex is always against the rules. Thats why it so fun. Sex, sex, sex, sex, sex, sex, its free, its fun, have sex today. Responsibly.

Its funny you mention the ALS/BLS debate towards cardiac arrests, because my partner and I were discussing it as well, and our latest CME journal article from one of our nice medical control physicians mentioned the debate. I will definitely agree that a major part of this rescusitation was the early CPR. The early AED on the other hand, thats a little more complicated. As I mentioned before, the first rhythm I saw on the monitor was a fine v-fib, looking very much like the type that likes to jump to asystole when defibrillated. So, either the first AED shock didn't work, or he did return to a sinus rhythm but slipped back into v-fib prior to our arrival. Whether it helped or not can't really be known. Interestingly enough, in our last CME lecture, our medical director had a great presentation on AED use. He showed a study over 10 years or so done in Seattle showed that after equipping all of their ambulances with defibrillators, the number of succesful rescusitations actually decreased. Why was this? Because people were coming upon cardiac arrest victims, throwing on the AED, and not doing CPR. If they really are serious about going the "BLS only" route towards cardiac arrests (shudder), then they had better be making some major changes in the BLS curriculum and standards for certification. In my opinion, they should require as a condition of certification a physical test where you are required to perform CPR at an adequate rate and depth for 2 minutes, followed by a break for 2 minutes, on and off for 10-20 minutes. If you are unable to perform, you cannot be certified. I think this would cause about 50% or so of currently certified EMTs to lose their certification, especially the 75 pound five foot two girls who I could fit in one of the tech bags, or the 300 pound Denny's manager/EMT who sweats when he takes a blood pressure. In addition, a fully working code scenario involving CPR in transit should be required as a condition of certification, which each candidate having to give the required orders and instructions to participating observers/proctors ending with the patient being in the ambulance and transport initiated. BLS may be the greatest factor in an arrest, I won't argue that point. But that doesn't mean that an ALS provider is not preferable to run a code. You haven't worked EMS until you've had five firefighters, two copsl and two EMTs turn to you and say "What should we do?"

As the old song says, it is indeed Christmas time in the city. Right now in my area people from all over the country are wandering around in a semi daze looking at lights and getting drunk. Needless to say, lately, I have been very busy. Upon finishing a transport of a guy who needed 5 mgs of a kick in the ass to the ER, we are dispatched for cardiac arrest in Port Authority Bus station, confirmed by responding Port Authority Police Officers (Port Authority of NY/NJ, Nicholas Cage in that film about 9/11, in case you're wondering). My partner does a great job of installing the fear of God into the motorists between us and the Port Authority, and arrive to find a 68 year old male pale, pulseless, apneic, pupils fixed and dialated, having CPR performed assisted by BVM by responding officers. Officers state man collapsed after getting off bus with wife, AED was applied, delivered shock once, no ROSC. I thought to myself that usually Christmas is depressing, but this is going to take the cake. However, at least we'll get to try out the new CPR guidelines and our new cardiac arrest protocols. I had my partner take over compressions while the officer continued to ventilate with BVM. Applied EKG pads, and briefly interrupted compressions to evaluate the rhythm, and found it to be a very fine ventricular fibrillation. My partner resumed compressions as the monitor charged, and I defibrillated at 360 joules, which patient converted into and idioventricular rhythm, and my partner immediately resumed compressions. I prepared the IV and asked the wife about his medical history which was quite extensive, including coronary artery surgery and an episode of cardiac arrest in the hospital about 3 years prior. BLS back up arrives, they take over compressions as my partner goes to intubate and I obtain IV access. As my partner attempts intubation, patient gags on the blade. I now have visions of vegetative family members on respirators during Christmas dancing through my head. Again, we briefly stop compressions to evaluate rhythm, and it appears to be a ventricular tachycardia, however, strong radial pulses are felt and patient is noted to be breathing spontaeneously. I have one of the EMTs take a blood pressure taken which holy Jesus, Mary, and Joseph is 120/P. I administer a bolus of Amiodarone 300mg in 20 cc D5W, and the patient converts to sinus rhythm with severe ST elevations and wide QRS complexes. Respriatory is rate 28, adequate, lungs clear bilaterally, saturation 92% and climbing. Instructed BLS to prep to transport, contacted telemetry, recieved orders for 1 amp sodium bicarbonate followed by one amp D50, followed by an additional ampule sodium bicarbonate en route. On way out of Port Authority, patient responds to verbal stimuli. Upon arrival at hospital, patient is able to weakly give first name. Patient is then started on amiodarone drip and nitroglycerin drip, found to be having a massive MI (well, duh), and transferred to MICU prior to going to cath lab. Took a field trip to the MICU today, visited with the patient, who was awake, alert, with no major tubes sticking out of him resting comfortably in the ICU and his only major complaint was the quality of the food at the hospital. He is scheduled for for the cath lab on Monday. In other words, he's fine. I shook his hand and told him that given the odds of just happening to go into cardiac arrest after being on a long bus ride through the middle of no where in a facility with EMT trained police officers and an ALS ambulance less than 1 minute away, he should consider playing the lottery. I many times cynically differentiate between the terms "dead" and "in cardiac arrest". This guy, initially, I really would have categorized as "dead". I guess the AHA might actually know something.

I'm with Rid. Sure, they may still be morons, but at least they are morons who are trying.

NREMT, to answer your question about the child, unfortunately, if you had gotten there a few minutes earlier, the only thing you could have done was perhaps watch the child draw his last breaths. If the child had landed on the operating table of a Level I trauma center with a trauma team ready to work, the outcome probably would not have been different, and if the child had survived, he would probably be on a ventilator the rest of his life.

NREMT, to answer your question, I have a good amount of tactical training but its not in the way you might think. My training includes pretty much recognition of dangers and eventualities that could be encountered on the scene and how to best mitigate the situation with minimum casualties. In other words, I am trained to place safety of the operators at the highest priority as a part of my responsibility as a medical officer on scene. I haven't done live fire exercises, but I have done many drills involving tactical elements. As I said before this usually involves recognition of the danger (armed perpetrator, violent EDP, hazardous chemicals, explosive device, etc) and mitigation, which to be honest, usually involves evacuating the area as soon as possible. I'm not saying there is not a place for EMS in a tactical situation, or that there is no need for specialized training, I'm saying most tactical training involves doing things that if you tried them in real life would make you very dead and has a very poor understanding of the requirements to provide good quality ALS care. If you want to utilize a paramedic, put him where he will be useful. Instead of sending the paramedic in through the hail of gunfire, have him sit back in the ambulance with his meds stocked, airway kit and suction and fluids ready to go, perhaps with a video and voice link up to the first responder trained SWAT officers and a direct line to telemetry at the nearest trauma center. If someone goes down during the operation, the paramedic will be able to use his skills and really be able to do some good.

Ahhhh, Christmas in the trailer park. Eh, what's childhood without a little psychological trauma? I hope the kid grows up to be a crossdressing necrophiliac because of the experience.

NREMT, what I'm saying is that when we have the riot shields and shotguns and sniper rifles out, a paramedics training is not really much of a help. The evidence of 12 leads on people suffering from gunshot wounds is dubious at best. In a hot zone, with bullets flying and bad people doing bad things, any life saving treatment that could be provided by an ALS provider would be tantamount to suicide if they actually attempted it. First of all, as all you charming EMT superheroes like to remind me, there is very little paramedics can do for trauma, really only airway maintenance, fluid therapy, some medications, and chest decompression. Making a mad dash, running in, grabbing the wounded guy, and dragging him to safety would be far smarter than trying to do any of that in a hot zone. You really expect to perform RSI with people shooting at you? Maybe you can ask them to stop shooting while you calculate the Lidocaine dosage? Sure, I'd like to give the wounded officer some pain medication, so why don't we get someone big and strong and fast to run in, grab him, and drag him someplace safe so I can do a proper assessment and treat him? Heck, I could even make an arguement that doing BLS care while being shot at is kinda silly. Splinting is really not a high priority in the midst of automatic gunfire. The active bleed that can be controlled with direct pressure and means the difference between life and death by holding that pressure is really kind of a myth, I mean, its really pretty hard to bleed out from an extremity injury and anything that is internal you can't control anyway, so, yeaaaah.

Wait, wait, wait, I just thought of a really funny response to this topic. *AHEM* "No, I can't, and that's why I'm having a sit down with my medical director next monday." BAH DUMB BUMP CHNNNG! Thank you, thank you, I'll be here all night, be sure to tip your waiter.

NREMT, the one scenario you provided, I'll answer with a yes and no. I understand what you're getting at, but in practical purposes, its not that easy. You provided the example from M*A*S*H where someone gave a paralytic when they meant to give Morphine Sulfate. Medication errors are a real danger in medicine. Of course you have a duty not only as an EMT but as a decent human being that if your really in your heart believe that a serious error is about to be made, to speak up. Lets look at a scenario where a paramedic has drawn up the wrong medication and is about to give it, and giving it will have a serious detriment to the patients well being. The worst thing of course is for the patient to get the wrong drug. However, the best solution is not the EMT making mention of it, the best solution is for the paramedic's partner, who is also a paramedic to do so, which is why I'm a big fan of the two medic trucks. Actually, the best solution is for the medication error to not be made at all, but that's beside the point. To treat people in the field well, you really have to be able to achieve and maintain confidence in not only your patient but the family and whoever else cares about them. You can only treat people if they let you, so you have to get them to let you, and to get them to let you, they have to be confident that what you are doing is necessary and that you are a capable person. People do not like getting stuck with needles, they do not like having people come into their house and tell them they are sick, especially when they are scared. If someone starts questioning the abilities of the person who is treating someone, that confidence is lost, and really there is no getting it back. In fact, losing that confidence can in some ways be worse than giving the wrong medication. If you don't believe me, you need to be up at 2 a.m. with an 80 year old person full of rales with her arms folded saying "YOU'RE NOT TOUCHING ME!" This real need for confidence is probably why paramedics get such a bad rap about being uptight and egocentric. I don't get on my high horse about roles in EMS because I need to think of myself as a life saving god, but I do need my patient to think somewhere along those lines if I am going to get my job done. Secondly, NREMT, you are obviously a dedicated, intelligent, rationale human being. That being said, you're unfortunately the exception when it comes to EMTs rather than the rule. For everytime you might be on the ball and politely mention the fact that I picked up the syringe full of etomidate rather than the one full of saline, there will be 8,000 times that some poor medic has to try and save face because Skippy the 16 year old EMT decided he was going to be in charge that day. So when I say no, EMT's should really not question medics on scene, I'm not saying You, NREMT-B (I mean you the poster personally, not the title in general) should not pose a concern to me if we working together, I'm saying as a general rule, it fits. Lastly, NREMT, I think really something you need to learn is how to let go. Its a really hard lesson and one it took me a long time to learn. Lets say you think the paramedic is about to give the wrong drug but you're not sure and you don't say anything, and he gives it, and the patient dies. Who's fault was it that the patient died? Its the paramedics fault, and his medical directors fault, and its the fault of his instructors and the state board for certifying him. Your responsibility is to do your job and do it to the best of your abilities, no more, no less. Its commendable that you want to go the extra mile and that you care about the patients who are under your care, but don't go overboard or I'm telling you, it will eat you inside and either burn you out or kill you, which ever comes first. I'm saying this because at my level I accept that fact and my responsibilities are far greater than yours. If I pull off a save and I get the patient to the hospital who promptly screws up and kills him, thats not my fault. I do not blame myself because I brought them to the wrong hospital. I had a responsibility to that patient and I fulfilled that responsibility. I once had a patient go from being conscious and talking to me to going into cardiogenic shock and die because my Lifepak decided it just wasn't going to pace anybody that day. I felt bad that he died. I was frustrated. But I didn't blame myself for his death, I am not a Lifepak technician, if I check all the connections and replace the pads several times and it still won't recognize there is a human attached to the other end of it, that's Medtronic's or the people down at the Medical Equipment Unit's or maybe God in heaven above's fault, not mine. By the same token, you have to let go a little. Take the weight of the world off your shoulders. Do your job, do it well, have a little fun and go home at the end of the day. No one can ask you for anything more.

Eydawn: Ouch! A box of condoms, a disposable enema, two pairs of nylon stockings, three tubes of K-Y, a minature vacuum cleaner, a pair of dishwashing gloves, a 25 ft length of nylon twine, and a copy of the farm report. How you like them apples?

You know, in third grade, as a writing exercise I really did write that what I wanted for Christmas was people to stop being mean to each other. Scouts honor I did. My teacher noted that I misspelled "people" "pepole" but other than that was very impressed, and my parents didn't smoke pot while they were pregnant with me. They dropped a little acid but that was it.

The head instructor took us out to lunch and drinks on him with all of our instructors and preceptors during the year. It was a lot more meaningful than any ceremony I've been too.

OKAY OKAY OKAY HANG ON TIME OUT HERE First of all, to put it bluntly, who the f--- is tactical medic Sean McKay of Clearwater Fire and Rescue to go lecturing us about the effects of motor skills vs. heart rate? I mean, shouldn't his name end with "Ph.D. in neurobiology" and be speaking about his double blind study done at the University of Costsmorethanimake? Thats f--ing BS. First of all, nearing 145 is getting into the SVT range. Anyone who is in reasonable shape and not a wussy should have a fine time keeping their heart below that level. Anyone who is above 175 bpm should be hooking themselves up to the EKG and starting an IV on themself. Why exactly the medics are crouching low behind the police shields to rescue the downed officer is beyond me. I'm not sure what they are planning on doing to him that an ordinary officer with a basic understanding of first aid couldn't do unless he has suffered a MI while in the midst of the melee. Can we just stop with the warrior medic, stuff, please? Its just silly.

NREMT, you seem to have a couple of unresolved emotional issues here. The medic you describe is a dick. He is a shallow, insecure little man who is pissed off about something in his life. Your friend worked for a place that tolerated such behavior. It is unfortunate. There are bad people all over this world, and unfortunately EMS tends to draw in people with serious psychological issues, and unfortunately has less than adequate supervisory personnel to appropriately deal with with them. I'm not sure why she put up with such abuse, or why you didn't step in to help your friend, but screaming at someone or telling them about the stuff in "your" ambulance has nothing to do with the job, its all about personality. All it takes is one phone call to bring behavior like this out in the open. The behavior of the person you mention and the behavior of the people on this board in regard to basics are two seperate issues. Sure, we get into little verbal sparring matches here and there, but usually if someone is getting reemed out, its because they said something really stupid. I may joke around about my job, but in all reality, the consequences of making a mistake, especially at the ALS level, are dire. I may be grandstanding here, but too much is at stake to not tell someone they are being dumb when they are. The simple fact of the matter is that the EMT-B class does not give you enough information to come to the table prepared for a debate in patient care decisions, unless it is something flagarant. It has nothing to do with your intelligence, or how dedicated you are, or how well you did in EMT class, it has to do with the application of learned knowledge, and unfortunately, due to many factors, some people take the EMT course and do not recognize exactly how unprepared they are to treat critically ill and injured patients. Doctors go to school for 10 plus years to learn to treat people, you have 120 hours of training, yet there are those who believe that they are qualified to expertly diagnose and treat illness and injury. These are the people who get the brunt of the verbal tirades on this site. I've seen many, many accusations of arrogance towards paramedics, but how arrogant is it to say "No, no, no, those guys don't know what to do, I know what do!" When you say that, you are saying your knowledge and experience supersedes all of the doctors, nurses, paramedics, and state boards that regulate a paramedic, all of them were wrong, and you are right. How arrogant is that? I don't care how many years you've spent in the field, I don't care how many books you've read or videos you've watched, if you haven't been through the lessons, classes, and testing that all the rest of us poor shlups have, you are not qualified to supersede your role. I guess what I'm getting at is of course its okay to ask me questions, I love it when people ask me questions. One real joy on my job is that given where I work, I get to chat with people who work in EMS from all parts of the country. I like answering their questions. I always have one or two brand spanking new EMTs around the station who like to ask me things. I like talking to them too. One thing that they even mention is as a paramedic, you will be expected to teach others. Its something I look forward too. On the flip side, it is not okay to question me about patient care decisions, particularly while on a job. Now, of course, there are exceptions to this, every rule has an exception, but it is the general rule. I'm glad your self educated, education is always good thing, but it doesn't take the place of a formal, professional education. If you are only self educated, how can you know for sure you didn't misinterpret something? How do you know you didn't read something that was out of date, or just plain wrong? The purpose of a formal education with all those tests and quizzes is to do just that, to make sure you read and understood the correct information and can apply it appropriately. To answer your question, whether an EMT can treat according to his own knowledge or whether he should follow the paramedic, the answer is he should follow the paramedic. A person relinquishes their control once a higher medical authority is on scene. Once I bring a patient into the ER, I hand over control to the doctor. I don't keep treating them. My duty is done. When I come upon a critical patient, I take in about a billion bits of information, try and make sense of it, and come up with a plan on patient care. The best thing for this patient is for everyone to just follow the plan, do their job, and get the patient treated and transported. If you have a suggestion, that's fine if its about having a better way to get the patient out the door or a better route to the hospital or something I can do to make what you're doing eaiser, fine, good, but if its because you think the medication I'm using is not the right one because of something you read in a book somewhere, it is really not the right thing to do. While we could come up with cases where it would be, in all practical purposes, it just isn't.

Some states have regulations against "impersonating an EMT". I'm not sure which is worse, someone wearing an EMT patch who isn't certified, or a police officer really having nothing better to do than bust someone who isn't certified who is wearing an EMT patch. Anyway, to prevent such an unfortunate (and lame) circumstances, if you collect patches, display them on your wall or something like that. Don't wear them. Problem solved.

Benign Prostatic Hypertrophy

If I were the supervisor, I'd tell them I though it was pretty funny, and then show them an example or my sense of humor. "You're fired! Ha ha ha ha! Get it?"

You know, its funny, I suppose because we are so saturated with units it doesn't matter, but are ambulances our routinely "flagged" for jobs while enroute to their assignments. Its pretty much standing orders that you must stop and see what the problem is if someone flags you down enroute.

I grew up in a very rural setting. I live and work now in a very urban setting. A person who has work experience in an urban setting perhaps will have to make some adjustmants working in a rural setting, but believe me, give me someone from rural america and send them up into the projects to treat a woman who speaks Pashtun who is having an MI, that'll take a lot of getting used to. Secondly JP, I'm not sure exactly what treatment tricks are up your sleeve for someone suffering from exposure to anhydrous ammonia is, but I'm guessing its along the lines of High flow 02 and transport. Am I close? You guys really need to get over yourselves already. Oh, and BTW, how do you treat a gunshot wound? You say "Boy, that sucks," then you put a bandage on it and drive real fast to the hospital. Oh and put them on a backboard too, and some oxygen for giggles. Lastly, Intermediate is pretty much a speed bump for those seriously considering a career in EMS. Just go to medic school ASAP and be done with it already.

For once, and I think I'm marking this on my calendar, I actually agree with whit. The other thing you have to realize, AnatomyChick, is that just because you are in close proximity to the hospital in an urban environment doesn't necessarily mean you will be grabbing your patient and running. While environments in rural and suburban settings are typically wider and rarely above 3 stories, In an urban environment just getting someone out of their apartment may take as long as traveling a great distance in a rural setting. The other night I had a cardiac arrest victim who lived about a mile away from the hospital. It took us approximately an hour and forty minutes from the time we arrived until we were at the ED. This was because among other things, she lived on the fifth floor of an apartment building with no elevator and very narrow staircases. Close proximity does not necessarily equal short transport.

Yes. Reading from the wrong book and then taking the EMT-B exam will cause spontaeneous decaptitation. Play it safe, don't read at all.

Would you mind elaborating on which BLS skills you are referring to? BLS is typically done rapidly without regard to wait time for transport.

Recall witness Write appropriate reports Look into labels for boxes to prevent further occurences. Big pink stickers stating "THIS IS NOT MORPHINE, DUMMY" perhaps would be appropriate.