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Get used to being judged. Its the only constant in this field. It sounds like you are a very dedicated student, and thats a good thing, but don't go the "I'm the bestest hardest working student out there EVER" route. Its makes you sound really arrogant and it pisses off the others who have studied just as hard or harder than you in their careers, myself amongst them. I'm glad you pulled off a save. It a very rare event to have someone go into cardiac arrest, respond to treatment, have ROSC, and then be discharged with little or no deficit from the hospital. My only question is what the crew that you were working with was doing while you pulled off the save. Did they go out for coffee and let you run the show? Just curious. Relax. Take yourself down a notch. If you fail your boards you have to take them again. There are worse things in life. Calls will be dispatched, ambulances will run and life will go on no matter what you do. Do your best and reevaluate your role in the world.

GOVERNMENT MANDATED DISCLAIMER: This is for humor purposes only. Employee drug use is a serious problem and needs to be addressed. TEN SIGNS YOUR PARTNER HAS A DRUG PROBLEM 10. He thinks the flashing lights are, like, AWESOME. 9. His presumptive diagnosis is repeatedly "Whoa" 8. He tells you to slow down and you haven't put the ambulance in drive yet. 7. His medical control requests often include Cheetos and Ho-Hos. 6. The siren has been replaced with speakers belting out bass heavy reggae. 5. Instead of filling out the PCR he simply traces the outline of his hand on the paper. 4. The patient interview often degenerates into debates about whether stars have souls or not. 3. After examining the patient's pain meds, you hear him scoff "lightweight". 2. His last random drug test sample was found to actually be melted 7-11 Slurpee. 1. He never complains and thinks he's overpaid.

I don't even want to hear it. Unless one of you has had the experience of literally getting out of the ambulance with the sirens blaring, walking up to the yuppie scum in front of you yakking on their cell phone and literally telling them to move out of the way, no one has traffic problems even close to mine.

CIVILIAN FRIENDS: Call your parents Mr. and Mrs EMS FRIENDS: Call your parents drunk as hell and tell them about the fat chick you tried to pick up True story: At a going away gathering for one of my former coworkers, in the middle of the festivities, my cell phone rings and I unwisely answer without checking the caller ID. Its my dear sainted mother on the other end. So, I try to make nice semi-coherent small talk with her and extricate myself from the debauchery that is occuring. Unfortunately for me, the rest of the party realizes who is on the other end. This prompts the female dispatcher to come up behind me, and in a pitch perfect breathy seductive voice go "Come on honey, come back to bed already..." right next to the mouthpiece of the phone. I think I just said something to the effect of "Ummm... I gotta go...", which of course didn't make the situation any better, and I had a lot of explaining to do. Friends can be such a mixed blessing.

Rid, you know far that it is far from me to suggest not knowing all you can about every facet of the human condition. I would say that basic human psychology should be a required course for all EMS providers, but really the only thing my introductory psychology couse ever taught me was that there are courses in college where you can not show up for half the semester and still pull a B plus. Mental illness of course is really hard to define. What may be mentally ill in one culture can be just fine in another. Defining what constitutes mental illness and what place society has in the treatment of the individual is a question that touches on ethics, sociology, politics, neurology, and philosophy, the debate of which would start a thread that could last for years. Yes, EMS providers should be able to identify signs and symptoms of mental illness, and should know the laws regarding involuntary treatment in there area, as well as knowing how to deal with mentally disturbed individuals. My point is that a little knowledge is a dangerous thing. Recognition and mitigation is one thing, but treating mental illness is a very serious business that can only be handled by highly trained professionals, and even they have only moderate success.

Psychiatric calls aren't that tough if you keep a few things in mind. 1. Crazy does not equal stupid. Many times, its just the opposite. Talking to someone who is mentally disturbed like they are five years old or condescending to them will generally piss them off. 2. Don't let your emotions get involved. If you have a family member with mental illness, this is particularly difficult. Remember, you are going to do what is best for this patient and what is required of you, not what would have been right for your loved one in a similar situation. 3. Mental illness is just that, an illness, and the person who is afflicted needs serious professional attention. Trying to play Dr. Phil in the back of the bus will get you no where and probably make the situation worse. Empathy is a good thing and a requirement of this job, but keep it in check. By the same token, trying to go all State Trooper/drill sergeant on them isn't going to help either. 4. Scene safety, at all times, of course. Have the appropriate resources necessary, and if you don't, don't transport. 5. The big questions are "Have you had any thoughts of hurting yourself or others," and the standard ones to gauge orientation. Besides a med list and a brief history, you really don't need much else.

Had CME on the new improved CPR last night, new protocols are out governing cardiac arrest procedures and will be implemented January 2001. I was designing some gameplans tonight for running codes with the new protocols in effect. It will be interesting to see how they work.

Sign of obvious death #336: You are able to visualize the vocal cords...from down the hall.

Heh, that reminds me of the time we brought a refractory SVT patient into the ER. The pretty yet very inexperienced resident decided that he needed cardioversion. Praise Jesus she was thinking aloud while setting up the defibrillator, as when she said the words "Okay, so lets charge to 200 joules" the entire room which included 5 nurses, two PA's, 2 paramedics and 2 paramedic students all said in unison "NO!!!" , as if on cue. Eh, guess you had to be there.

I say yes, with a qualifier. My usual explaination to patients as to "why they need to go to the hospital" is that the hospital can provide definitive tests and diagnosis, while we can only do so much with the equipment in the field. Maybe someday I'll get to test for troponins, but until that day comes, I can only look at an EKG and make certain assumptions and form an educated opinion. This is why I make a "presumptive diagnosis" in the field, while the guy with the MD after his name and a nice bright ER with nurses helping him out and a laboratory at his disposal makes a definitive diagnosis. In other words, yes, I do make a diagnosis, but its not the same as a physician's diagnosis. That being said, the only reason you should be treating a patient is because you formed a diagnosis. BTW the word 'diagnosis' comes from the Greek 'dia-', across, and 'gnosis', or knowledge. A diagnosis is something you make from across different tests and knowledges. Just droppin' some knowledge.

You know whit, for a guy who has had many lengthy, drawn out slugfests about how happy you are working as an EMT, you seem awfully bitter. Anyone ever tell you that?

Dwayne, take everything you hear about being hired with a grain of salt. I can't tell you for sure why those two were hired, maybe the know it all jackass had a know it all relative as a know it all higher up someplace. Maybe the rotund little miss was performing mouth to <CENSORED> rescustiation, its a crazy world out there. What I do know is that if you are devoted and competent, eventually you will get picked up. You may tear your hair out watching lousy people hire other lousy people for the wrong reasons, but hang in there, keep plugging away at school, and keep searching. I know part of what is infuriating about EMS is that your skills and knowledge do not have the same effect on your employment opportunities that it does in other fields, and nepotism, cronism, and favoritism runs rampant. Stick it out, wait for the know it all jackass to get bored or the rotund young lady to hurt herself, which will be sooner than you might expect, and try again. I wish you the best.

You know, when I read the text referring to the creation of HIPPA, part of it was to allow patients to have control over their medical information. I'm really having a hard time understanding why HIPPA doesn't protect those that are not billed. I'm going to have to do some more research on this one.

Actually, HIPAA applies to all healthcare providers, volunteer or paid. FROM WIKIPEDIA: The Privacy Rule The Privacy Rule took effect April 14, 2003, with a one-year extension for certain "small plans". It establishes regulations for the use and disclosure of Protected Health Information (PHI). PHI is any information about health status, provision of health care, or payment for health care that can be linked to an individual[12]. This is interpreted rather broadly and includes any part of a patient’s medical record or payment history. Covered entities must disclose PHI to the individual within 30 days upon request[13]. They also must disclose PHI when required to do so by law, such as reporting suspected child abuse to state child welfare agencies[14]. A covered entity may disclose PHI to facilitate treatment, payment, or health care operations[15] or if the covered entity has obtained authorization from the individual[16]. However, when a covered entity discloses any PHI, it must make a reasonable effort to disclose only the minimum necessary information required to achieve its purpose[17]. The Privacy Rule gives individuals the right to request that a covered entity correct any inaccurate PHI[18]. It also requires covered entities to take reasonable steps to ensure the confidentiality of communications with individuals[19]. For instance, an individual can ask to be called at his or her work number, instead of home or cell phone number. The Privacy Rule requires covered entities to notify individuals of uses of their PHI. Covered entities must also keep track of disclosures of PHI and document privacy policies and procedures[20]. They must appoint a Privacy Official and a contact person[21]responsible for receiving complaints and train all members of their workforce in procedures regarding PHI[22]. An individual who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR) [23][24]. SOmedic, you're going to have to clarify exactly what you mean by "protected minority" status. If you mean you can't discriminate against someone because of their sexual preference, well, that's been around for some years. What exactly is "protected minority" status? Oh, and just so everyone remembers, not just gay people have AIDS.

A post-op patient c/o nausea and weakness is actually a better candidate for the ER than many of the patients I treat.

I have some friends in Vancouver, BC, well, technically Richmond. Was out there in April of this year, and I was absolutely blown away, pictures just really do not do the landscape justice. I hope to get back there in March, maybe I can meet some of you BCers.

I nearly got kicked out of NIMS class when they started referring to 'task forces' and 'strike teams'. Ooooh, ooooh, I want to be part of "Task Force Autobots"! Once you find something funny, its hard not to laugh.

I'm not going to say that cardioverting him was necessairly the wrong thing, but I agree with the others that in traumatic situation in a young, previously healthy individual with no signs of blunt force chest trauma, the VT is probably caused by myocardial irrability secondary to hypoxia and acidosis, and so establishing an airway and reversing the hypoxia and acidosis is what's needed to correct the situation. If any of the council of elders wants to weigh in on the issue of trauma induced v-fib/v-tach, I'd love to hear it, but that's my understanding. On the other hand, no one is going to fault you for cardioverting v-tach. Our protocols to not differentiate between medical and or traumatic v-fib/pulseless v-tach, so defibrillate and be merry. The long and the short of it is that you got to a trauma victim and got him to the proper facility in an amazingly short amount of time and were even able to pull off some interventions in route. You really can't ask for any more than that. Good job.

I'm sorry, but no matter how many times I read that line, it makes me laugh.

You forget Dust, I didn't grow up here. Not that I grew up in a trailer park, either, but anyway, I could have said "the ghetto", but then I'd probably be accused of racism, so I decided to pick on the honkies instead. Besides, you don't necessarily need trailer parks for a tornado, only middle aged, overweight white women willing to go on camera in housecoat and curlers to talk about where they found their roofs in the morning.

You know, I'll play the bad guy as usual here, but I have to make this point about this subject. I am going to sound like the most bitter, cynical, and possibly misguided misanthropist out there, and while I don't have the exact figures in front of me, I do know that prenatal care plays a large part in whether a child is born premature or not. This isn't to say that because your baby is born premature, you didn't take care of yourself while pregnant, but the fact of the matter is that not taking care of yourself while pregnant is a large factor in being born premature. So, as a member of the medical profession and as a fairly decent human being, I don't get all choked up about "mother's wishes" when it comes to making medical decisions for a child that will die or have horrible deficits for the rest of its life when the reason or it is the either inaction or misdeeds of the mother. Take the mother fresh out of the trailer park, who has pretty much smoked, done meth, and drank for the duration of her pregnancy, and have her say "No, you're gonna keep my baby alive, I don't care what you say to me, you do it now, here's my Medicaid card," and a part of me wants to just say "Why should we? Why should we invest so much time and effort in caring for your child when you obviously don't give a damn about him? On the off chance that we do sacrifice and work our asses off and get your baby to pull through, you're just going to raise him horribly anyway, why should we care so much when you couldn't even get a simple prescription filled while you were pregnant that would have prevented this entire mess in the first place?" Of course, I don't say that, but a part of me sure thinks it from time to time. We live in America. Being stupid and irresponsible is our God given right, its up there with owning firearms and driving monster trucks, so of course we cannot make treatment decisions based on the moral and ethical qualities of the patient or the patient's mother and father. That would be wrong. But, by God, we are the professionals here, can't we just draw one line, and say "No, we did the studying, we are the ones who work at this, this line, right here, is where your right to live your life the way you want and dictate the treatment ends and our professional opinion and feelings on what is b est for the patient begins." Isn't there any line where we can just say "No, its wrong, we're not going to do that," or will we always be bending to the will of the patient, no matter how ignorant and irrational they might be? To answer Eydawn, the slim 1 in a million chance survivors are the ones that may make us feel good and make Reader's Digest, but unfortunately, medicine doesn't exist in a vacuum, and there has to be some balance between the resources devoted versus the odds of benefit, because there are a lot of people out there who can't even get the most basic of medical care, let alone all the machines and doctors and specialists it takes to try and give a 21 week old a very slim chance of survival. There are children right in this country who die every day because they didn't get simple, really inexpensive immunizations. You can't really take the moral highground when the $5,000 you spent in one day on an expectant preemie in the NICU could have been used to provide $10 immunizations to 500 school aged children who might just end up dying too if they aren't properly vaccinated. We don't decide who lives or dies, but we do follow an informed course of action that is in the patient's best interest, and sometimes, as hard as it is to understand, the most beneficial thing for a patient is to pass on, whether its a 96 year old in the nursing home or a 20 week old on the ventilator, or even, heaven help us, the 16 year old laying mangled in the trauma slot after the MVA, sometimes death really is the best thing for the patient. I learned that extremely hard lesson at a very young age because I grew up on a farm with a lot of animals I helped take care of and watched die, and its still one of the hardest thing in my personal and professional life to accept, but ultimately, it is the truth.

I suppose or your 1 MVA a year Rescue Squad, this might work, but or any service that reuses spinal immobilization devices on a regualr basis, this thing looks like it will suck it after a month or two. Is it easy to decon, or does the foam suck up ickies?

I here New York Presbyterian/Cornell EMS unit 08Willy was instrumental in this study. 08Willy... Ate willy... Oh, nevermind.

John Wayne always knew how to handle these situations... GOVERNMENT MANDATED DISCLAIMER: THIS IS A JOKE. VIOLENCE NEVER SOLVES ANYTHING. VIOLENCE AGAINST WOMEN IS BAD, AS IS VIOLENCE AGAINST CO-PILOTS.

Hey, I'm not that eld, all right. Dustdevil, I think she must be talking about you.