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Que? No comprende, senor.

I never think applying cold numbers to health care decisions is a good idea. Nothing particularly mindblowing occurs between week 22 and week 23, it all depends on the state of the mother, the fetus, etc. That being said, I wish that the medical profession and people in general would reevaluate their stance on human development. I'm not religious, I won't criticize others beliefs, but my own personal one is that God never intended for an anacephalic baby to sit in an ICU hooked up to life support.

You know whats funny, "Its better to be feared than loved" is actually from "The Prince". Machiavelli really got a bad rap.

Pumpernickle, I'm sorry that one bad experience has left you with a bad taste in your mouth, but I urge you to not give up and try again, perhaps you just need a change of shift or even employer. There are just plain bad people in this field. In the classic movie, WarGames, one of the final lines is "The only winning move is not to play." This is my attitude towards interoffice politics. I might vent once in a while to a coworker, but I don't back stab, and I pretty much ignore anything bad thats said about me behind my back. Its not that I don't respect my co-workers, its just that I really don't care what they think about me. If all else fails, find the person who's doing it, wait until they're in a public place, and call them on it. Let everyone know you know what was being said and give your plain, honest, andd simple opinion of what you think about it and what you think of the person who did it. Sure, you might get labeled as a psycho, but its always better to be feared than loved, anyway.

First of all, relax. Unless your preceptors are burnt out dicks from hell, they'll remember they to were students once and remember that every paramedics is at all times a student and a teacher, it goes with the turf. Just try and make an honest effort and do your best, know as much as you can for where you are in your course, be respectful of your preceptor and remember that he or she is not making any more money that day for training you in your career. A couple of pointers that I could add. Attire and equipment shouldn't even have to be mentioned. If you are serious student and are serious about your career, this shouldn't even be an issue. Know when to ask questions. If your preceptor is giving orders, on phone with telemetry, interviewing a patient, or trying to concentrate on something delicate, asking a question right then and there is not a good idea. Write down your question if necessary and ask it later. Cell phones. Again, use good judgement. Put it on silent or vibrate if its absolutely necessary for you to have. Don't argue. There are a lot of points of contention in EMS, and when you are finished and pass all the tests, feel free to join in the spirited debates on any number of topics that we like to beat each other up about. Until then, remember, you're a student, you don't know as much as your preceptor does, you don't have to agree with him or her, but don't argue about it. I think arguing with your preceptor is in the top ten of major annoyances and frustrations. Go the extra mile. Offer to do the jobs, like emptying the trash or cleaning equipment, no one else wants to do. Even if they decline your offer for assistance, it'll still show you're on the up and up. Minor screw ups are tolerated. Liked Dustdevil said, we all make mistakes, no matter how many years we work. The other day I had an unstable hypotensive patient with a rapid atrial fibrillation. What were the first words out of my mouth? "Let's call for diltiazem." AHHHHNNNNT, WRONG, MORON! Now, I know you can't give a hypotensive patient diltiazem. I used it many times. I could recite to you the contraindications. For whatever reason, my brain just went on vacation for a couple seconds. My partner of course politely informed me that killing the patient is frowned upon, at which point I felt stupid and called telemetry for Amiodarone. I felt a little better when the telemetry doctor and first said diltiazem and then caught herself midsentence. It happens. However, be educated about what you're doing. Do something incredibly stupid, and you'll be looked upon as stupid. Relax, take a deep breath, and go do it. Good luck!

Medic, I'd say take a few days off, if you can spare them. The human body and mind, even if its battle hardened, can only take so much. Take a few days off and relax.

Here's my advice, and I say this not because I don't like you or I have a great need to keep people away from becoming a paramedic, but I say this because its my honest belief. I also say this as a guy who has spent his share of time at the university level studying. If you want to be a paramedic, be a paramedic. If you want to be a PA, be a PA. One is not going to help the other. No physician that I know of will really give a crap if you spent XYZ hours working as a paramedic. Maybe you could get some experience points and it would look good on the resume, but other than that being an EMT or paramedic is not going to help your career. Not only will it not help much, but especially at the EMT level, you put yourself at a risk of being in a career killing incident. All you have to do is get embroiled in one lawsuit, or contact one minor but incurable bloodborne disease, and you can wave bye bye to any career in medicine. I've considered going the PA route, and who knows, maybe when I decide to grow up I'll take that route, but if I went and applied, right now, I wouldn't be looked at as an educated and fairly experienced paramedic, I'd be looked at a guy who's been out of school for a couple of years with a bad knee and a worse attitude, and not much more. Just my advice.

They all pretty much suck, are governed by a monopoly, and woefully underpay and abuse their employees. Change states if you want a serious career in EMS. Jersey's EMS system is a sinking ship and it will drag you down with it.

Lets put it this way. If you put any marks on your personal vehicle identifying you as an EMT, be prepared to open yourself up to a world where any person, regardless of age, sex, or mental stability can take down a license plate and call the board of health or even the local news and make your life miserable, no matter who's driving your car or your circumstances for your actions. I pretty much view EMT plates as the legal equivalent of "kick me!" signs taped on your back, but I guess people have some reason for having them, kinda like MD plates.

With the help of top doctors and scientists, I am pleased to offer you a formula that will deactivate any government implanted microradio transmitters in your body and restore you to perfect health. Its perfectly safe and looks just like Normal Saline, only $49.99 plus s/h, e-mail me for details.

The reason you're getting sick is because the micro radio trackers that the government has put into every flu shot are toxic to human cells.

No, because I think its a communist conspiracy to sap and impurify our precious bodily fluids. I'm kidding, I got mine a couple of days ago, so now I can work overtime filling in for the people out sick because they didn't. Yay!

I think the problem is that adrenaline and endorphins have the interesting effect of allowing you to push your body past its physical limits. Now, this is fine once in a while if you have to get yourself out of a life and death situation, but using this ability day in and day out, or even less so but on a fairly regular basis does serious damage to your body. There have been many times on calls where afterwards I sit down and my muscles hurt, my joints ache, and I may even have a cut or bruise I didn't notice before.

I try to be diligent with gloves when I'm working with a patient, but there are times I just work with my bare hands, like doing a quick BP or taking a pulse. My skin comes in contact with far more people on the subway on the way to work than when I'm actually at work. I don't mind getting my hands dirty, but I am sure to get them clean right after wards, if all else fails I do a quick rub down with alcohol preps. If there's bodily fluids around, you should have gloves on, that's common sense, but I'd say be more diligent about washing your hands then making sure your gloves are on at all times. We have these extra thick rubber gloves that are good if you are banging around, they are very hard to tear, but doing delicate procedures with them is a real challenge. Our IV start kits come with a pair of sterile gloves, and when I'm doing an IV I always change into them before proceeding, not to fool myself into thinking that I'm going to be doing a sterile procedure, but at least they are cleaner than the other gloves I was using, and they are much easier to work in. This brings to mind a question I was debating with my partner. Say you have a long sleeve uniform shirt on and you are working on an actively bleeding patient. I have a tendency to pull my sleeves up to keep them out of the way of anything oozing. Now, my partner asserts its better to get it on your uniform shirt then your bare arms, but me, I honestly think that if you clean it off quickly its better to get it on your forearms than your uniform. If you get it on your uniform, especially a dark one like mine, you may not notice. In addition, if it seeps through, it is trapped by the cloth next to your skin for a prolonged period, unless you want to do a strip tease in the back. I don't mind getting blood on me. Yes, I ideally, I should be wearing a disposable gown if the person has a bleed, but falling short of that, which do you think is better, on the uniform or on your arms?

We can keep this up all night, or we can get back on topic. Politicians on both sides are scumbags who are willing to use children for political gain, and we elect them and trust them, and that's the way American politics is. So, truce, here's a picture of a cute kitten as a peace offering:

Dust, if it makes you feel better, I wanted to clock Hillary with her own dumb "It Takes a Village" book. Anyway, take my word for it, the first ad was pretty low, even for a political ad, and I'm not saying it because I disagree with its sentiment, I'm saying it because it was in really bad taste. The second was pretty funny. Heh, what's next, an ad showing a little girl being thrown out on the street when the issue of tax cuts comes up, lol. I still say the right uses the "Won't someone think of the children" more often than the left does. Maybe the left does it too, they just care about kids in Africa more than the ones in the United States.

You know, its hard not to lean left when the right-wing side of an issue trot cute kids out for their arguement on an issue, and the left uses humor and logic to to make theirs. Using elementary school kids for political gain, talk about desecration of something sacred. I would have some serious issues with any work place that brought up the sexual orientation of its employees in job interviews. I mean, unless sex with co-workers is part of your job environment, whether people are gay or straight in the workplace should not be brought up under any circumstances, and don't give me this "we're EMS and its different, we work closely together, yadda, yadda, yadda". We are professionals and people's personal lives should have absolutely no bearing on the workplace. In fact, the employer committed a fairly serious EEO violation by even asking you that question. How come I never get people who basically have signs around their neck saying "sue me" coming up to me? I could have retired by now.

My question is that he seems to work an excessive amount of hours. 12 hours a day 7 days a week would strain any relationship, whether its a paramedic or a CEO. Is there a reason he works so many hours? Do you need overtime that badly? If the answer is yes, my advice is to prioritize your expenses. There are a lot of things in life we can do without, and in my opinion, having a simple life with time off here and there with the people you care about is better than wrecking yourself and your family to have some shiny things.

Anyone heard of/seen the IO sternal 'gun' that shoots painful sounding spikes into the sternum?

I use Dustdevil's approach, though not as much as I could or should. When I have an interesting case or something I haven't seen before I like to take notes afterwards on specifics and then cross reference the condition, symptoms, treatments, etc. with information in my texts, protocols, and even online. Once in a while I'll even type one up for everyone here at EMT City.

I supposed the answer "I'd be a knife, and a sharp one!" would probably not get you the job.

Well, we tried, but he just won't take his Xanax.

I'm not sure why I would feel the need to give him a 'heads up'. If he's a clean guy, why would I even give it a second thought in telling him. Now, if he came to me and said 'Look, this is what happened', then honestly, yes, I'd probably try and help him out. If it was a once in a lifetime, stupid thing to do, I just can't see the bright side of ruining this guys life, and his kids life, because he smoked some whacky tobaccy while camping. I would like to know why exactly he was dumb enough to risk all the stuff he has by doing so, and he'd better give me a good answer, but other than that I'd help him. I have no use for most zero-tolerance policies. I think they are usually put in place by unintelligent politicians and bureaucrats when they feel the need to look 'tough on' something (Tip: When your local politician starts advertising legislature imposing stiffer penalities for either drunk drivers or pedophiles, he or she is officially out of ideas). America's justice system was based on evaluating a crime and meeting out punishment fairly using wisdom and reason, not slogans and catchphrases. One of my philosophies and the one that gets me in the most trouble is that one should be concerned with the principles and overall big picture behind rules and laws, rather than strictly adhering to the details. Marijuana is a Schedule I drug and therefore (according to the FDA, or is it the DEA? I always mix those kids up) has no medicinal use. I'm up in the air about that one . Legislators elected by the populace made laws saying smoking it is illegal. To break this law shows a contempt for democracy, if you believe in democracy, you follow all the laws, not just the ones you agree with. Executive branches put these laws into effect, as they are required to do, work places complied, as they are required to do, all of which is good and fine. However, I just do not believe, in my heart, that when all of these people did all of these things, they intended it so that if someone admits to smoking a joint, they lose their livihood, their source of income, and probably their source of pride. I do not think they would believe that is the workings of a just society. I believe they wanted to benefit people by limiting their access to what they felt was a dangerous substance, and also to keep impaired people away from people who depend on them. So, if my dear friend wises up and doesn't do it again, and comes to work and helps others and is good to his family, then I think the spirit of the law is upheld, and in this crazy world, that's good enough for me. Interestingly enough, Marijuana is a Schedule I narcotic. MDMA (Ecstasy) is Schedule II, which means it can be prescribed under certain circumstances, such as treatment of PTSD. You find the psychiatrist, I'll find the glow sticks.

You know, elitism maybe good practice at Harvard or MIT, but try and keep it inside their walls. In EMS, its bad practice. The first rule of EMS is don't believe your own hype. I mean, sure, we could get the guys from Seattle in here, and have them butt heads with the guys from LA, and then bring in the guys in Alaska who have like 3 day transport times, and then have Dustdevil come on in and tell us all how we're just fooling ourselves into believing we're paramedics, and then one of my colleagues who used to work the South Bronx during the crack wars of the 80's and 90's will make his case, and we could wear our patches and flash respective gang signs, but that would get us no where. I'm sure Boston has a good system, and I applaud them for having high educational standards, but if it their screening and training programs are elevated to a level that trancends into arrogance (which, from the descriptions of it I get that impression), then it no longer becomes a benefit for the system but a hinderence.

No Boston accent? Oh come on, don't tell me Rhea Perlman as Carla Tortelli on Cheers wasn't a complete turn on.