Asysin2leads

You know, for the record, while Dustdevil can be a bit of a schmuck from time to time, compared to my instructors in paramedic class he's still Mary Poppins. Think being razzed about being an EMT Basic is traumatizing? Try having your unit quiz ripped up and marked as a zero because you forgot to put your name, or having your way cool volunteer EMT badge thrown in the garbage because when they said badges weren't allowed in class, they meant it (neither of these things happened to me, just things I witnessed) Trust me when I say Dustdevil is cranky, at worst.

Oops, double post

Wow, Dwayne, well put. This site does have a bit of a reputation, but quality is worth the price. Take a look at some of the discussions in the ALS or even BLS boards, I can tell you they are at a much higher level than anything else you might get off of the net pertaining to EMS. Trust me, I am friggin' terrified everytime I post one of my calls for review and discussion here, but so far the reward has been excellent. The big thing about EMT City is that it is a place for professionals. There are career paramedics, nurses, even doctors who post on here, it is a higher level than most are used to. If you went to the ASCE (Civil Engineering) website and posted something like "Hey, I want to build a dam next summer, you guys have any tips?" you might get some rather rude responses, same as if you said "Hey, I want to take that twisty metal thing off that's below the doohickey near that big bolt" on a mechanic's website. No one is out right MEAN to anybody new, however, newer people tend to get mean things said to them, because new people tend to say stupid things. Look at the Meet and Greet section, its usually all how-do's, howdy's, and welcomes. Its only when someone says something that is completely ignorant, asinine, or just plain wrong that they get abused, and if that hurts they're feelings, there are plenty of websites that will hold their hands until they feel better. But you know what's worse than having mean things said to you on a website? Sitting down in a small uncomfortable room with a physician on the other side of a desk asking you to explain why you did what you did, because no one took the time to tell you that you weren't doing the right thing. Hurt my feelings, please, its better than being sued.

All right, you know, kids, I could post some of the stories some of the crews who work at my station came back with after FDNY EMS went and helped get Upstate out from underneath all that water this summer, but I won't. See, Dust I expect stuff from, but all the rest of you can take a long walk off of a short pier. Tell all of your "EMT-CC's" that they're not really ALS and never will be.

I would like to reiterate Federal Law # 4532.267, or more commonly referred to as the "Anti-Third-Watch-Wannabe-Retard" law, which states "No individual who is employed in EMS, volunteer or paid, in any capacity, outside of the five boroughs of the City of New York, may refer to an ambulance, in whole or in part, as a 'bus', for any reason outside of a direct quote, theatrical production, or for sarcastic and/or humorous effect." NYPD really does say 'bus'. I usually call it the 'Truck', because to me a Type I is a truck. Then the firefighters get annoyed because to them, a ladder company is a truck company, and therefore the ladder is a truck.

My advice? Paramedic school is not EMT part 2. It is totally different. Study everyday. Don't try to get a passing grade, try to know it all, verbatim, backwards and forwards, because there is no such thing as a 75% successful intubation or cardioversion. Every person that was in my paramedic class who now works professionally used to consistently score at least 90% on their written and skills exams. Know your BLS skills, but don't obsess on them. You will have the bitter 'experienced' EMT's try to rattle your nerves by making it look like knowing the textbook ratio of compressions to ventilations in CPR is more important than knowing the principles of circulating oxygenated blood in a person in cardiac arrest. Correct splinting might save a limb, knowledge of cardioversion and cardiac drugs will save a life. Know yourself and be confident in yourself, because everyone will be trying to tear you down, from the EMT's who can't hack medic class and will use you to vent their frustrations, to the nurses who don't think paramedics should go anywhere near 'their' patients, to the doctors who were born with 'argentum coclearium rectus' (silver spoon in the ass), to your preceptors who will only be there to make sure you can do your job, not to be be your friend, you will be on your own, you will be a new person in a relatively new profession. Be sure you want to do this, be sure your desire is pure, the adrenaline rush will wear off, you will get to the point where you want to tear the siren off of the ambulance, shoot it twice, and throw it into the river, you will realize for how many patients how little you really can do, and if you got into this field for any other reason other than the purest of intentions (or, I suppose, because you are sociopath who enjoys hurting others), you will be burnt out before you graduate. In the end, however, if you make it through, if you pass the tests, written, skills, and life, you will be a very special person, you will be unique among men and among the medical profession, no one will appreciate you, no one will respect you, few will even know what you are actually capable of, your victories and defeats will be personal and private, but if you succeed, as my Clinical Instructor once said, you will have earned my respect and you may call yourself my colleague.

Well, some services carry Flumazenil, but according to an ER doc I chatted with, the dangers of using it outweigh the benefits of giving it in the field. I suppose you could try giving a rapid infusion of NS 0.9% to try and "dilute" the drug, but that theory to me has always been a bit dubious, only because while I may have fallen asleep during a few A&P lectures, I did do fairly well in chemistry. Blood is a colloid, with some stuff dissolved in it and some stuff not dissolved. Now, you could decrease the concentration of a drug by adding more solution, but if you actually did give enough NS to appreciably dilute the blood (If the human body has 5 liters of blood, then to decrease the drug concentration by 50% you'd have to give 5 liters of NS) and overcame the bodies homeostatic measures to maintain blood solute concentration, you'd also decrease the concentration of all the other stuff in the blood, such as RBC's, platelets, WBC's, and so on, not to mention increasing the intravascular pressure to the point where you'd probably end up with pulmonary edema and a whole host of other stuff, which is probably a lot worse than having too much drug in you. So really, all you can do is supportive measures. Maintain airway, monitor pulse rate and BP, be wary of vomit and aspiration, etc. etc. etc.

Dust, I fully agree with you, but this still doesn't address the issue of communities with long transport times and negligible or absent ALS interception/response. As much as I'd like to see everybody be paid ALS, until that happens, I really think there needs to be reevalution of arrest procedures in the field. My brother who did his rotations in a hospital which serves a rural area in the Northeast told me the stories of time and time again seeing volunteer ambulance crews come in, exhausted, having done CPR on someone for the past 40+ minutes. Even if the driver drove like Morgan Freeman in driving Miss Daisy, it still takes a toll on the crew, and still places them at risk by being unbelted in the rear of the ambulance, probably standing up, for the duration. As someone said before, however, increasing the lienency for a presumptive DOA at the Basic level can be dangerous territory we are treading given the low demands of the EMT-Basic course. This is why I think there should be a national push to change the requirements for EMS. While I am a big fan of Dust's RN first, medic second provider model, I think in the mean time a more feasible model would to make the EMT-B curriculum a standard only for First Responders or a course for people wishing to work in the transport field. Anyone who responds to medical or traumatic emergencies, volunteer or paid, should be at the EMT-I level at least. Then we put more lienient standards in for calling dead people in the field, and benefit the profession and the public by not having to engage in rescusitation efforts on unsalvagable patients.

An inferno in a Bronx 99-cent store killed a probationary firefighter yesterday and critically injured a decorated lieutenant after a catastrophic floor collapse trapped the duo and three other Bravest in a smoky hell for nearly an hour. Michael Reilly, 25, a Marine who served in Iraq and realized his dream of joining the FDNY just last month, died after tumbling with colleagues into a basement when an air conditioning unit plunged through a burn.ing roof and through the ground floor. For an agonizing hour, rescue workers from across the city desperately struggled to reach Reilly, of Engine Co. 75, and his colleagues. But it was too late to save the probie. "He did what he wanted to do and made a difference, whether it was defending the country in Iraq or defending our lives here on the streets of New York City," a somber Mayor Bloomberg said of Reilly last night. Lt. Howard Carpluk, a twice-decorated 20-year FDNY vet, was clinging to life last night after he was pulled out of the basement of the burning Mount Eden building. Doctors (EMS, actually) managed to revive Carpluk after he arrived at the hospital in cardiac arrest. But sources said he was in dire condition and on a ventilator. Bloomberg asked New Yorkers to pray for the family of Reilly and for Carpluk's recovery. It was the worst tragedy to hit the FDNY since the two Black Sunday blazes on Jan. 23, 2005, that killed three firefighters. One of those fires, in which two firefighters plunged to their deaths from a burning apartment building, took place on E. 178th St., barely a half-mile from yesterday's tragedy. The blaze at the Mega 99 Cent store on Walton Ave. started behind a refrigerator around 12:30 p.m., and officials said it did not appear to be suspicious. Shopkeeper Anis Shaibi said he tried to douse the fire with a fire extinguisher, but fled with his workers when the fridge's glass door blew out and flames shot up toward the ceiling. Firefighters quick.ly raised a second alarm at 12:38 p.m., and a third alarm was called 30 minutes later. "We saw the fire expanding so quick and stuff falling from the ceiling," Shaibi said. Firefighters raced to the store and rushed inside to search for possible victims after determining that there were no flames below them, Bloomberg said. Reilly, Carpluk and the others were directing a hose onto the fire, but the worst danger was above them on the roof, where a large air conditioning unit sat. With flames licking at the roof, the unit came crashing through the roof and the ground floor - creating a hole that swallowed the firefighters, sources and witnesses said. "It fell through the roof and the roof went with it," said Jashira Abreu, 25, who watched in horror from her apartment across the street. In a flash, the five firefighters were trapped in mounds of debris and rubble, surrounded by smoke and flames. "I just kept praying for them," Abreu said. The firefighters quickly issued Mayday distress calls, drawing more than 130 Bravest, as well as ambulances and other rescue workers from across the city. Smoke billowed out of the dingy one-story building, which also houses money transfer and cell phone businesses. Even as torrential rain pelted them, scores of soot-covered firefighters swarmed the building as rescuers tried to reach the trapped men. It was a race against time because firefighters are equipped with oxygen canisters that generally last for about 40 minutes. Three of the firefighters were rescued before their air ran out. But it was harder to get to Reilly and Carpluk. "They knew where they were, they just had a lot of debris," said a top rescue official. "The last two, it took a lot of time to get to them." The first men to get help were Thomas Auer, 47, of Battalion 17; John Grasso, 45, of Engine 92, and Wayne Walters, 30, of .Engine 75. They were taken to Jacobi Medical Center, where they were all listed in serious but stable condition. "He's okay," said Walters' relieved father-in-law, Frank McKenna. But Reilly and Carpluk were in far graver condition when they were rushed to nearby Bronx-Lebanon Hospital. Reilly, a Marine Corps veteran who served a tour of duty in Iraq, was pronounced dead at 3:17 p.m. Doctors said they believed Reilly, who was in cardiac arrest when he arrived at the hospital, did not die from burns or smoke inhalation. Carpluk was transferred to Montefiore Medical Center, where doctors were desperately working to save him as family and firefighters kept vigil. Back at the scene of the fire, huge klieg lights shone down as fire marshals inspected the still-smoking ruins. Sources said investigators were looking at whether the store was illegally subdivided and whether there were pre-existing structural problems. "To see it all burn up, it really hurts a lot," Shaibi said. "It's sad." I posted a picture relating to this in the gallery (the guys in the orange helmets are FDNY EMS), the look on the one firefighters face in the background says it all. Several of the units from my station responded to this call, and the combined rescue efforts of police, fire, and EMS were truly heroic. As of this writing, Lt. Carpluk has succumbed to his injuries. May God bless the lost and help their families with the pain they are feeling right now.

My suggestion would be to find a paramedic school you can do part time, work your regular job and wait until you can find a service that will pay you adequately as a medic. Its not worth making $6.50 or so an hour as an EMT-B to work as one in your situation. The only experience you'd get is what its like to be constantly broke, lol. Or, even better, go to school part time for nursing, get your RN, then take the medic bridge course. If you really love EMS that much, you can work as a paramedic full time and pick up a shift part time here or there at a hospital as an RN and supplement your income. I know a great deal of paramedics who do this, and in retrospect, its really what I should have done too, if only because I want to smack the smug little smile off of the Medic/RN I know who makes $40/hr on the side, lol.

To answer your question, the reason you give the drugs to a patient who needs them when the hospital will give them the same is so they will get them quicker. In some aspects, you are right, I'd like to also see a person who is 98 years old in arrest be left alone as well, but we can't just stop working everybody. However, I think that who we work does need to be reevaluated, and it is to some extent. Even in my relatively short career I've gone from orders to push high dose epi and bicarb in every asystolic arrest prior to termination to just pushing bicarb to just calling it if there has been no change in the rhythm after standing orders, and I think its a great thing. How about this for a traumatic arrest protocol? BLS: 1. If patient was in arrest when found, has no evidence of hypothermia, has a patent airway, and has had no ROSC for the duration, and the AED has given three successive "No shock indicated", and telemetry has been contacted, patient may presumed to be unsalvagable and no further action is necessary. Of course, the problem here would be that it would rely on checking for the presence and/or absence of a pulse. It could be possible to pronounce a person with a weak, nearly unpalpable pulse, and we have the hypothetical dumbest BLS provider in the world on scene who couldn't find his own pulse if he tried. The AED would indeed still say "no shock indicated", but because it was detecting a regular heart rhythm. ALS: 1. If the patient was in arrest when found, has no evidence of hypothermia, has a patent airway, and has had no ROSC for the duration, and the EKG monitor shows asystole in 2 leads, patient may be presumed to be unsalvagable and no further action is necessary. All right, so I don't have all the answers. The reason I think there needs to be more lienency in pronouncing traumatic arrests is because while I may work and live the big city, I'm a country boy at heart, and I know there are a great deal of rural communities in the nation who's BLS ambulances are transporting dead people who are going to be pronounced as soon as they reach the ER, risking ambulance crew members and the general public in their efforts, and that needs to change. Of course, we could just push for making all ambulances in the US equipped with paramedics, but lord knows we wouldn't want that.

Well, let me ask you this, what are the chances the 34 year old who is found in cardiac arrest in a motor vehicle accident went into a sudden cardiac event that is reversible with ALS, let alone BLS? I'd say slim to none, but at least a great deal less than the chance of the ambulance transporting him to the hospital crashing and killing all aboard.

The old adage is "treat the patient, not the monitor", and yes, if this was simply a case of a completely asymptomatic patient who all of a sudden showed EKG changes, I'd probably rap the monitor a few times and try again. However, it was more that the EKG changes were the final piece of the puzzle that fell into place. Before the EKG changes, I wasn't 100% sure of what was going on, but was leaning towards GI distress, but after the EKG changes, I was 100% certain of what was going on. As for the NRB, I always use an NRB. I usually only use the nasal for either someone who can't tolerate the mask or to hold a broken tech bag closed.

I wish the DOT could expand the rules to include traumatic arrests as DOAs, something like "cardiac arrest from a traumatic cause", but then of course you'd have to define a traumatic cause and then you'd have the what if guy asking "Well, how do you know for sure..." and all that, but especially in rural areas, if you weigh the time and money spent, not to mention the extreme risk it presents to the rescuers and EMS involved, anything that could allow us to pronounce traumatic arrests in the field is worth it to me. Sure, we'd be treading on thin ice sometimes, but thats what makes prehospital care so much fun.

Ready for this one? 61 year old female, called for 'cardiac'. Pt reports having severe epigastric pain for the past 2 days, has not been eating well. When asked about the cardiac call, patient son states she was having chest pain, but is quickly corrected by his wife (okay, not really his wife, more his baby's momma) that it wasn't chest pain it was pain in her abdomen, but lower. Pt. denies chest pain, only pain in periembilical area, severe,sharp pain occasionally radiating to back, 10/10. Negative nausea/vomiting, negative blood in stool, normal bowel movements. Negative SOB, Negative dizziness. Speaks no english, son is used to translate. PMH: Diabetes type II controlled by medication, HTN, high cholesterol, ulcers, negative cardiac history NKA Meds: Norvasc, Zocor, Simvastatin Vitals: BP 110/80, RR 14, GCS 15, Pulse: 54, SP02: 97% on room air, skin warm, dry, unremarkable PE: perrl, negative cyanosis, negative JVD, trachea midline, negative accessory muscle use, equal chest expansion, lungs clear bilaterally, abdomen soft, non-tender, negative pulsating masses, negative incontinence, PMS present x 4 in extremities, negative edema. EKG: Sinus Bradycardia, rate 54 12 lead: Isoelectric, minor T wave abnormality noted in V1, nothing I haven't seen before in a normal healthy adult TxN: Administered 02 10lpm v/NRB, obtained IV access 20 gauge in L AC with 250 cc bag @ KVO. Okay, so pretty straight forward, right? History of ulcers, reported severe pain in abdomen, but does not show physical signs of extreme pain, history of ulcers. Her rate is the only thing concerning me, there is absolutely no evidence of her being on a beta blocker, so her rate really doesn't fit. However, she is asymptomatic, with a stable BP, clear EKG, resting comfortably on the stretcher. Perhaps shes just one of those members of the population with a lower heart rate, but it still raises the index of suspicion. We start taking a slow easy ride to the hospital, no lights or siren at this point. Upon applying the NRB, I notice she is starting to cry. When I ask her through her son what's the matter, she states that she is afraid that because I am giving her the NRB that something is seriously wrong with her. I tell her not to worry, she'll be fine, that she was doing fine and everything so far was checking out. But honestly, I could see she was really scared, and it bothered me, raised my medic-spidey sense to think there was something else going on. At the next stop light I do another quick 12 lead. What the hell, why not. This one is so drastically different than the one I did three minutes before that I couldn't believe I was looking at the same person. Major ST depressions in Leads V5, V6, and II, III, and aVF. I tell my partner what is going on, ASA, NTG, notification to the hospital, vitals held all the way. 15 minutes after arriving at the ED, she was being prepped and on her way up to the cath lab. One of these days, I tell you, one of these days, I will have the 64 year old overweight chain smoker who is pale, cool, and diaphoretic breathing 40 times a minute and clutching his chest, who's family all died at age 35 of cardiac problems. Until then, I'm never going to catch a break with presentations. Effing diabetics, don't they ever read cardiology primers?

Fiznat, you are absolutely right in that if the patient is asymptomatic, treating the monitor is not a good idea. However, I have one case that haunts me to this day of the mostly symptomatic patient with a bit abnormal EKG. Actually, I wrote it up and posted it here a while back, but basically, I had a 50 y/o male who was complaining only of mild dyspnea (when found he was sitting chatting with police comfortably) with a heart rate of 165 and a hx of Asthma, showing an SVT on the monitor. The only treatment initiated on scne was IV access and high flow O2. En route (a transport time of less than 5 minutes), his heart rate went up to 175, and he complained of increased difficulty breathing. I tried to break it with Adenosine, no luck. Two minutes later, after coming through the doors of the ER, he was in cardiac arrest. He was revived, and it was found the SVT was from an active MI. This is part of the reason why I personally am a bit more aggressive in treating arrhythmias with out a great deal of associated symptoms.

I hate to disagree, but it to me it doesn't sound like a mid-shaft femur fracture, if anything, its a fracture of the femoral neck, the same type commonly seen in the elderly. If this was the case, a traction splint could have exacerbated the problem by putting pressure on the area of the injury. As for the doctor, I don't know what to say, I don't have all the facts. I've seen it both ways, people feigning injury for pain meds, and asshole doctors not doing the right thing, it could go either way. If she walked out of the ER, then it was probably a good bet she didn't have a fracture, midshaft or otherwise. Whether you did the right thing or not, I guess thats up to you. If you really didn't think the doctor was doing the right thing, then you did the right thing, and if there's retribution for it, then take it on the chin and be willing to do it again in a heartbeat.

I'd have to disagree with the paramedic's decision to fly these two as well. Everyone has to remember, a helicopter landing at a field location, loading, taking off, and landing at a facility puts a lot of highly trained people and expensive equipment at risk for disaster. I also disagree with the concept of flying someone to a trauma center simply because they are "one of our own." Going the extra mile for an MOS is one thing, but using a helicopter to transport should be based solely on need. Also, to sound like a complete dick, given the scenario where the 911 ambulance is 15 minutes out and the private is 6 minutes out, at the BLS level, what exact intervention will be provided that will make a world of difference for the patient?

All right. so, the consensus is that you can be in true v-tach and still look some what normal, its good to know. To answer a few questions, the rate didn't slow after the lidocaine, it slowed after a calcium channel blocker was given in the ER. The fact that lidocaine had no effect on the rhythm also made me believe that the rhythm was not ventricular in nature. We do have 12 lead capabilities, and I spend much time enjoying reading and interpreting and passing them around the station. This guy's rhythm was such a mess that the 12 lead was good only for making a med list. So, for field diagnosis and treatment, besides the patient's presentation, which apparently can't always definitively rule out ventricular tachycardia, any ideas for making a differentiation between v-tach and a sneaky SVT with a bundle or variancy or other oddity that like to pop up just to make my life more interesting? The ER doctor also made the recommendation that you use Amiodarone if you are on the fence, the reason being I assume because the prolongation of the cardiac repolarization cycle will effect both the ventricles and the atria, so either way you'll do some good. However, I supposed you need to weigh in the added risk of throwing a clot if there is an underlying atrial flutter. So lets say we give the guy diltiazem instead and it turns out that he was actually in a stable ventricular tachycardia. If the guy is hemodynamically stable but in a ventricular tachycardia, how bad are talking in terms of effects? Would it just be better to risk throwing a clot using Amiodarone than risk dropping the patient's blood pressure couple with ventricular tachycardia? Will Stephanie tell Ted that she's having Elian's baby?

This all comes from two very specific cases I have worked on, I'll give you the short synopsis on the second. Pt. is male 45 y/o male found sitting on bus AOx3 reporting asthma attack. pt. sts he has been having difficulty breathing over the past few days, particularly at night, worse on exertion, described as tight feeling in chest like an asthma attack, chest pain denied, 6/10 on severity, has used albuterol inhaler several times without relief. PMH: Dx Asthma, reported history of IV drug use. PE: perrl, conjunctiva pink, negative cyanosis, negative JVD, trachea midline, negative accessory muscle use, lungs clear, slightly diminished, negative incontinence, PMS present x4in extremities, negative edema, pulse rapid, weak. Skin: Normal, dry. VS: BP 130/80, HR 160, RR: 20, SP02: 96 on room air, GCS: 15 EKG: I don't have a copy of it, but just take my word for it, this guy had a rhythm that looked like classic ventricular tachycardia. Wide complexes, if it was on a test you'd say "that's easy" and check ventricular tachycardia as the answer. TxN: Administered 02 10lpm via NRB, obtained IV access 20 gauge in L AC. (Just to make sure that everyone knows how cool I am, I'll reiterate, I succesfully put an IV in on one shot on an IV heroin user while kneeling on the floor of a bus.) So, now we come to medication choices. The problem is I think way too much to be a good shiny soldier/medic. As mentioned before, I had one case before that was similar, a rhythm that looks like what you could point out from across the room as v-tach, but a patient presentation that just does not fit. From the previous patient I knew that an SVT with a variancy can mimic v-tach on the monitor, and I had a strong suspicion that this was what was going on with this guy. However, since would still fall under out wide complex tachycardia protocol, I administered a bolus 1.5mg Lidocaine, I really would have like Amiodarone, but the FD decided to buy me $2500 PPE rather than update our meds. We're supposed to follow up with the 1-4mg/min lidocaine drip, but I was so sure that the guy was not in ventricular tachycardia, and he was complaining about the effects of the drug, (mostly ringing in the ears), that I made the decision to not continue the protocol treatment. If I had my way, I would have given him 0.25mg/kg diltiazem, but I knew there was no way I was going to convince telemetry of what was going on. At the ER, it was found that after slowing his rate down, the guy actually was in 4:1 Atrial flutter. I was right. The dilitazem would have worked and the lidocaine was not indicated. Score one for the nonconformist paramedic. Okay, so here's my question. Given the impaired pumping function of the heart in a person in true ventricular tachycardia, is it possible, or at least likely, to have a person who is in true ventricular tachycardia to have normal skin, normal respirations, and a normal BP? In my mind, v-tach is secondary to v-fib, as in, you're heart isn't working right, you are pale, cool, diaphoretic, possibly without a palable BP. I need to have some people who have more experience in treating v-tach than I do to way in on how the patient's present; have you ever had a v-tach patient (confirmed by ER diagnosis) that was walking around with this life threatening arrhythmia?

Yeah, apparently the editing software has a problem with gerunds (that thars fancy larnin' talk for verbs ending in -ing), sorry about any offense taken, I was hoping for a '#@%ing headlights' You know, it must be karma or something when someone kills a cop, they just suffer the worse misfortunes when in jail, like the guy who shot and killed a cop that I later saw brought in board and collared as a transfer from the jail. Must have fallen.

All right, someone hand me my cane to shake at the whippersnappers and help me up onto my soap box, ahem... One of these days kids, one of these days, you'll realize that medicine, and by extension EMS, is not about saving lives, but about helping others. Oxygen doesn't save a life. It may in the long term prevent someone from dying, but then again, you could say the same thing about oh, drinking water or such. Isn't it enough just to make someone feel better? I mean, today, I didn't do a single lick of emergency medical care. No IV's, no defibrillations, no medications or daring high rise rescues, I didn't treat a single sick person today. But what I did get out of today was a nice quick chat and a hug and a little kiss from a lonely sweet elderly lady who accidently set off her medic alert while napping, just because I made her feel good by showing up to make sure she was ok. So, ummmm, there. Do your job, qive them the oxygen, and stop worrying about it. With liberty and justice for all, amen, God save the Queen.

But Nate, that type of attitude is exactly what causes road rage. Maybe it isn't illegal to have the type of headlights that really bother other drivers, but it also isn't illegal in most states to talk on your cellphone and drive at the same time either (there are a few that have outlawed it ). The point is, once people get behind the wheel, it becomes an offensive onslaught against other drivers. It follows the same principle as driving an SUV with a brush guard on the front when everyone knows its never gonna see anything other than asphalt; its a ploy to intimidate other drivers. I probably should also make mention that due to a slow pupilary reflex (diagnosed by my optometrist), I really hate those fucking headlights.

But Nate, that type of attitude is exactly what causes road rage. Maybe it isn't illegal to have the type of headlights that really bother other drivers, but it also isn't illegal in most states to talk on your cellphone and drive at the same time either (there are a few that have outlawed it ). The point is, once people get behind the wheel, it becomes an offensive onslaught against other drivers. It follows the same principle as driving an SUV with a brush guard on the front when everyone knows its never gonna see anything other than asphalt; its a ploy to intimidate other drivers. I probably should also make mention that due to a slow pupilary reflex (diagnosed by my optometrist), I really hate those fucking headlights.

But Nate, that type of attitude is exactly what causes road rage. Maybe it isn't illegal to have the type of headlights that really bother other drivers, but it also isn't illegal in most states to talk on your cellphone and drive at the same time either (there are a few that have outlawed it ). The point is, once people get behind the wheel, it becomes an offensive onslaught against other drivers. It follows the same principle as driving an SUV with a brush guard on the front when everyone knows its never gonna see anything other than asphalt; its a ploy to intimidate other drivers. I probably should also make mention that due to a slow pupilary reflex (diagnosed by my optometrist), I really hate those fucking headlights.