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Okay, so, I occasionally take one on the chin for my attitude. I am very anti-hero. I have reamed out a great number of people in real life, and on this board, for doing something stupid that could have gotten themselves or their crew injured or killed. I've been called harsh, I've been called a coward. This video I found may give you some insight into why I don't suffer morons in the field of emergency services lightly. It comes from our colleagues in firefighting, but I think there's a message here that holds true for EMS and Fire. WARNING: DISTURBING FOOTAGE: http://www.firefighterclosecalls.com/downl...iningMishap.wmv I don't know WHAT the fuck these guys were thinking, but, remember this video next time you have that 18 year old rookie going off about 'charging through the flames'.

Tell her she's a redneck piece of trailer trash who needs to get a life and save up for new car so she won't be so concerned with 'her' ambulance. Then deny you said such a thing and complain to management. If they stonewall claim she sexually harrassed you. It seems to work for the women folk.

Want me to post the X-rays of my missing molar courtesy of a patient unhappy with our customer service? BTW, he was a drunk, not a psych, he swung first, I didn't say anything to provoke him (really, I mean it). I still did the transport. The guy, unfortunately, fell several times on the way to the ambulance, the poor fellow. You really need to watch your step when you're intoxicated. :wink:

AND ANOTHER THING!!! I realized I'm not done yet. The thing that pisses me off the most about poems like this is the arrogance of them. 'I wish you could...' which of course leads to the question, well, why CAN'T the reader of the poem know or experience these things? Oh yeah, I forgot, because firefighting is for the unique special gods among men who rise above us mere mortals, but alas, they are alone in their lofty atmosphere, if only we had it in us to dare dream what they can... oh the shame of it all. Get over yourself. And if your job is that hard, quit.

You know, I behaved myself with my posts. I feel so left out now. Try and tone it down a little and I miss out on the the fun. This is the last guy who posted syrupy poetry: And he got off easy!!!

Sorry, but if I hear another FF doing the "You don't know, man, you don't know..." routine, I'm going to hang myself with my stethoscope. Save it for the badge bunnies.

"Mr. Lumbergh told me to talk to payroll and payroll told me to talk to Mr. Lumbergh and I still have not received my paycheck and they moved my desk to storage room B and there was garbage on it." For five points, what movie is that?

This is the way I look at it. Take two EMT's of comparable training and skill at a similar point in their career. One goes into a 911 BLS service, and one goes to paramedic school. The first gets hands on field experience with other senior BLS providers, learning the tricks of the and procedures from people who have always been at the BLS level. The second gets hands on field experience with senior BLS providers, senior ALS providers, hard core didactic sessions, clinical experience, plus the opportunity to follow up and discuss with physicians, nurses, and a variety of other healthcare professionals. Now, I ask you, who will be better prepared to hand a call at the end of a year?

No offense, but there are plenty of places where firefighters can lament over the difficulties of their job. This is not one of those places. This is a site for EMS professionals. Sorry, I'm really not in the mood for fire heroics right now. :roll:

I think with an amplified stethoscope it wouldn't matter with a blood pressure reading. Remember, the sound we hear for the systolic reading is the sound when there is just enough pressure to squeeze past the pressure of the cuff, and the absence of sound is when there is no longer enough pressure to produce Kortikoff's noise. So, even with an amplified stethoscope, you're not going to hear what's not there, i.e. when the pressure of systole overcomes the pressure of the cuff, it's going to produce a noise, and when it hasn't, it won't. You may be able to hear the noise EARLIER with an amplified stethoscope, but really, that's just a more ACCURATE reading, because you're hearing a closer approximation of the pressure when it overcomes the cuff. Did I lose everyon there? Also remember, every vital sign must be taken in context. Nothing physiologically different happens when you give nitro to someone who is 106/82 and someone who is 98/78. Now if they had an absent radial pulse, now we're talking problems. Don't sweat the numbers, look at the patient.

If my partner keeps pissing me off I'll soon know of one. Sorry, couldn't resist.

Last time. Dude, the original was a joke. A little good natured interdepartmental ribbing. Now if I give you a great big Super-Duper-CPR-Saver-Hero-Man medal, can you let it drop? And btw, my 'equipment' is more than adequate. That's why I don't need to drive around in an oversized pick up or carry a large gun....speaking of which, how's Texas these days?

Ahem, Lone Star... Firefighter Level I, 1999-2001 Hazardous Materials Medical Technician, 2005-Current I have plenty of experience singing off my eyebrows and donning my SCBA, my brother is a professional firefighter/paramedic, and my stepfather is a volunteer fireman. You don't have the monopoly on making the pumper jump from water hammer, you know.

I like kitties!

Nope, sorry, I'm going to have to disagree with you on this. For a transport service, yes, its a customer based service, supply and demand, keeping the customer happy, et cetera. But on the 911 end of it, it is an emergency service, just as important as a police or fire response. However, because of the consumer culture of the United States, patients expect that they can place the same demands on an service provider that they can on as you say, a mechanic or a repairman. This is not the case. Medicine is about doing what is appropriate for the patient, not what makes the patient happy. Sure, usually they're the same thing but not always. I'm not going to risk an injury to myself or my partner just because the person who called the ambulance wants to be carried today, if they are fully able to walk. I'm not going to push diazepam because the patient is feeling a little anxious and wants to take the edge off. I will do these things when I deem it medically appropriate, not when the patient does. Don't believe me that consumer culture has no place in emergency services? Listen to the 911 tape of the woman who called Burger King to have the cops come down to have her burger made the way she wanted. By your rationale, to keep the consumer happy, we should rush down there to try and fix the problem. I guess where we differ is that I believe that people shouldn't call the ambulance unless they really, really, need to, but you believe that since we can generate a bill, the more time someone calls 911, the better. Maybe it'll make you money, but that ain't right. When it comes to emergency medicine, the customer is not always right.

That's not true. Too many services believe they need to run their service like a customer service based for profit business. That's not what EMS is about. Do providers need to maintain a professional and caring attitude towards their patients? Yes. Do providers have to bend to every whim of the patient to ensure 'good customer service'? No. My job is not to make people happy, or put on a show, or sell goods, my job is to provide the appropriate medical care. Unfortunately, many administrators of ambulance services are so far removed from the operations level, they try and run it like Wal-Mart or Starbucks.

While the attitude may need a little tweaking, I think that he has a right to be annoyed. I'm amazed at the number of doctors and nurses who are completely ignorant of prehospital emergency care. I don't go up to a construction worked and tell them how to rivet, so why is it okay for people to tell us how to do our jobs. As for the CPR thing, well, there are dumb people in the world, but we still need them for bystander CPR. Do your best.

Tell them "How about you keep your f---ing opinions to yourself? Now am I too nice?" Remember career EMT-basics are generally frustrated and unhappy. Don't let them drag you down.

It was bullshit. I wish I had a fake plastic Oscar in my tech bag to give to people when they were doing their routine. Look at his vitals. Right on point for someone who was agitated and upset but physiologically ok. I mean, sure maybe he was having some sort of weird off the wall House M.D. episode TIA where he had a sudden onset of hemiparesis, but I really doubt it, more like he was some schmuck looking for attention. I really hope his parents were well insured, its always heart breaking when you see someone like that sattle their poor family with hospital bills because they need a little attention. I've noticed in my career that people of lower economic class tend to have a lower incidence of paroxysmal idiopathic syncope, with one notable exception. In certain parts of the city, there is a certain ethnic group who shall remain nameless, who are occasionally stricken with a related syncopal disorder known colloquially as the "Ai-yai-yais." This usually occurs when a young woman and a young man get into a heated discussion following some Coronas, words get exchanged back and forth and back and forth until, finally, the man has enough and CRACK! smacks her across the face. In our culture, this is spousal abuse. In their culture, apparently, it is legitimate means to end an arguement. After that, its all over, suddenly the woman is on the floor, passed out, not moving, and the family is around her DESPERATELY trying to wake her up (hence the term, 'ai-yai-yais') and throw water on her and pray and light candles (I'm not exaggerating, this is really what happens) and call 911, for the ambulance to come and revive her. This leads the poor, inexperienced, bewildered EMS crew dispatched to an unconscious secondary to trauma, and given the chaotic scene, can really look very bad, after all, you really can get very hurt if someone hits you hard enough in the face. But usually, almost always, its not neurogenic shock secondary to cervical trauma, its just a case of the ai-yai-yais. Arouse her gently, start making like you're about to start an IV, and you'll get a miraculous recovery and even walk away with an RMA, plus a few new friends. Really, you could probably go back later off duty and have a few Coronas at the party, you'll be the star of the scene, and let me tell ya, being a hero in front of a few of the girls from Telemundo is not the worst place you can find yourself. Yes, that was sexist and innappropriate and I don't care. Suck it up. Note: The comorbidity of the families presentation, charactized by hypertension, tachycardia and tachypnea, is known collectively as 'status hispanicus'.

Anthony, the point is this. When you are a paramedic student, you are (or at least should be) held to a certain standard. The paramedic is given so many powers and abilities in the field that trust me, you only want people of the highest standards in that position. There's a reason that in the police academy and fire academy they brow beat you on your conduct. It's a weeding out procedure. My paramedic class was set up very similarly. We were to arrive at 6 p.m. at the class room, at 6:05 we were marked late, at 6:15 we were marked absent. We were to arrive at the ER with ties, button up shoes, lab coats, and proper equipment. We were checked on it every day. Anything missing and we were sent home and the rotation didn't count. It was one of the toughest years of my life, but at the end I was a better person and a better paramedic for what I went through. The reason the Army, Navy, Air Force, Marines, etc. beats the crap out of their recruits is to turn them into responsible people who can be relied on. I think the same should be done for people entering into the field of paramedicine. Any certification below it, I don't hold to the same standards, but the paramedic, as one of my instructors used to say, might as well have a '00' before their certification number because it is basically a license to kill. On the same site, under a different thread, another person posted a comment under the debate of whether basics should start IVs or not (NO!), saying he didn't see what the big deal was because he was a basic and started IVs all the time. That's why the type of attitude in question is so dangerous in medicine, "Yeah, I know I shouldn't drink while I'm underage, BUT... leads very quickly to 'Yeah, I know I shouldn't start IVs out side of my scope of practice, BUT... and 'Yeah, I know I shouldn't drive this fast BUT... or 'Yeah, I shouldn't carry a gun with me, BUT..." These are real things I've seen real people who are employed in this field do or say at some point, and those are not people you want with your family members. People can run their units the way they run their units. But as for me, when I'm working on my patients, I'm going to do everything that is asked and expected of me, to the best of my abilities, and only for the single reason because I said I would. Yes, I was a Boy Scout at one point, no you can't see me in my uniform.

Okay, I this holds the record for thread detours, but gotta throw my $.02 in here. Working in one of perhaps the most diverse work forces in the United States gives me an interesting perspective on race. I think it is far to oversimplified to state that the South is more racist than the North. Quite frankly, my feeling is the South is simply more blatant and open about it. Sure, the South is home to Bob Jones University (shudder), and segregated proms in the 21st century, and some good ol' boys like the charming men in Jasper County, Texas, who dragged a man to death because he was black. But the North, for all its intellectual posturing, is not without its faults. Just look at the dispatch grid for NYC. Division 1, The area encompassing everything below around 110th street, is almost saturated with EMS units, and is an area that is predominately white and aflfuent. Division 2 encompasses Harlem and the Bronx, and trust me the differences in the EMS response between the two is night and day. I use to get a chuckle when I was at my old college in Vermont, hearing the liberal students denouncing racism right and left, yet they were all from Massachusettes and Connecticut, and my college itself was something like 92% white. Its easy to pick on the beer swilling redneck who goes on and on with his opinions about minorites, they're and easy target. Less easy to spot are the people who may champion civil rights, yet hire illegal immigrants for less than minimum wage, or denounce racist acts, yet belong to a country club that has some interesting unspoken rules about who they do and don't admit. To risk using a really bad pun, the issue of race is never black and white.

Well, at least compared to the ones im Maryland.

Generally hot chicks don't need to be heroes. It's only the ugly ones that have so much to prove. Everyone already likes the pretty ones. Anyone want to disagree with that?

Wow, thanks for the feedback. Actually I just posted it here because they closed the thread and I have a bit of a problem letting things go, I need validation, its a a real problem, they're going to up my Prozac soon. I really don't know what capacity this young lady is involved in Fire/EMS, but I do know she does make some key mistakes in her posts that are very telling. I think you would be very hard pressed to find a situation where entering an involved structure unprotected will make much of a difference before the arrival of the first equipped fire unit, unless you're out in the complete boonies. Every firefighter in the world I think knows you don't go in unless you have your gear and your team behind you. In the movies you rush in and grab the five year old. In real life you rush in, take one breath of superheated gases, and then die. And yes, it can be argued back and forth, but in my realm of ethics and morals in prehospital care, to honor the trust that is placed on you, the trust of the families who count on you, the trust of the doctors who's license you are working under, and the trust of the coworkers who you are leading, you do need to hold yourself to the highest standards, and for me, even if its harmless, knowingly and willfully breaking the law so you can have a Superbowl party does not run along those lines.

From what I've heard and seen, the only way you can really tell a pneumothorax in the field is by unequal breath sounds (and how hard is it to hear sometimes?), dyspnea, and mechanism of injury. Tracheal shift, according to my sources, is usually something found on a post mortem. Have fun popping those chests.