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I agree. Once you get to the point of "stress induced tachycardia", you need a break. You'll always have bills, your house WILL get messy, and the kids WILL act up, but you don't HAVE to do a shift tommorrow. It's that easy.

Well, actually, its a moot point now, since the thread has been locked, but all in all it turned into a really good arguement. What actually REALLY started it in the first place, wasn't so much the idea of carrying a weapon on an ambulance (this is bad, trust me) but more what it was about was the guy's attitude. First it was the passive remark about carrying, like it was no big deal, then his oh so important "tips" for if you do decide to carry (these were forehead slappers, really), coupled with the phrases that sounded like they came right out of a Jean Claude Van Damme movie, coupled with the repeated queries by him of 'What, do I INTIMIDATE you?', coupled with well, a lot of other things, was really what got under my skin. Having grown up on a farm in Vermont, along with interactions with a roomate who is a professional law enforcement officer, along with my studies into trauma and ballistics, and of various self defense issues, I believe I know a good deal about firearms and their uses, and I can tell you, this guy was not someone you would want to have a gun in any capacity. He just could not seem to grasp the first, and possibly most important rule of firearm safety, the very first thing I was ever taught when I was taught how to shoot growing up, and that is, NEVER POINT A GUN AT ANYTHING YOU DON'T INTEND TO KILL. I just wish someone else could have backed me up on that point. As for the whole legality issue of it, sure, I didn't check into every single state's specific statutes on carrying a concealed firearm, but I think it was just a bit short sighted to say "Because there isn't a specific law against carrying a firearm on an ambulance, its perfectly legal to do, and because the law provides for defenses against homicide in certain situations, its okay to use deadly force when working professionally in EMS." which is what your arguement was. You may be able to sleep soundly with those notions, but I wouldn't stake my career or my life on them. (By the way, I added a vote for Patrick Buchanan and now its up to 7%. Someone call the Florida Supreme Court! )

On a different EMS site that will remain nameless (It is of poorer quality than this one and I recognize diverting traffic to a rival site is not something that the administrator would want), I have been having an arguement for DAYS now with two people who think carrying concealed firearms (with the appropriate permits), while working EMS is a pretty nifty idea. I have written more on that thread than I think I ever did in college. Should I just give up or keep up the fight?

The only problem I ever have with my good old Lifepak 12 (besides the occasional dislocated shoulder, lol) is that occasionally it decides the fully charged batteries are really in fact "dead" and needs to shut itself off. Popping the batteries back in and out will get it to behave itself. Other than that, I don't ever really have a problem with it, and believe me we are rough on it. Drop, oops, stopped to fast, oops...etc. etc.

Hello to everyone in Division 3 from Division 1... Bellevue told me to say "Take them King's General, dammit!"

I looked at the map in Time magazine, and surprise, surprise, its the states in the bible belt of the south that are pushing this "intelligent design back-door to lovin' jaysus" stuff. I say, let them. New England, the Mid-Atlantic states, much of the Midwest, the West Coast, we all say "SAY WHAT?" when someone says "let's make up some wacky theories to why we are the way we are rather than the scientifically validated ones". If the south wants to remain steeped in the Middle Ages, they can knock themselves out. Their children will be less prepared for the reality of a science and technology driven world, leaving more jobs and opportunity for those of us who paid attention in biology class. Like Darwin said, its survival of the fittest.

Anyone notice how quicky 1EMT-P shut the hell up when I pointed out he was full of crap about the NYC protocols? The higher on their horse they are, the longer the trip on the way down is. Man I love making arrogant condescending jerks look foolish.

"Central, make this a 90 (no patient), apparently the caller dialed 911 to get their quarter back." "<XXUnit>, Can you 10-5? (repeat)?" "Ummmm, the caller states they have no emergency, that dialing 911 apparently refunds their quarter." "<XXUnit>, 10-4... Ummmm... Wow... You can't make this stuff up."

Intimidating cab drivers.

>1. BLS >2. Cardiac Monitoring >3. Start an IV/Saline Lock >4. Administer 25 gm of 50% Dextrose IV. >5. Administer Lorazepam 2 mg IV or IM if IV access is not available. >What I told you was not wrong, it was correct... I would highly suggest >that you review your protocols and that you follow them. If you go >outside of your protocols and something happens a good lawyer will say >that you were practicing medicine without a license! Look, I don't what exactly you were smoking, when you looke up the NYC REMSCO protocols, but the REAL ones are here: http://www.nycremsco.org/images/articlesserver/als-513.pdf You nicely admitted the big ORS between Lorazepam, Diazepam, and Midazolam, and kinda just glossed over the part about IF IV ACCESS IS UNAVAILABLE. I know this because I had to write it from memory during paramedic class for an exam. So let me ask you, why do you feel the need to lie and misconstrue information to make your point? Do you do that on your ACR's as well? Try and hold yourself to a higher ethical standard from now on.

Because starting an EJ in the neck on someone who needs Narcan to start breathing again is excessive and needlessly places the patient in jeopardy. Adenosine is not indicated in an opiate overdose. Neither is D50. It was a hyperbole, but I guess it kinda went over your head. You sure showed me. :roll: Now do you really want to whip it out and see who is bigger, or can you just accept the fact that maybe, just MAYBE you don't know everything? Really though, thanks for the info on diabetics and benzodiazipines, because during paramedic class all I did was scratch my ass and pick my nose. Thank god your around to keep me in line.

Well EMT-P1, my feelings on this subject come not only from my own experiences with patients, but also from picking the brains of the senior medics I work with, some of whom have over 20 years of experience in the New York City EMS system. They're opinion on the matter is the same as mine, that in an actively seizing patient, give the IM injection, stop the seizure, then treat appropriately. Now if you want to tell these guys, who can start an IV on the ankle vein of an ODing junkie, that you believe that "They're doing it because IV's are difficult", go right ahead. Until then, from the bottom of my heart, stick your opinion where the rectal Valium goes.

>Marion 2 respond to a 56 y/o F unconscious, no pulse but breathing >regularly Actually, anyone who is hypotensive fits this description... but I know what you mean.

New medics? Oooooh... Again, I have someone who quotes from statistics and studies and glosses over the fairly obvious, that you can't get an IV on an actively seizing paient. It's nice that you just kind of assume that I have no idea about diabetes, or the pharmacodynamics of benzodiazapines. Arrogance and medicine never produced really good results.

>How does having someone who "knows more" which is really >questionable in many cases, not beneficial? Ever looked at scene times? >Paramedics are far more likely to sit on scene and dick around trying to >start IV's and secure an airway, etc. Okay, let me say ditch, with no hesitation, that that is a LOAD OF CRAP. This is the arguemnt I get all the time from BLS providers, "medics want to 'play' on scene". Yeah, right, because you know, sticking a tube down someone's throat gets my jollies off. That's why I do it. The truth of the matter is that trauma protocols for paramedics DO NOT CALL FOR STARTING of IV'S or SECURING OF ADVANCED AIRWAY ON SCENE UNLESS THERE IS A DELAY TO TRANSPORT I.E. EXTRICATION. As for "knowing more" the fact that I knew that and YOU DIDN'T, pretty much proves my point. Get your head out of your ass, a good paramedic is first and foremost an excellent EMT. It's uninformed and ignorant opinions like yours that make my job just that much harder.

What gets me snarling during the evolution debate isn't so much the ones who believe that there was something more than random chance involved, but those who try and discredit years of scientific research with half-assed, misleading pseudoscientific falsehoods to try and lead the less educated down the wrong path. If you so strongly believe in creationism, you shouldn't have to lie so much to convince others. Personally I think the fact that evolution happened reinforces the miracle of life and gives me a stronger hope that there is something more than what we see here on earth, but then, I suppose the ones in Kansas trying to slap warning labels on biology text books have their merits too. No wait, they're a bunch of illiterate morons.

After reading these posts, I'm kind of convinced the posters are of two camps. Camp A: Those who have treated an actively seizing patient in the field. They understand that getting IV access ain't gonna happen, and the seizure needs to stop. Buddha's analogy, very descriptively I might add, made this point. Camp B: Those who have read about treating seizures in the textbook, and insist that treating the underlying cause is most important because that's what the book says.

It looks like it does provide a better chest compression than the old model sewing machine looking devices I was refering too. I say use it to replace the old style machines, but never use it to replace a trained professional.

Rid, I agree with you fully. The point I'm trying to make is that an ALS provider providing BLS care to a patient has its merits. While the medic haters will hem and haw at the BLS skills of the ALS provider, in the real true adult world, having someone who has worked as an EMT prior to training, done rotations in the emergency room, operating room, pediatrics, and ICU's, will have a better working knowledge of a patient tht is put before them and what the patient needs. That's why ALS has its place in major trauma, good emergency medicine is about knowledge combined with skill, and while the skills may be similar, the knowledge is far greater in an ALS provider.

I'd really like to have someone who is against ALS for trauma sit down, and explain to me one more time exactly how having a person with a better knowledge and understanding of physiology and medicine will make it worse for the patient. No, really, explain to how knowing more and being able to do more is a bad thing? I mean, heck, if we want to continue with that rationale, why don't we just say the less training the better, and go back to the old days of firefighters wrapping people to pineboards with gauze and throwing them in the back of hearses. That should improve patient out come.

Well, of course, in someone's infinite wisdom, unless there are extenuating circumstances, trauma calls here in NYC are BLS jobs. I've had this arguement many times, mostly with BLS providers. There refrain is "What can ALS do for trauma? NOTHING!" I turn this around on them by asking them what BLS can do for major trauma, do which I answer "Even less than ALS can." I still beleive in having ALS on critical traumas, if for no other reason than a good ALS provider can bring their knowledge of the injuries to the scene, along with airway maintenance, fluid rescusitation, and chest decompression. Traumas are load and go jobs. But that doesn't mean ALS doesn't have its place. Anyway, if you are counting survivability for intubated patients, I am sure that many of them were trauma arrests, which of course rarely turn out well. This doesn't mean that intubating a patient lowers their survival chances.

That's basically what I was saying, rdenman, but I said 10 of midazolam IM rather than 5 diazepam rectally. In an actively seizing patient, most times you have to control the seizure before you can treat the cause.

Personally, I like using a bag whenever I can because I don't like having to fiddle around with a flush after the meds. We still haven't graduated to a needleless system (heck, they've only been in place for like, 10 years, right?), so in my mind, the less sharps, the better. Plus it makes you look cooler when you have a bag hanging. Admit it.

I'm sure everybody has had calls, especially arrests and kicked themselves for when something didn't go exactly as planned. Nothing ever does. But this is real life. Sometimes the ambulance won't start. Sometimes the machines will decide to do their own thing. Stretchers collapse, people trip, doors are barricaded, etc. etc. While some of these things can be minimized (i.e. maintenance on the ambulance), many of them are simply beyond our control. The only thing you can control is your own training and skill, which is why all those instructors and everybody in class was so hard on you, so that when you graduate and you wear that patch, you will do the right thing. My question is, is there something specific you feel you could have done better? Or is it just a wracking of your brain wondering if you did everything right? If its the former, maybe there's something you can work on. If its the latter, you're probably just feeling bad that, yeah, the patient in your care died, which is the hardest thing to accept, that sometimes, no matter what we do, people still die.

I found the original text on what Shannon was talking about. Here it is if anyone is interested. N.J. Paramedics Face Inquiry Over Emergency C-Section By DAVID W. CHEN 9/27/97 The New York Times New Jersey health officials are investigating the actions of two paramedics who performed an emergency Caesarean section on Thursday to deliver the baby of a woman in North Bergen who was in cardiac arrest and could not be revived. The paramedics acted while consulting by radio with emergency room doctors at Jersey City Medical Center, officials said, but state health regulations forbid paramedics to perform surgical operations. The emergency workers said they believed the procedure was their only hope of saving the baby. The full-term baby girl survived but is in critical condition; the mother, who was 37, died. The two paramedics were placed on desk duty, with pay, pending the outcome of the state investigation, which officials said should be completed next week. "This was so unusual," said Dr. Leah Ziskin, the deputy commissioner of the state's Department of Health and Senior Services. "Our review is not complete." But to hospital and volunteer officials, the only thing clear was that the two paramedics were heroes, in spite of the rules. "These two people, a man and a woman, they've gone through probably the most traumatic situation of their professional career, so light duty is more than appropriate," said Bill Dauster, a spokesman for Jersey City Medical Center. "We probably didn't need the state to tell us to do that." The events, according to spokesmen from the Jersey City Medical Center and the North Bergen Volunteer First Aid Squad, unfolded as follows: At 5:30 a.m. Thursday, the North Bergen squad received a 911 call from someone in a residential neighborhood in the uptown section of North Bergen, saying that a woman was not breathing. Two volunteers, who were on the midnight-to-7 a.m. shift, arrived a few minutes later, finding the woman in cardiac arrest, with no heartbeat and no sign of breathing. They tried to revive her, said Mary Ellen Cleveland, the president of the first aid squad. A few minutes later, two paramedics from the staff of Jersey City Medical Center arrived at a house in the neighborhood from their base in Weehawken. The woman had still not been resuscitated; the baby was lodged in the birth canal. "They made a determination that she was dead," Dauster said. "And then they said, 'Oh my God, we have to do this."' In a telephone consultation with doctors at Jersey City Medical Center, the paramedics and the doctors made a "joint decision" to try a Caesarean section, he said. The two paramedics, both of whom were described by Dausteras seasoned, delivered the baby just after 6 a.m. The baby had no pulse at birth but was revived by the paramedics. Another ambulance from West New York then came to assist, and the woman and the baby were taken separately to Palisades Medical Center in North Bergen. The woman was pronounced dead at the hospital. The baby was later taken to Jersey City Medical Center. Officials said they had not yet determined what caused the woman's heart attack. Friday, a woman who answered the phone at Palisades Medical Center said the hospital had no comment on the incident. Dauster and Ms. Cleveland declined to give the names of the family, the paramedics or the volunteer emergency medical technicians from the North Bergen squad. It was the first time anyone at Jersey City Medical Center could recall such a case, Dauster said. But he added that everyone was proud of the paramedics. "What they did was step over what regulators have outlined for them into the moral arena," he said. "Most people are going to view this as an act of heroic endeavor; that's how we're viewing it." The baby, he added, was named Davida by the nurses at Jersey City Medical Center. She weighed about 10 pounds.