ckroll

Censorship seems harsh. That said, free speech isn't free any more than 'freedom' is. Freedoms come with a responsibility to others to show respect,restraint. To paraphrase a well known opening line in a letter addressing a complaint.... Dear Sir, Thank you for sharing your views. I agreed with you until I read your letter.... I wasn't aware people were unhappy, thought it sounded less than serious..... but if there is one more comment about "grow a pair", "man up", or "quit being a girl" you're really going to piss me off. There is nothing wrong with having a 'full set' [a.k.a. two XX's] of chromosome 23. And there is no honor in being thick skinned if it leaves the person insensitive, indifferent, unable or unwilling to show compassion. Grow a thicker skin or take a walk is more or less the same as saying, my sandbox, my rules. The only person who has a right to say that on this forum has asked us our opinion about how to keep all participants engaged. We owe him better answers. I've never met anyone from whom I could not learn something and to whom I could not teach something, if one actively keeps an open mind and an open heart. Pushing to the sidelines members who don't meet some 'manly' standard is giving up the opportunity to teach and to learn. I hope we are all here to do a little of both. Is there value in anonymous posts? Require everyone put their real name on what they write... and maybe try 'girling up' once in a while.

Red though they may be , I think it's rogue.

Given what Gandhi did with a diaper and determination you might want to rethink that point. Too tired to discuss history??? WEAKNESS I smell blood in the water!

Please do, I'm dying to read it.

First,substitute Iranian for American and that's about the way 'our adversaries' look at us. Actions have consequences. We are where we are because it is human nature to defend territory against threats. Let's talk history. The US overthrew a democratically elected prime minister in Iran in order to install the Shah as a puppet who was willing to trade Iranian oil for hot cars and hotter women. In response to foreign intervention designed to destabilize an elected government and pillage another country's natural resources there was a revolution that brought into power a hardline response against a soulless aggressor. When we did it to the British in the 18th century it was an act of heroism on our part. In the 1950's when the US went adventuring in Iran on behalf of Standard Oil and friends we chose the role of aggressor and we got beat at it. We earned the wrath of the Iranians. Their desire to defend themselves against a superpower by putting nuclear capability up against nuclear capability is as justified as it is horrifying. Earth--and history-- is littered with the remains of super powers that fell prey to hubris, selling off their vast resources to feed a war machine at the expense of domestic investment. As finite resources are sucked out of domestic programs into insatiable militaristic adventures once dominant nations become walled fortresses defending an empty, impoverished, society that fails, not by being overrun, but by succumbing to ignorance, disease and eventual anarchy as desperate people with nothing left but guns have to kill each other for bread.

Only the rescuers on the call are in a position to judge the risk/benefits/value of the operation. They know their abilities, which from viewing the clip are remarkable. It looks like the ultimate training exercise. Pulling a mannequin is nothing like dealing with a terrified living creature. As we all know, when conditions are right for one emergency, they are right for many. Had there been a need for the resources that were at scene, say for a person in the water, one may assume those resources would have been redeployed to the higher value target---and response time would have been excellent. Having been bitten or kicked a time or six on rescues, when handling wild/terrified animals it is almost a given that teeth or hooves will be an issue. Getting bitten is not that bad. It's why some of us have had rabies vaccinations and why there is prophylaxis for animal bites with unknown vaccination history. Motorcycle tie down straps from wreckers work well for securing legs of large things that kick. Cargo netting, commercial or home made, especially out of rope that floats is light weight and works well for 'If you can't tie it, tangle it.' situations in conjunction with a handful of carabiners. A jacket/shirt flipped over a head with sleeves used to secure it buys time. As for, 'it's only a dog'. A life is a life; where one draws the line on value is a personal decision. -- A society can be judged by how it treats its animals and its elderly--- [someone else said that]. If we start placing a value on a life before deciding what resources it gets.... well that might be a slippery slope. Operations one is well trained for will be easy/safe and operations one has not trained for will be difficult/dangerous. My opinion is the rescue of the dog was a well orchestrated act of compassion that speaks volumes about those who did it and their dedication to training and preparedness. It should make us all proud.

There is arguably not a more important topic on the planet to be discussed. What we are suffering, globally, locally can be traced to ignorance of other cultures and belief systems. A century ago, travel and communication were arduous enough that it sufficed for most people to know what was happening on the next block. Today a person 10,000 miles away can change our lives tomorrow. The US does not understand that other cultures see our export of our way of life as a dire threat to theirs. We don't understand how they will respond. A 17 year old boy did not understand how his actions would be perceived; a flight attendant did not understand what he was doing. In this case a plane got delayed, inconsequential nuisance [as long as it wasn't your plane]. Wars have been started over less. We all have an obligation--as citizens of a free country-- to educate ourselves so that we can be mindful, compassionate and tolerant of other cultures and so that we can properly know when there is a threat and when there isn't. How many people understand the differences between Christianity, Judaism and Islam..... or what they have in common? Clearly not enough. I think education is the answer, but how do we live our lives and make good choices in the interim?

Catholicism is a subset of Christianity. Not all Christians are Catholics. Logic 101. See something, say something is a valid argument. If I had been a flight attendant, I might have done the same thing. That said, every laptop is a black box with wires and those are allowed because we are comfortable with that. Ignorance of or discomfort with prayer rituals is not sufficient reason to abort a flight. If flights were canceled every time something looked 'funny' we'd all be taking greyhound buses. This is what makes this such an interesting topic. Prayer is deeply personal. Is it appropriate to do it in public? If the answer is no, it is not, then 'God' needs to come out of the pledge of allegiance. If public prayer is acceptable, then this 17 year old was within his rights. He might also have saved his fellow passengers some anxiety and grief by telling the attendant what he needed to do and asking to be accommodated.

Great topic. Yes, use of strung beads to count repetitions of a prayer or mantra are found in lots of belief systems. And I might add that atheists and atheism do not feel "threatened" by prayer, for reasons that ought to be obvious. That said, what this does bring out is that unless one practices a religion or belief system, then one probably doesn't know much about it. We could all use to educate ourselves on this. A couple of things don't make sense to me. The tefellin made it through security, right? So even a cautious flight attendant might have considered that it might be harmless. And landing in Philadelphia made more sense than landing in Louisville why? So the plane could be disabled over one of the largest cities on the east coast instead of over a horse farm? If the stewardess did not know what it was, did not one of the passengers recognize it and could not that person have spoken up? It seems that the opportunities to get this situation back on the tracks were many. It also brings up the great debate over the place of religion in a secular society. Those things we call freedoms also have limits or responsibilities attached to them. Freedom of speech is the freedom to have a thought and to say it out loud. One still might expect to be escorted out of a movie theatre if one chose to exercise that right in the middle of a film. Religion may have obvious limitations as well. If one felt the compelling need to slaughter a chicken in business class because it was a part of their religion.... well it's not going to happen. Nor will a tree hugger get to bring with them their lucky shrub. My experiences have been that if one lets an airline know in advance that they need some special consideration during flight, that efforts will be made to accomodate the passenger. What happened here was an unlucky set of circumstances where someone different looking did something different, and did it in a plane. And given the world in which we live, everyone's neck hair stands up, or ought to. In a sealed metal tube 30,000 feet up, one can't just ask the person to take it outside. I don't know what the right answer is here. If the need to carry small black boxes while reciting prayers is that important, a greyhound bus might be a better option for travel. Religious freedom may need to be weighed against the discomfort caused to the other passengers. And that said, 'I don't like it, you can't do it' is a sentiment that a free country cannot even consider.

[it does help to have a military presence in the Florida Straits.] As we all know, organizations already on the ground have the best opportunity to make a difference. I can add my support for DoctorsWithoutBorders/USA a.k.a. MSF. It is a limited scope organization that focuses on providing medical aid. They have two hospitals in Haiti that are badly damaged. Visit their website for information on what they are doing NOW and please consider making a donation.

Excellent point. We need to recognize a distinction between EPCRs and electronic submission. Submitting call information to the state should be electronic in all circumstances. When and how data entry gets done is worth discussion. In an ideal environment the patient would have their patient information in electronic format that could be uploaded to a laptop that could deliver patient and care information to a hospital computer on arrival...... while instantaneously debiting their mastercard for services. In an ideal environment one teaspoon of yeast could cover the earth 15 feet deep in yeast in something like 5 days. Frankly, I'm betting we get covered in yeast before we get coordinated patient information. A question that needs to be addressed is what 'we' [as patients, as providers, as DOH] want data entry to do for us..... QA/QI, billing, improved information transfer, improving patient care? In theory, it can do all those things. In practice, it can't do all of them at the same time. Given 10 minutes on scene and 15 minutes in a moving ambulance, I do not see a primary EMS provider being able to do an adequate initial assessment, package, move to the rig, perform ALS interventions, reassess, contact the hospital, give a report, and complete an ECR while doing all of those things well. Nurses in the ED do not meet the patient with a laptop; physicians do not meet the patient with a laptop. EMS does its patients and itself a disservice if we let data entry become our primary purpose. Unless EMS is willing to dedicate a member every call to field entry, then I don't think a laptop should be taken out of the ambulance or opened prior to delivering the patient to definitive care.

The work of the devil, they are. Being married to a computer scientist, I love almost all things techie and was prepared to love ECR's. Not so, and this said, I don't use them in any of my EMS capacities, but I work with those who do. Part of it is transition but my sense is that both patient care [or perception of patient care] and transfer of information are suffering in the interim. As an ALS provider I have walked in on patients in distress and found three BLS providers huddled anxiously over.... the computer. Yes, it is those drop down windows.... and on occasion I have asked for new vitals and been told..'wait a minute', something that did not happen so much when we were paper based. At the hospital, if I ask for a copy of what information BLS has collected, they can't do it. I don't think the hospital is consistently getting timely info either. Early last year I went to an all day call audit. Even the poorer paper based reports had vital signs and enough of a narrative to get a sense of what was going on. The electronic based reports were maybe 7 pages long, what was important was buried in rafts of 'normal' results that had no value. And I am guessing in the event of legal action that a computer generated list of dozens of 'normal' findings that in fact were never checked is going to reflect badly on providers and call into question the veracity of the work that was actually done. None of this is meant as criticism of BLS providers I work with who are working hard to provide both patient care and learn a new information system sometimes under difficult circumstances. In time it will no doubt improve, but for the moment, information seems to be getting sucked into the box and is doing so at the expense of patient contact. While the elderly woman who feels sick may not be in need of emergent care, both she and the family think of it as an emergency. A care giver baracaded behind a black or silver wall, typing away just doesn't look or feel like patient care, and it isn't, it's data entry. In circumstances where there are sufficient crew members that one can scribe and another can provide care this is not an issue, but running with small crews and in situations where companies are demanding quick turn around, something has to give and it's not the computer program. Obviously ECR's are the future and the future is now. What needs to be addressed is how, while paying homage to the computer god, to keep primary focus on what matters, which is the patient.

http://www.delawareonline.com/apps/pbcs.dll/article?AID=2009911210330 While visiting my mother in Delaware, this was a headline on the newspaper. The short version is that a woman, a firefighter, was assigned to an ambulance crew and was killed at the scene of an accident. If she were considered a firefighter acting in the line of duty, killing her would be murder. If she were considered to be an ambulance driver, be charge would be manslaughter.

If one looks closely at the cartoon, the meshed cogs of volunteers and career by definition have to turn in opposite directions. Therefore all they can do is grind the teeth off cooperation. It doesn't even take the ego wrench to stop the machine. It is designed to never start. Anybody find this a teensy bit ironic?

That part of the world is where I come from and fire is a part of the process. Some of these are the finest pictures I've seen taken. If anyone is interested in what it's like to fight fire out there, Young Men and Fire by Norman McClean about the Mann Gulch Fire that took 14 lives in 1949 is probably the best account of the subject. Every fire fighter should read it. A five pointer? That elk's a yearling.

It is not mentioned in the section regarding blue lights. It is mentioned in the section of law regarding operation of emergency vehicles. the phrase is"so long as it is safe" and I will get a reference for it. The principle as I understand and apply it is that one is given a great deal of discretion, so long as no accident occurs. If there is one, the lion's share of responsibility falls to the operator of the vehicle responding to an emergency who did something, as determined by its consequences, that was not safe.

A poor choice of words on my part, but I must respectfully disagree. The greater good is served by reducing drunk driving, yes. That is what law enforcement is tasked with. EMS is tasked with health care. Ask me to use my down time looking in on the elderly, picking up prescriptions, educating people, that's fine. I believe, in the strongest terms that EMS needs to keep our focus on care. If the police want to draw blood and the law allows it, that is the way to do it.

Bureau of EMS Policy Statement Policy Statement # 01-03 Date 05/08/01 Subject Re: Drawing Blood by AEMTs Pursuant to NYS V & TL Section 1194(4) Supercedes/Updates New The New York State Vehicle and Traffic Law has provisions to allow advanced Emergency Medical Technician (AEMT) certified by the New York State Department of Health, when requested by a police officer and under the supervision and at the direction of a physician, to draw blood for the purposes of determining the presence or alcohol and/or drugs. This law allows an AEMT to draw blood on an individual, that may or may not be a patient, if the individual is suspected by police of having violated the Vehicle and Traffic Law. [ and it goes on to say the individual may refuse. REMACs were tasked with coming up with policy statements to direct when and how this would happen.. standing orders, online medical control, whatever,. To my knowlege, none of this happpened, so while it is permitted by NYSDOH there is no protocol for doing it. I wouldn't consider initiating invasive procedures without a protocol. EMS really needs to maintain the trust of the community and I think it essential that we limit our scope of practice to patient care and leave all enforcement to law enforcement.]

Nah, it's still nickering. And consider this, in my town/county 'deputy' chiefs are permitted red lights for responding [ to the fire house to sit there]. The clear intent of the law is to permit people of authority, i.e. deputy inspectors, to respond with red lights, yet the fire service uses it as a perk for former chiefs. Someone who was a chief 20 years ago should not have red flashers in their grill. Second, I am persuaded by the argument that a law is a law and the proper course of action is to abide by it while getting it changed. That said, if memory serves, we had this discussion with respect to enforcing marijuana laws and the majority felt on that issue that law is the law and must be enforced. Blue light laws should be no different.

It is beyond a tragedy. For those of us who frequent the northern Adirondacks, Oscar's was where you went for smoked pork chops and a smoked pepperjack that would bring tears to your eyes. It's worse than losing family..... you can't eat them.

There have been several retrospective studies done on patient outcome with and without spinal immobilization. The gist is that there has been no evidence that spinal immobilization improves outcome and some evidence that patients do better without it. If generalized spinal immobilization were a 'treatment' it would be banned by the FDA as useless, possibly dangerous. This is what led the state of Maine to introduce a spinal immobilization protocol in 1994. Several approaches to selective spinal immobilization have been examined across the country as demonstration projects and these have been successful. The best use of spinal immobilization protocols is not as a mechanism to rule OUT immobilizing, but to rule it IN. If the practitioner looks for reasons to use a backboard... neck pain, back pain, head injury, distracting injuries, numbness, tingling, altered mental status with mechanism, and in spite of best efforts cannot find a good reason to use a backboard, then in all likelihood there is no injury that will benefit from immobilization. Like any skill, ruling out immobilization has to be learned, practiced and applied properly.

Not all that well, actually. Back when Putnam Valley [which has a reputation for alternative horticultural prowess] had its own PD, they raided the barn of a local LLL [left leaning liberal] and got quite the haul......of drying basil. The raid was front page news. The lab report, not so much. I'm guessing any carefully cultivated garden a mile from the nearest house is, well, suspect. Yes, air surveillance is a valuable resource if you consider 'homegrown' a threat to the fabric of society. I was questioning the value of air harvesting. If it was indeed days from harvesting, then they just seeded half the Valley for next year...... thank you PCSO!

OK, I've got to ask...... appropriate use of a helicopter? "As many as 300.." means in all probability fewer, and "some as tall as six feet" means one of them was. I saw no estimates of poundage associated, which might lead a cautious person to wonder if the haul was maybe a teensy weensy overstated? The fine photo in the paper is taken from the 'fisherman's angle'--low, wide, head on--- that naturally emphasizes the size of the catch. If there were a barn full of 6 footers, there would have been a shot of proud officers holding them up like prize corn at the State Fair. Our intrepid organic farmers certainly weren't planning to get the stuff out using a helicopter, so, and this is just speculation, perhaps maybe an ATV would have been a completely reasonable choice. The FD does hiker rescues and brush fires all the time. Without question, marijuana is dangerous. It is a gateway drug to cigarettes, which have a devastating effect on health and performance. I just wonder if the best use of manpower and resources was staging a helicopter mission, when less dramatic options may have been available. We can't just put it in a pile and let a good rain compost it? It is grass after all.

RE: snakebites. Over 2 inches between primary fang marks would be the mother of all pit vipers. Many snakes, even non venomous ones will have larger teeth in the canine position that can mimic fang marks. My burmese python could leave marks you'd swear were fangs but were just over developed incisors. A snake will not strike at something too large to eat unless under extreme stress and will release as quickly as possible. Snakes' upper jaws are quite flexible. In the process, a snake can bite, release and reset some distance over. The result, if one is not careful, will appear to be a bite much larger than a single bite. In any case, if it were an adult pit viper, it did the right thing and delivered a dry bite as a warning. I believe that Hudson Valley Hospital Center has anti-venin. I will check on this, but as recently as 2 years ago the rep was giving us an in-service on using it. And one is seldom wrong to fly to Jacobi where they have cases of the stuff, and the staff is prepared for the sequelae associated. Important to know is that Jacobi is the place to go for snakebites. NYC gets a lot of imported creatures on its docks and the Bronx Zoo keeps anti-venin on hand for all its creatures. Sounds like a job well done.

Well...... rapid is pretty much always better for anything EMS related, and yet we don't use helicopters for every call. The window for antivenin is several hours. I think the admonition to seek rapid attention is in part directed at the drunk 18 year old male who is ill advised to wait to until morning to seek help. A consideration is whether concentration or dilution of the venom is the better approach for crotalids. If it were my hand, I'd opt for dilution [ no lymph band] and more aggressive treatment as local damage to a hand can have consequences. If it were my calf and I were several hours hike from a trailhead, I'd consider slowing venom to the core with a light lymph band on the grounds that local damage to the calf was less of an issue than getting to civilization prior to potentially getting shocky in the backcountry. That said, if I was OK at the trailhead, I probably would not seek emergency treatment at all. But then I'd carry a sawyer extractor as well. Lymph bands are controversial to say the least and have no value for questionable envenomations. I'd never make that decision for a patient without contacting medical control. Just as important, it's not necessary to make a circus out the event. I got called...and this was over a decade ago... to assist with a snake bite situation. A group of teenage campers were wailing and sobbing, the bitten person was off lights and sirens to the hospital...... all over a medium sized northern watersnake. The hospital insisted on seeing the snake for identification, I wouldn't let the officer kill it. So I had to go in the back of a patrol car, also lights and sirens even though I'd told everyone it was harmless. In the intervening 20 minutes, the snake's size and ferocity had grown in the telling so that by the time I walked into the ER with a remarkably healthy 4 foot water snake, it was nothing less than a scene from 'Snakes on a plane.' The camper never needed medical attention at all, and some cooler heads might have prevented unnecessary panic. The poor snake was terrified.