# Silly things your instructor said



## EMT91 (Jun 27, 2012)

My Intermediate instructor is rather funny and has some really silly but useful sayings. A few are:

Before we give them the sweet, healing hands of love, you have to put on your gloves. 

Normal Saline= Norma Sal In

Ways of saying using the AED: Ride the lighting. 

What are some things your instructors have said that were funny but helpful in one way or another?


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## Aidey (Jun 27, 2012)

Ok, I'll be the spoil sport. How are any of those helpful?


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## Achilles (Jun 27, 2012)

My instructor may have said some dumb things but I didn't really care as he was a great teacher and I passed. I think the only time he said something dumb was when someone asked a stupid question and I can only remember one student arguing with him about using a tampon to stop a nose bleed. But it was funny still.


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## airborne2chairborne (Jun 27, 2012)

When I was working civilian EMS we had someone who applied at the company who mentioned his instructor said that starting pay was $16 an hour for all companies in the area... might not be the same type of funny but still hilarious.


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## usalsfyre (Jun 27, 2012)

Stupid instructor tricks:

"Treat the patient not the monitor"

"A radial pulse means a pressure of at least 80"

"Always have a line before NTG"

This is all stuff I've heard from instructors in the last year.


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## medicdan (Jun 27, 2012)

usalsfyre said:


> Stupid instructor tricks:
> 
> "Treat the patient not the monitor"
> 
> ...



Here's the problem. All three are dumb and incorrect, but at least the last two are supported by current edition textbooks.


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## EMT91 (Jun 28, 2012)

Aidey said:


> Ok, I'll be the spoil sport. How are any of those helpful?



I admit, the only one that is useful is the Norma Sal In. Saying it that way makes patients think its something special...thereby calming them etc. They are all useful as they make me laugh, and laughing is healthy.


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## Aidey (Jun 28, 2012)

Lying to your patients is almost never a good idea.


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## EMT91 (Jun 28, 2012)

Aidey said:


> Lying to your patients is almost never a good idea.



I never said I was going to do that. And he never says its something its not. He says "I am gonna give you some Norma Sal In. Let me know how you feel in a few minutes." 

IMPORTANT: I agree with your idea. It is against my duty to help others to try to trick them with how I pronounce something. I am not gonna do that in any situation, as it is wrong. It is still funny how he says it in class though.


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## Aidey (Jun 28, 2012)

Deliberately misleading your patients is lying. It is an attempt to play off of the placebo effect by making the patient think they are getting a medication.


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## EMT91 (Jun 28, 2012)

Aidey said:


> Deliberately misleading your patients is lying. It is an attempt to play off of the placebo effect by making the patient think they are getting a medication.



As I mentioned, when I thought about it, you are right. I apologize if I offended. I would not /will not do that . Besides, the only "pain" med I can give as an I85 is ASA, for chest pain.


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## JPINFV (Jun 28, 2012)

...except ASA is given to patients with chest pain because of its antiplatlet properties, not it's pain management properties.


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## medichopeful (Jun 28, 2012)

JPINFV said:


> ...except ASA is given to patients with chest pain because of its antiplatlet properties, not it's pain management properties.



Technicality.


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## mycrofft (Jun 28, 2012)

I teach a silly thing and I tell them it's a silly thing and why I'm doing it.

1. The Sheriff's Academy teaches "Take Five to Stay Alive" (make a good approach and on scene safety survey).  Every time I say it I raise one hand and waggle the fingers. I do this at least three times during the lesson.

2. I tell them, "This is silly, so it will stick in your head". Then at least once during the rest of the class I will ask "And before you render care, you ..." and waggle my fingers and_* look*_ expectantly at them. Often I get a verbal response. Always, I see eyes go "Huh? Hahaha" but it is learning taking place.


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## EMT91 (Jun 28, 2012)

JPINFV said:


> ...except ASA is given to patients with chest pain because of its antiplatlet properties, not it's pain management properties.



I know . But its mechanism helps to relieve pain.


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## STXmedic (Jun 28, 2012)

EMT91 said:


> I know . But its mechanism helps to relieve pain.



Can you explain that mechanism?


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## Handsome Robb (Jun 28, 2012)

EMT91 said:


> I know . But its mechanism helps to relieve pain.





PoeticInjustice said:


> Can you explain that mechanism?



Oh dear... leave it alone for the benefit of this thread. 

With that said, I feel like a little kid trying to stay in his seat while raising his hand cause he knows the answer...


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## EMT91 (Jun 28, 2012)

PoeticInjustice said:


> Can you explain that mechanism?



Well it helps to relieve or reduce inflamattion thereby allowing more blood and o2 to the heart. Its anticoagulant properties help thin the blood making it easier to get through those swollen vessels or damaged vessels. It has to do with thromboxane I think. It also sticks to another chemical and makes it not send pain signals if I recall.


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## airborne2chairborne (Jun 28, 2012)

The placebo effect can be a powerful thing, I told a new guy at my unit a couple years ago we spiked his coffee with ipicac syrup, he ended up puking for an hour. Funny part is there was no ipicac syrup in it, he just psyched himself into it. I think this is kind of the same thing as telling a patient "Relax, you'll be ok." instead of saying "hey you're :censored::censored::censored::censored:ed pal."

I don't see anything wrong with pronouncing something differently if there is a serious reason to believe it will improve patient care. Saying you'll give a med and then not giving it is one thing, but if you have someone who has mild dehydration and saline is all it really calls for and he's asking for something he doesnt need, then norma sal in would be fitting. It's like when you get a patient who's racist or sexist, I've gotten the "I don't want anything from that guy, I want that white man's medicine!" line before when we were trying to give a patient glucose and I was working with a partner who was african american... we ended up calling it "white glucose" and the patient accepted it. did he get the treatment he needed? yup. is it really called "white glucose?" nope. but who cares? the only 3 options were leave him with a dangerously low blood sugar level, argue with him how its the same med until his conditioned worsened and he became altered so we could restrain him, or give a little white lie (no pun intended) so he can recieve treatment. sometimes you cant go by the textbook answer of "be direct and honest."


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## Medic Tim (Jun 28, 2012)

airborne2chairborne said:


> The placebo effect can be a powerful thing, I told a new guy at my unit a couple years ago we spiked his coffee with ipicac syrup, he ended up puking for an hour. Funny part is there was no ipicac syrup in it, he just psyched himself into it. I think this is kind of the same thing as telling a patient "Relax, you'll be ok." instead of saying "hey you're :censored::censored::censored::censored:ed pal."
> 
> I don't see anything wrong with pronouncing something differently if there is a serious reason to believe it will improve patient care. Saying you'll give a med and then not giving it is one thing, but if you have someone who has mild dehydration and saline is all it really calls for and he's asking for something he doesnt need, then norma sal in would be fitting."



Misrepresenting what you are giving your pt is unprofessional, unethical, and if caught could mean you lose your license. You are doing your pt no favours by being dishonest with them. It blows my mind how little integrity some EMTs and Medics have.


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## EMT91 (Jun 28, 2012)

Medic Tim said:


> Misrepresenting what you are giving your pt is unprofessional, unethical, and if caught could mean you lose your license. You are doing your pt no favours by being dishonest with them. It blows my mind how little integrity some EMTs and Medics have.



Agreed. I never thought I would do it, nor did I say I would. If the pain is caused by being dehydrated, then I might explain that giving saline, which is not a pain killer, MAY help to relieve the pain.


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## Medic Tim (Jun 28, 2012)

EMT91 said:


> Agreed. I never thought I would do it, nor did I say I would. If the pain is caused by being dehydrated, then I might explain that giving saline, which is not a pain killer, MAY help to relieve the pain.



I wasn't singling you or anyone else out. Just an observation from being on here for a bit and past experiences.


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## Hunter (Jun 28, 2012)

usalsfyre said:


> Stupid instructor tricks:
> 
> "Treat the patient not the monitor"
> 
> ...



But the first and third is really good advice for a paramedic right out of school so, wether they annoy you or not


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## CritterNurse (Jun 28, 2012)

Just after Michael Jackson died, my grandmother had to go under anesthesia for minor surgery. She had had Propoflo before without any problems, but she was terrified that she would die if the doctor gave her "what killed Michael Jackson". I was with her when she met with the doctor since she is a bit hard of hearing, and sometimes needed medical terms explained in plain English. When he said she would be given Propoflo, I saw her get a bit of a panicked expression as she asked the doctor to repeat himself. I stepped in and said that she'd be getting Propofol (the generic name). She then nodded and said that would be alright. The pronunciation was different enough to relax her. She was scared enough about having to go for surgery.


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## usalsfyre (Jun 28, 2012)

Hunter said:


> But the first and third is really good advice for a paramedic right out of school so, wether they annoy you or not


It has nothing to do with annoying me and more to do with the gross misunderstanding of medicine they promote.


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## airborne2chairborne (Jun 28, 2012)

Medic Tim said:


> Misrepresenting what you are giving your pt is unprofessional, unethical, and if caught could mean you lose your license. You are doing your pt no favours by being dishonest with them. It blows my mind how little integrity some EMTs and Medics have.



Integrity doesnt just apply to what you say it applies to doing what's best for the patient. If your patient is against saline because he thinks its not enough (despite his medical knowledge ending with bandaids) and you know that's what he needs, I dont see any ethical discrepency with saying "ok, then how about NaCl?" Unless there is a med out there called norma sal in I dont see a difference, you're just pronouncing it goofy. saying you'll give him LR when you actually hook up NS would be unethical.


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## Handsome Robb (Jun 28, 2012)

airborne2chairborne said:


> Integrity doesnt just apply to what you say it applies to doing what's best for the patient. If your patient is against saline because he thinks its not enough (despite his medical knowledge ending with bandaids) and you know that's what he needs, I dont see any ethical discrepency with saying "ok, then how about NaCl?" Unless there is a med out there called norma sal in I dont see a difference, you're just pronouncing it goofy. saying you'll give him LR when you actually hook up NS would be unethical.



That's when I tell them there's a reason I'm the one sitting in the chair while they are on the gurney. 

I'm with Kyle on this one. If you are misleading them intentionally it's unethical. 

Just like I don't tell people or their families that they are OK. I tell them the truth and what I think, then I tell them I'm going to take good care of them and get them to the help they need. I'm not a doctor and I'm not gonna be the guy on the receiving end of a company's wrath when a patient dies and the first the the family says is "The paramedic said he was going to be fine!!!"


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## JakeEMTP (Jun 28, 2012)

"Treat the patient not the monitor"

This should depend on the context of the discussion.

The values of a well functioning monitor should definitely be considered as part of your assessment.

However, there are situations where the what you are seeing on the monitor and the appearance of the patient are not in sync. You might have a patient with crushing chest pain and diaphoresis but have NSR in 3 leads on the monitor. In that case further assessment should follow and more diagnostics if available to you for the treatment. 

You could also have varying results on a pulse oximeter. Some will turn their attention away from the whole patient and focus just on getting an SpO2 reading by repeatedly squeezing and warming each finger until they get what they think is a satisfactory reading while wasting several minutes not performing other assessments.

You could also have the 3 pk a day cigarette smoker or nonsmoker bartender in bar that still allows smoking who is short of breath but has an acceptable SpO2 of 98%. His actual blood saturation value might be closer to 88%. 

Sometimes you might get a patient which seems to be an inbetween size for all of your BP cuffs and you get strange numbers with each one. Even with a palpated systolic the surrounding tissue gives you a problem with feeling a brachial or radial. You could try the leg or you may just have to rely on mentation and cap refill. 

I think also some instructors want to emphasize the use of all the senses and not just the technology to make decisions on a plan of care.  That doesn't mean the monitor should be disregarded.  But neither should the statement mentioned above in certain circumstances.


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## EMT91 (Jun 28, 2012)

Agreed about treating patients. The medic I did my basic ride a long with really disliked the pulse ox reader.


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## airborne2chairborne (Jun 28, 2012)

Can ANY EMT/paramedic honestly say they've been 100% truthful with all patients?  This includes worrying about your own safety with psych patients or telling a patient you don't think he'll last to get discharged from the hospital. I'm all for honesty, unless it makes a patient's condition worse. The "the patient had a heart attack because the paramedic stressed him out" isn't a recieving end you want to be on either


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## Handsome Robb (Jun 28, 2012)

airborne2chairborne said:


> Can ANY EMT/paramedic honestly say they've been 100% truthful with all patients?  This includes worrying about your own safety with psych patients or telling a patient you don't think he'll last to get discharged from the hospital. I'm all for honesty, unless it makes a patient's condition worse. The "the patient had a heart attack because the paramedic stressed him out" isn't a recieving end you want to be on either



I didn't say stress them out. I said be honest with them. Doctors are honest, why shouldn't we be? It's their body, their medical condition, they have a right to know.


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## EMT91 (Jun 28, 2012)

I will never lie but I will never say 'hey kids your dad here on my gurney is a goner. Say goodbye.' I would tactfully and lovingly say 'I am doing all I can to help.'


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## airborne2chairborne (Jun 28, 2012)

There was a study done recently that showed that patients with chest pain were more likely to code during transport where the siren was blazing because of the added stress. Maybe this is just my opinion, but if I was on a gurney I think the words "I don't think you're gonna make it" or even the paramedic saying "they'll do all they can for you" (which might as well be saying "i don't think you're gonna make it") when I ask if I'm going to be all right or not would stress me out more than a siren. that's just my $0.02, everyone is different though.


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## Achilles (Jun 28, 2012)

Did you guys know there's a new method for choking infants? You lay the infant on its back and move the legs up and down, this moves the diaphragm and air is exhaled out! It's really cool!


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## airborne2chairborne (Jun 28, 2012)

I've just been letting them play with small snack-sized objects, is that what I've been doing wrong?


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## usalsfyre (Jun 28, 2012)

JakeEMTP said:


> "Treat the patient not the monitor"
> 
> This should depend on the context of the discussion.
> 
> ...



I've seen one or two patients and can't say I've ever seen a pulse ox OVERstate SpO2.

All the above falls under the category of "clinical correlation". If an instructor can't teach this concept appropriately than I question if they have the knowledge base to instruct at the advanced level.


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## usalsfyre (Jun 28, 2012)

airborne2chairborne said:


> There was a study done recently that showed that patients with chest pain were more likely to code during transport where the siren was blazing because of the added stress. Maybe this is just my opinion, but if I was on a gurney I think the words "I don't think you're gonna make it" or even the paramedic saying "they'll do all they can for you" (which might as well be saying "i don't think you're gonna make it") when I ask if I'm going to be all right or not would stress me out more than a siren. that's just my $0.02, everyone is different though.



Citation on the research?

It's about having the ethical fortitude to be honest. The patient is going to have to know. Sooner is better than later. Early in my career I took the easy way out. I've been 100% honest with my patients the last several years and have yet to have a problem.


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## JakeEMTP (Jun 28, 2012)

usalsfyre said:


> I've seen one or two patients and can't say I've ever seen a pulse ox OVERstate SpO2.



The SpO2 number is a combined reading. Unless you have a Rad57 equipped for the other 2 values you will not know the break down.  In other words, that number does not mean the actual _oxygen_ saturation. There are other components such as  Carboxyhemoglobin and Methemoglobin which make up the total saturation measured by a pulse oximeter. If a heavy smoker has an SpO2 of 98%, 10% of that could easily be Carboxyhemoglobin.  This is the same as someone exposed to smoke inhalation in a fire. The Carboxyhemoglobin may give you an SpO2 of 100% but that is not the actual saturation of the blood. The combination of the Carboxyhemoglobin plus the hemoglobin saturated by oxygen gives you the total SpO2.

Methemoglobinemia at a very high critical level will also give a higher value on the SpO2 than the actual oxygen saturation. At lower levels of methemoglobin the SpO2 may read fairly accurately.

Various light sources may give you a higher SpO2 than what the patient is.

There are alot of things that must be clinically correlated when using a pulse oximeter.


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## Aidey (Jun 28, 2012)

Methemoglobinemia also causes the pt to be cyanotic, quite dramatically in some cases. If you somehow manage to miss that it is probably time to find a new job.


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## JakeEMTP (Jun 28, 2012)

double post


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## JakeEMTP (Jun 28, 2012)

Aidey said:


> Methemoglobinemia also causes the pt to be cyanotic, quite dramatically in some cases. If you somehow manage to miss that it is probably time to find a new job.



I see you must live in an area where everyone is white and have the very best of lighting to work in.

It also depends on the level of methemoglobin.

A good history of recent events must be taken also. 

Not everything is as black and white as you make it which is why relying on more than just numbers is a must.


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## Hunter (Jun 29, 2012)

It's not just about treating a symptomatic patient with seemingly normal vitals it'd also about not treating an asymptomatic with seemingly unstable vital signs


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## Impulse (Jul 10, 2012)

They mostly gave the kids in class who were going fire a hard time.


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## VFlutter (Jul 10, 2012)

"each month when women shed their ovaries" Say what? :unsure:


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## heatherabel3 (Jul 10, 2012)

Not medical related at all but one of my instructors says "Holy buckets" about 30 times each lecture.  

He also just taught us the "radial pulse means 80 systolic bp".


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## xrsm002 (Jul 10, 2012)

emt.dan said:


> Here's the problem. All three are dumb and incorrect, but at least the last two are supported by current edition textbooks.



What about the 4th?


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## xrsm002 (Jul 10, 2012)

Wow this thread got thrown off topic


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## PandaBear (Jul 10, 2012)

One of my instructors had a song for Ob... 
Went something like "head down, butt up, now find someone to drive that truck and go... And go...
Oh my god, cords hangin out. Make EMS scream and shout and go... And go..."


Good times...


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## lightsandsirens5 (Jul 10, 2012)

usalsfyre said:


> Stupid instructor tricks:
> 
> "Treat the patient not the monitor"
> 
> ...



I HATE those! Probably three of my BIGGEST hates I have acquired.


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## Altered Mental Status (Sep 10, 2012)

Silly as in dumb? Or silly as in "good times?" Cause my basic instructor had a ton of "good times" gems. Imagine all of these spoken in an Emo Phillips-esque inflection:

"If [the scene becomes _unnn_safe], you don't have to outrun the _patient_, you jusssst have to outrun your _partner_."

"If the patient throws up during resuscitation, that's ooookay. Just tiiip the backboard towards your partner and suction..."

"The solution to pollution is dilution!"

"DON'T pull the knife out of a stab wound. IT'S A PLUG IN A HOLE. And if, for _soooome_ reason, the plug comes OUT of the hole, whatEVVVER you do, DON'T put the knife back INto the hole."

He was fond of saying "hypoperfusion" a lot. a lot a lot. I mean, a LOT. And he said it with a funny sort of emphasis that really drilled the "CO2 goes out, O2 goes in, blood goes round and round" concept into our heads. As in:

"Aaaand NONE of these things will ever _kill_ your patient. An head injury won't kill your patient. A heart attack will never _kill_ your patient. The only thing that evvver _killlls_ the patient is...HYPOPERF_UUUUUU_SION!"

He had some interesting ways of pronouncing stuff. Like Pancreas was the "PIIIINEcreas!" 

But my absolute favorite, by far was week one, chapter two, right after "Making A Difference" Hx of EMS. It was Ethics and providing us with a mnemonic to remember the difference between "Assault" and "Battery." It was:

"THIS is what you CALLLLED him       --->[*****]ault
and THIS is what you HIT him with!"  --->[*BAT*]tery


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## JPINFV (Sep 10, 2012)

Sontimeter.


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## STXmedic (Sep 10, 2012)

Whether that's the correct pronunciation or not, I cringe when I hear that...


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## traumaluv2011 (Sep 11, 2012)

Altered Mental Status said:


> But my absolute favorite, by far was week one, chapter two, right after "Making A Difference" Hx of EMS. It was Ethics and providing us with a mnemonic to remember the difference between "Assault" and "Battery." It was:
> 
> "THIS is what you CALLLLED him       --->[*****]ault
> and THIS is what you HIT him with!"  --->[*BAT*]tery


That is a very good way to remember the difference. Thanks


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## Bullets (Sep 12, 2012)

At this point, basically half the stuff they said in class was "silly" 

I went into the EMT class wide eyed, not having any medical training past Boy Scouts. I looked at these instructors with a certain respect, most having 10+ years in EMS and accepted what they and the book said.  Once i passed the test i began to question why we do the things we did. Why does everyone get 15L NRB when i have all these other settings? Why do We backboard people with no pain?

And then i found guys like Tim Noonan, Michael Morse, Justin Schorr and realized what i was taught was actually killing or not helping.

3 years later i go back to recert and there are those same instructors saying the same stuff, even though the evidence isnt there. Now they look like fools in my eyes, gone is the respect i had for the knowledge i believed they possessed. I almost got thrown out for challenging them


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## GoNoles01 (Sep 14, 2012)

If you drop the baby fake a seizure


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## TheLocalMedic (Sep 15, 2012)

From a paramedic who claims that she is also an ACLS instructor: 

 "If you are more than an hour away from a cath lab, there isn't really any point in doing a 12 lead.  They're just going to do another one at the hospital, and then if they need to they can just transfer the patient to a cath lab later.  That's why rural companies that don't have a nearby cath lab don't need to have monitors that can do 12 leads, and it saves the company money by not having to get all that special equipment."  

Say WHAT?


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## DrankTheKoolaid (Sep 15, 2012)

Ouch thelocalmedic, Quite the "instructor" you had. Im in Norcalems, what part of norcal you in?  I need to make sure not to have her co-instruct with me if I happen to know that person


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## 74restore (Sep 16, 2012)

I can't be the only one who feels the tension in the last two posts.... ^^


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## TheLocalMedic (Sep 17, 2012)

Yep...  shot you a message about that one, Corky.  It's scary sometimes...


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## Tigger (Sep 17, 2012)

GoNoles01 said:


> If you drop the baby fake a seizure



If you drop the baby, first look around. If anyone saw, fake a seizure. If not, pick it up.


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