# Nerves, or true difficulty



## Lucy212 (Apr 12, 2011)

Hi EMS family,

Just got my EMT cert, the hospital I want to work at wants me to volly first and get experience before they hire me. I've completed about 70 so far and have frequently bumped heads with the one guy whose tour I usually run on. He has no patience for teaching and no care to even recognize me on the bus with him let alone when we're on calls. There are times when I'm told by him "don't move, don't touch, go stand over there" kind of deal - but I am only able to complete night tours on my volly process and usually complete 95% through him. Some of the other EMTs I've run with allow me to take vitals, start oxygen, question the patient all while they are standing next to me. So, here's my ? - had a call last night, an elderly women fell down in her apartment - the nephew called 911. When we arrived she was sitting on her bed. I went to take her vitals, however I could not feel her pulse and truly could not hear her heartbeat. She was alert and oriented and actually a bit humorous with us. I even passed my scope to the other EMT who also could barely hear her heart beat. At that point, the first EMT said - 'wtf is wrong with you, you shouldn't be doing this. You're no good, go back to school - and get out of my way." All this was said in front of the patients family and the 2nd crew member. I simply moved to the side, asked him to feel and hear her to which he had some difficulty also.  We stair-chaired her and drove off to the local hospital. I ended my volly tour early out of intense frustration with him. 

In addition, he smokes in the ambualnce ALWAYS and frequently talks about every call we're on in the most negative way (I can't believe that last patient was so friggin' stupid - wtf is their problem - can't they do anything right?) but when we're at the call with the patient he kills them with kindness - "How are you dear? Tell me what's hurting you hon "... How can I work with this guy if I can't even volly with him. I usually have a thick skin, but yesterday - I just cracked. Secondly, should I as a volly speak to a supervisor or not about his routine behavior? As a 3rd on his bus would I be out of place mentioning this to anyone? Or should I just go and observe and continue to feel the uncomfortableness that I currently do?

Any advice from you guys would greatly help me. 

~ L


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## Shishkabob (Apr 12, 2011)

Go to someone in charge and let them know your feelings.



If nothing else, get the idiot in trouble for smoking in an ambulance, which is not only illegal, but stupidly dangerous.


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## Pittma (Apr 12, 2011)

People like this ruin EMS's rap.

As Linuss said, not only is smoking IN (or even near) an ambulance illegal, it is extremely dangerous. Oxygen tanks _are_ bombs. 
http://www.necn.com/02/02/11/Oxygen-tank-explodes-in-ambulance-fire/landing_newengland.html?blockID=402759&feedID=4206

That being said- don't let him make you feel like an idiot. I must say it is commendable that you are willing to admit when you can't hear vitals, sounds, etc. It really goes to show that you are confident in abilities within your realm, and work well as a member of a team. Kudos for that. This guy clearly is a burnout, and should probably lose his job, especially if he's in charge of educating you. Perhaps request another FTO? Do you have a supervisor you can trust?


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## JPINFV (Apr 12, 2011)

Pittma said:


> As Linuss said, not only is smoking IN (or even near) an ambulance illegal, it is extremely dangerous. Oxygen tanks _are_ bombs.
> http://www.necn.com/02/02/11/Oxygen...ng_newengland.html?blockID=402759&feedID=4206



Err... a pressurized tank exploding under the heat of a fire is completely different situation than smoking around a pressurized tank. PV=nRT


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## bigbaldguy (Apr 12, 2011)

JPINFV said:


> Err... a pressurized tank exploding under the heat of a fire is completely different situation than smoking around a pressurized tank. PV=nRT



Yes but a lit cigarette near an open tank can lead to a fire which could lead to a box fire (rather quickly or so I've been told) and then BOOM! Unlikely yes impossible certainly not.
Besides smoking is nasty and makes everything around it smell nasty. Why would someone want to add to the funky smells in the back of an ambulance.


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## Anjel (Apr 12, 2011)

bigbaldguy said:


> Yes but a lit cigarette near an open tank can lead to a fire which could lead to a box fire (rather quickly or so I've been told) and then BOOM! Unlikely yes impossible certainly not.
> Besides smoking is nasty and makes everything around it smell nasty. Why would someone want to add to the funky smells in the back of an ambulance.



My company is trying to implement a policy that says no smoking in your uniform period. It's nasty. And for someone who doesn't smoke you can smell in 10ft away.


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## bigbaldguy (Apr 12, 2011)

Lucy212 said:


> Hi EMS family,
> 
> Just got my EMT cert, the hospital I want to work at wants me to volly first and get experience before they hire me. I've completed about 70 so far and have frequently bumped heads with the one guy whose tour I usually run on. He has no patience for teaching and no care to even recognize me on the bus with him let alone when we're on calls. There are times when I'm told by him "don't move, don't touch, go stand over there" kind of deal - but I am only able to complete night tours on my volly process and usually complete 95% through him. Some of the other EMTs I've run with allow me to take vitals, start oxygen, question the patient all while they are standing next to me. So, here's my ? - had a call last night, an elderly women fell down in her apartment - the nephew called 911. When we arrived she was sitting on her bed. I went to take her vitals, however I could not feel her pulse and truly could not hear her heartbeat. She was alert and oriented and actually a bit humorous with us. I even passed my scope to the other EMT who also could barely hear her heart beat. At that point, the first EMT said - 'wtf is wrong with you, you shouldn't be doing this. You're no good, go back to school - and get out of my way." All this was said in front of the patients family and the 2nd crew member. I simply moved to the side, asked him to feel and hear her to which he had some difficulty also.  We stair-chaired her and drove off to the local hospital. I ended my volly tour early out of intense frustration with him.
> 
> ...



We had a call a little like this one where I was 3rd on crew and tried to get vitals and just got nothing, no radial pulse no blood pressure tiny tiny little hearts sounds. I did the same thing and turned it over to the experienced EMT-B on crew and sure enough he turned it over to the ICP and he finally turned the vitals over to a training supervisor who happened to be riding with one of our supervisors and had shown up at the call. She had a hard time too. The guy was conscious but loaded to the gills with medications and had arms like toothpicks. The EMT-B I first turned it over too also started to give me the "oh your just an idiot look" but had the decency to admit he couldn't do it either. 
You're in a tough spot. Sometimes you just come across people like this and trust me they aren't limited to the EMS field. They are everywhere.  Just try to remember that this guys problems are just that "his problems". It sounds like he wants you to be as miserable at work as he is. It's pretty common. Someone hates being at work for whatever reason (family,money problems whatever) and they just can't stand seeing anyone around them being happy about being there because it somehow invalidates their anger. So rather than doing the logical thing and calming down and taking care of business they spend their entire time at work trying to make everyone miserable. Most likely his coworkers have reached the point where they just ignore him or shrug his comments off but it sounds like your a little newer so he probably focuses on you. Try taking a step back and viewing this guy objectively during your little exchanges. Could you take him and drop him into a role on a sitcom called "burned out grumpy paramedic". Every time he rides you just picture it with a laugh track in the background and smile because it really is just a little comic relief.


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## JPINFV (Apr 12, 2011)

bigbaldguy said:


> Yes but a lit cigarette near an open tank can lead to a fire which could lead to a box fire (rather quickly or so I've been told) and then BOOM! Unlikely yes impossible certainly not.


Could it lead to a box fire? Sure, so could a dozen other things. Oxygen itself doesn't burn (in the same sense of fuel), but is necessary for fire to occur and higher levels cause fires to burn quicker. Smoking around oxygen tanks is something to avoid, but it's on a much lower level than, say, smoking at a fuel pump. 



> Besides smoking is nasty and makes everything around it smell nasty. Why would someone want to add to the funky smells in the back of an ambulance.


I can't argue with this, but I'll point out that whether smoking is nasty or not is irrelevant to whether you can cause an oxygen tank to explode with a cigarette.


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## usalsfyre (Apr 12, 2011)

I'm fairly certain (as in the same level of certainty that the sun will rise in the east tommorow) that a single cigarette doesn't have the BTU potential to expand the molecules to that point...

The reason it's incredibly stupid to smoke in an ambulance is not that oxygen will explode (remember O2 itself doesn't even burn) it's that in the possibly hyperoxic environment of the truck, everything is more likely to burn. 

To the OP, yeah, report this. If nothing else so someone else he trains doesn't think this is an acceptable attitude.


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## mycrofft (Apr 12, 2011)

*Dear OP*

Know what you want. 

Do you want to work there if they employ a guy like that? If his other co-workers didn't do something about him, then what he is doing is culturally accepted. You will probably wind up working with him once in a while.

If you want to hang in there, initially go in and either simply ask for another preceptor, or just ask if you are required to work with him. This may, without elaboration, get you precepting with others. Once you are asked, as a volunteer, to start elaborating what's wrong, you can either become their goat to fire the guy, or get a "snitch jacket" with the other EMT's, or (more rarely) they keep it confidential and handle it.

What if you precepted somewhere else, claiming a schedule conflict or something, then came back? (See paragraph two above).


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## Lucy212 (Apr 12, 2011)

*Thanks everyone*

I've read everything you guys have written to me. I will work out a solution to this problem by the end of the week for sure, whether it's really talking to the EMT himself or speaking with someone in the department - ideally and realistically I should make the situtation calm if I can before going over to someone in charge.

I will keep everyone updated on my progress - thanks for all the feedback. This is why I became a member of this site - for advice, guidance, humor, and support. 

~ L...


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## HotelCo (Apr 12, 2011)

Anjel1030 said:


> My company is trying to implement a policy that says no smoking in your uniform period. It's nasty. And for someone who doesn't smoke you can smell in 10ft away.



Wish mine would do that...


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## abckidsmom (Apr 12, 2011)

This ambulance burned for a long time before the oxygen tanks blew.  http://www.youtube.com/watch?v=yfFJbpvBN0I&feature=player_embedded

It's less of a hazard than, say, the Apollo 11 disaster.

ETA:  Smoking cigarettes in the ambulance is still disgusting.


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## zmedic (Apr 12, 2011)

More of an issue than fire is that fact that the third hand smoke can trigger asthma in kids, plus is rude if you patients just don't like the smell and are now forced to ride in the back with you for awhile.


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## shfd739 (Apr 12, 2011)

Anjel1030 said:


> My company is trying to implement a policy that says no smoking in your uniform period. It's nasty. And for someone who doesn't smoke you can smell in 10ft away.



I wish mine would go that far. No tobacco use in or around vehicles and stations. Employees just have to walk further away to do it. The way it sticks to some of their clothing is horrible though. I cant hardly stand next to them and the smoke usually doesn't bother me. 

OP I think you're going in the right direction. Try talking to the medic. If it doesn't work go to a supervisor. We've had a few of our preceptors act similarly and once we knew about it they were quickly counseled and the actions stopped.


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## Feuerfli (Apr 17, 2011)

*To the original poster*

There are two ways in which you can approach this situation --

(1)  Go to the supervisor of that shift and speak to him/her about the EMT in question.  You don't need to so much be a rat, just be frank and inform them that you don't feel like you are being given the opportunity to learn/practice your skills and would rather be placed with someone else who might have more patience.  (Rather than the alternative of kicking and screaming 'nobody wants to play with me!')  At this point you could also inform them that it concerns you that this particular EMT is smoking in the ambulance and it is not only for the safety of the patients but for your personal health and safety as well.

(2)  Confront the EMT directly.  Ask him if he has a problem with you.  Remind him that everyone had to start out somewhere and he was once just as green.  It sounds like he is burnt out and needs to find alternative employment (not in a customer-oriented atmosphere).  Don't raise your voice, just be honest.  If he begins to get testy, refer to option 1.

I don't particularly recommend option 2 (I have done both in the past with mixed results), but if this is someone that you truly _have_ to work with, it might be best to get everything out in the open.  Sometimes the attitude is over a petty misunderstanding that can be resolved with adult conversation.  If he is incapable of such, go immediately to option 1.  Just be prepared for potential repercussions from either option.  Like someone before said, this is not isolated to EMS -- I've encountered these people everywhere I have been employed so please do not be disheartened or down about it.  Remember, there is an entire community here to help you.


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## Pittma (Apr 17, 2011)

JPINFV said:


> Err... a pressurized tank exploding under the heat of a fire is completely different situation than smoking around a pressurized tank. PV=nRT



actually you might want to add in the correction factors in order to correctly analyze the pressure due to the attractive IPF that occur with such a high pressure and ammount of gas:
(P+[n^2a/V^2])(V-nb)=nRT

But, sorry to use a relevant example to explain how dangerous and volitile these tanks are. Smoke in the ambulance, accidently leave a regulator open, and for some crazy reason you create a fire, then you have that exact same situation. I'm not saying smoking in an ambulance is a guaranteed way to get your limbs blown off...but I wouldn't want to try to see what it takes.


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## usafmedic45 (Apr 17, 2011)

> Oxygen tanks are bombs.



In the same way that you're apparently well versed in the matter you're chiming in upon. 

Two things:  Veneficus is right.  There's a vast difference between, say, sticking a tank of O2 into a fire and letting it cook off and even opening the regulator and holding a lighter to it (seen it done before....don't try it at home because you get a two foot flame as a result).  Oxygen is not burning itself in that situation, it supports combustion which is why it will make a small fire get a hell of a lot bigger and a whole lot hotter.  You're not going to have the flame go back into the tank and make it blow up.  

You might understand a basic physics equation, but you certainly seem to know little beyond the myths of oxygen and fire.


> But, sorry to use a relevant example to explain how dangerous and volitile these tanks are.



LMAO  You sir are clueless.


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## rescue99 (Apr 17, 2011)

Any advice from you guys would greatly help me. 

~ L[/QUOTE]

First, he would be fired and secondly...why have you not filed a report yet? He doesn't belong in EMS with that behavior, period. The creep has no business acting like a mornon in front of anyone, at anytime on the job.Yes, it sounds like you aren't taking the bull by the horns and jumping in there with a little more confidence but, you still have a harassment problem on your hands with the so-called mentor. Get rid of him, quickly! If the boss tells you to go someplace else, it wouldn't be without going to the county medical control athourity and state licensing board first, and I'd make that very clear. The bosses job is to prevent abuse, not allow it. On the other hand, if he/she doesn't know, how can it be fixed? This creeps mouth is reason enough to  fire his butt IMHO!


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## rescue99 (Apr 17, 2011)

Feuerfli said:


> There are two ways in which you can approach this situation --
> 
> (1)  Go to the supervisor of that shift and speak to him/her about the EMT in question.  You don't need to so much be a rat, just be frank and inform them that you don't feel like you are being given the opportunity to learn/practice your skills and would rather be placed with someone else who might have more patience.  (Rather than the alternative of kicking and screaming 'nobody wants to play with me!')  At this point you could also inform them that it concerns you that this particular EMT is smoking in the ambulance and it is not only for the safety of the patients but for your personal health and safety as well.
> 
> ...



Forget the smoking....the boss already knows about it, I'd bet. The piss poor professionalism is unacceptable behavior. It's harassing to the 3rd riders and to the patients. Neither is accpetable.


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## Pittma (Apr 17, 2011)

usafmedic45 said:


> In the same way that you're apparently well versed in the matter you're chiming in upon.
> 
> Two things:  Veneficus is right.  There's a vast difference between, say, sticking a tank of O2 into a fire and letting it cook off and even opening the regulator and holding a lighter to it (seen it done before....don't try it at home because you get a two foot flame as a result).  Oxygen is not burning itself in that situation, it supports combustion which is why it will make a small fire get a hell of a lot bigger and a whole lot hotter.  You're not going to have the flame go back into the tank and make it blow up.
> 
> ...



I really don't appreciate being told I'm clueless. A simple explanation of why I was wrong, and perhaps teaching me what I said that was wrong would have been more than sufficient. Were you trying to learn once, or were you born into superiority?

I understand the thought process. I'm aware the flame won't go back into the tank. I know that these tanks are also very well built, and aren't bombs in the classical sense of "light the fuse and get away".  I don't want to add more potential for a bad fire. Regardless of the reason, cigarette ash starts small fire, small fire near oxygen, etc. I have also seen what happens when you add fire to an open regulator. I'm not a dumb***, but thank you for explaining your thought process with me. Just try to be a little less rude, there is no need for that. 

Best,
Nick


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## rescue99 (Apr 17, 2011)

Pittma said:


> I really don't appreciate being told I'm clueless. A simple explanation of why I was wrong, and perhaps teaching me what I said that was wrong would have been more than sufficient. Were you trying to learn once, or were you born into superiority?
> 
> I understand the thought process. I'm aware the flame won't go back into the tank. I know that these tanks are also very well built, and aren't bombs in the classical sense of "light the fuse and get away".  I don't want to add more potential for a bad fire. Regardless of the reason, cigarette ash starts small fire, small fire near oxygen, etc. I have also seen what happens when you add fire to an open regulator. I'm not a dumb***, but thank you for explaining your thought process with me. Just try to be a little less rude, there is no need for that.
> 
> ...




Sooooo....think you can apply this same response to your mentor? 
A lesson can be learned from almost any experience.


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## usafmedic45 (Apr 17, 2011)

> I really don't appreciate being told I'm clueless.



Well, you were told nicely by JPINFV that you were wrong.  You responded by trying to show that you're smarter than him.  I was being nice in my response.



> Were you trying to learn once, or were you born into superiority?



My parents taught me not to open my mouth on professional topics unless I was damn sure I knew what I was talking about.  It's not that I was born into "superiority", I just learned not to cram my foot into my mouth before I left elementary school.



> I'm not a dumb***,



Then don't give me a reason to question your knowledge level.  If you don't know something, say so.  It's not a cardinal sin.  



> but thank you for explaining your thought process with me.



Not a problem.



> Regardless of the reason, cigarette ash starts small fire, small fire near oxygen, etc.


OK.  Cigarette ash won't start a fire.  It's cool enough that you can grab it off the end of the cigarette with your fingers if you are careful.  The reason is that it has a very high surface area to mass ratio which allows it to cool exceptionally quickly.  

Even if you hold a cigarette in direct oxygen flow, you're going to end up with a pile of ash in a matter of a few seconds.  Is it possible to start a fire with a cigarette?  Of course, but the chances are extremely low outside of sticking the cigarette directly into something flammable (bedding, trash can, etc) and if you're wanting to dance on the matter of the scenario you are presenting, I am more than game for that.  

Honestly, oxygen is a moot point in a vehicle fire.  It's not going to increase the rate of burn significantly (due to dilution of the oxygen in the atmosphere more than a couple of inches from the valve) and if you're not out of the vehicle by the time the tank would cook off, you're going to be already dead due to the toxic products from everything else that has burned previously. 



> Just try to be a little less rude, there is no need for that.



I'll try but sometimes being blunt is the only way to get one's point across.


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## JPINFV (Apr 17, 2011)

usafmedic45 said:


> Well, you were told nicely by *JPINFV* that you were wrong.  You responded by trying to show that you're smarter than him.  I was being nice in my response.


Fixed that for you...


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## usafmedic45 (Apr 17, 2011)

JPINFV said:


> Fixed that for you...



Sorry...this whole being off caffeine thing isn't easy for me.


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## JPINFV (Apr 17, 2011)

Pittma said:


> actually you might want to add in the correction factors in order to correctly analyze the pressure due to the attractive IPF that occur with such a high pressure and ammount of gas:
> (P+[n^2a/V^2])(V-nb)=nRT



Rather irrelevant since no one is going to be calculating it out on the scene of a fire. The important concept is that pressure and volume are inversely related to each other and both are directly related to temperature. As temperature rises, volume and/or pressure also increases. 



> But, sorry to use a relevant example to explain how dangerous and volitile these tanks are. Smoke in the ambulance, accidently leave a regulator open, and for some crazy reason you create a fire, then you have that exact same situation. I'm not saying smoking in an ambulance is a guaranteed way to get your limbs blown off...but I wouldn't want to try to see what it takes.



Assuming someone is smoking in the back and starts a fire, why would they wait around while the fire spreads and the back heats up for the tank to explode? It's not like exposed to fire->explode sequence is a short sequence.


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## lightsandsirens5 (Apr 17, 2011)

Ok peoples.....original question was not about gas laws, combustion,  cigarette ash temperature or anything like that. Lets get back on track.


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## Lucy212 (Apr 23, 2011)

*Update:*

Hi everyone,

    I did a little bit of everything you all advised. I spoke to the EMT himself, I did go to a supervisor and I also asked for advice from other EMTs/Medics at the hospital.

     In my conversation with the EMT, he's made it clear that he sees no point in me or anyone else on "his" bus except his partners. He believes my first job should not be at a hospital, I should start off even lower and just do patient transport where vitals/oxygen/or even questioning the patients are not a big part of the job description. 

     Shortly after that I had almost no choice, so I went to one of the two EMS Supervisors and did not "RAT" him out, but did kindly explain I was not learning much on that tour, and that opportunity for hands on is very minimal more often than not. The Supervisor has given permission to work at other times and even jump on ALS units, so that I can do the EMT things on those calls. He was very open and receptive to my concern.

     Thirdly, some of the other crew at the hospital have just advised me to avoid him if I can. One of them has been kind enough to even tell me when this EMT works so that I am able to come in on another night of the week and still do an evening tour.

     Everything seems to be working out okay right now. I don't know what, if anything will happen with this guy. Others know he smokes on the bus, all of them know he can be quite demeaning when he wants. I'm even told the Supervisor's know about some of his behaviors. 

     Thanks again everyone for helping/hearing me out. 

~ L


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## medtech421 (May 5, 2011)

lightsandsirens5 said:


> Ok peoples.....original question was not about gas laws, combustion,  cigarette ash temperature or anything like that. Lets get back on track.



That seems to happen quite a bit in these forums.  Great visual aide!  
OP- Glad things are working out for you.  Unfortunately, in a field where lives are literally at stake there seems to be many people wanting to attack one another more than educate, support, and guide the new people.  Firefighters and police officers are members deep-rooted brotherhoods.  They will haze the rookies a little but overall, they want to make sure the young person gains the skills to do the job effectively and efficiently.  There are a few people in EMS that will do this for you, but mainly EMS workers eat their young.  You will notice in this very forum people will attack one another if one has a differing opinion than another.  Patience with the PARAGOD or EMT-MD will take you far.  You can learn alot from a dummy.  Like how to treat a 3rd rider when you are the senior member on a truck in a few years.


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## mspazz (Jun 11, 2011)

You're part of the service even if your volly.  Grab a BP cuff and a steth and go to town on the vitals.  If he doesn't like it let him whine and keep doing it.  Let him go tell a sup that he is being a power hungry turd and get his own self in trouble for being a douche.


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