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Thu, 3 Jul 2003 11:16:08 -0700 (PDT)

Wow.  I'm not sure that a response here is even
necessary, as Craig's post clearly speaks volumes for
itself...  

But since it seems some are misinterpreting my words
let me just set the record straight.  My posts were
never about whether paramedics were PHYSICALLY or
INTELLECTUALLY capable of cutting another person with
a knife.  There is no question that they are.  So
please stop whining that I am picking on you for being
dumb or misunderstood or underappreciated, you are
none of those things.  I validate your importance. 
Save your insurance company some money and cancel the
appointment with your therapist.  

That said, one cannot dismiss the fact that limits
must be set on what people with a particular level of
unvisualized dependent practice with a particular
level of formal education should be allowed to do.  In
terms of cutting on people, anything more than the
RARE emergent cric under DIRE cirumstances should NOT
be allowed.  Diagnosis and treatment algorithms are
tough enough for experienced fellowship trained trauma
surgeons in IDEAL settings.

If you want to wield a knife and call the shots, my
advice to you is the same as it is for Dr. Crowe: 

Go back to school.

Ben

--- Craig Pierre <cpierre@nbnet.nb.ca> wrote:
> Kudos Terry,
> 
> There may be a few questions that need to be asked
> in these situations.  Why
> is it that the Paramedical Profession seems to be on
> the forefront of
> teaching these emergency skills.  Its because our
> exposure to situations
> needing immediate intervention happen quite readily.
>  We haven't the liberty
> of nice theatres for operation or being able to
> control our environment.
> Some ppl cannot fathom the wealth of knowledge from
> this area of medicine.
> yet they bock at it..  But the best part is we get
> to rise above the
> ignorance.  Paramedicine is respected amongst those
> that matter....the ppl
> that we serve and those that receive our patients in
> good order.
> Beware Dr. Aneurysm if you trek through some CV's of
> your colleagues the
> well versed and highly regarded generally have some
> field skills to add to
> the diversity.
> Keep up the good work.
> 
> Craig Pierre P3,FP
> ----- Original Message -----
> From: "T.A. Dinerman" <dinerman@computron.net>
> To: <trauma-list@trauma.org>
> Sent: Wednesday, July 02, 2003 4:40 PM
> Subject: Please Wash Your Hands Before You Cut My
> Throat
> 
> 
> > Ben-
> >
> > I am deeply sorry that you are so uncomfortable
> with the concept of minor
> > surgical procedures being placed in the hands of
> us dirty ol'
> > Paramedics...........
> >
> > If the occassion arose and my own airway was in
> such a sad state of repair
> > that I  coudl not be intubated, I would welcome
> the attention of  Dr.
> Crow.
> > His broad experience with mamaillian physiology
> and experience with a
> knife
> > gives him a decided edge over those of us who
> specialize solely in
> hominids,
> > and run into a truly mangled airway only
> infrequently.
> >
> > Please endevour to avoid injury in Brazoria County
> Texas, as well  as
> Carson
> > City, for me and my ilk lie in wait for such as
> ye.......
> >
> > Regards-
> >
> > Terry Dinerman EMTP
> >
> >
> > ----- Original Message -----
> > From: "Ben Reynolds" <aneurysm_42@yahoo.com>
> > To: <trauma-list@trauma.org>
> > Sent: Tuesday, July 01, 2003 7:36 PM
> > Subject: Re: Video education
> >
> >
> > > You are a very scary man.
> > >
> > > >From reading your posts it is apparent to me
> why you
> > > practice only on animals (with the exception of
> your
> > > EMT practice).  If you are truly interested in
> > > performing surgical procedures on the species
> sapiens,
> > > I humbly suggest medical school.
> > >
> > > Until then, do MANkind a favor by recognizing
> that
> > > even the best and brightest of paramedics MUST
> have
> > > limitations on practice, not unlike all
> professions
> > > INCLUDING surgery.  These limitations must
> include any
> > > procedure where a knife is put to flesh,
> ESPECIALLY if
> > > it is to be done in the back of an loud, bumpy,
> dirty,
> > > poorly lit, poorly equipped ambulance by someone
> who
> > > has been 'tested off' to do it after
> successfully
> > > completing the 'see one, do one, teach one'
> symposium.
> > >  The variable phenotypy of trauma disease in
> humans is
> > > not something which can lend itself to be field
> > > treated per say on the observation of someone
> who
> > > doesn't do it several times a day, INCLUDING
> those who
> > > treat canine, bovine, porcine, and feline
> patients.
> > >
> > > It's simply not the same animal.
> > >
> > > Note to self:  Don't get hurt in Carson City.
> > >
> > > Ben
> > > --- CROWEHOME@aol.com wrote:
> > > > Kate: I have some very good video on
> performing
> > > > surgical trachs and emergency
> > > > thoracotomies on the cadaver dog that I use to
> teach
> > > > emergency vets,
> > > > residents, EMTs, paramedics, etc.  Let me know
> if
> > > > you would want copies. This is my
> > > > concern however.. there seems to be a big
> problem
> > > > with developing these tapes if
> > > > many of the trauma surgeons can't agree on the
> roles
> > > > each part of the team
> > > > should play.  At least here in the USA.  As an
> > > > example we have some that say
> > > > "never should a surgical trach be done in the
> field
> > > > by paramedics" while others
> > > > teach and expect their paramedics to be doing
> such
> > > > procedures and then these
> > > > are done!  I believe you still need to train
> the
> > > > trainer including some that
> > > > think its only their way that is correct (as
> > > > exemplified by the last two weeks of
> > > > dialog on the list). My thoughts are that when
> there
> > > > is no time for the
> > > > patient to make the trip to the hospital ER as
> will
> > > > a blocked airway that cannot be
> > > > remedied with Magill Forceps and laryngoscope
> that a
> > > > surgical CT or trach
> > > > should be done NOW as other wise the patient
> is
> > > > going to be a dead patient!  You
> > > > better train those that are going to be there
> so
> > > > they can save the patient's
> > > > life and not have complications from doing it;
> > > > whether it be flight physician,
> > > > EMT, paramedic, nurse or other rescue
> personnel. You
> > > > don't have to be an MD or
> > > > DO to place a chest tube or do surgical
> tracheotomy
> > > > (as is what has been
> > > > proven in many rural areas of the US where the
> MD in
> > > > charge of the paramedic/EMT
> > > > training have been aggressive). You just have
> to be
> > > > trained properly and
> > > > regularly and then tested off that you can do
> the
> > > > procedures rapidly and safely.
> > > > Let me know.
> > > >
> > > > Dennis T. (Tim) Crowe, Jr., DVM, DACVS,
> DACVECC,
> > > > NREMT-II PI, FF
> > > > Veterinary Surgery and Emergency - Critical
> Care
> > > > Consulting
> > > > 2621 Simons Court, Carson City, Nevada 89703
> > > > phone and fax 775-841-6821  crowehome@aol.com
> > > > <><
> > > > Clinical Associate Professor, The Institute of
> > > > Critical Care Medicine
> > > > 1695 N Sunrise Way, Palm Springs, CA 92262
> > > > 760-788-4911
> > > >
> > >
> > >
> > > __________________________________
> > > Do you Yahoo!?
> 
=== message truncated ===

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