There are plenty who … claim to be competent at intubation even though their last intubation was months ago on the third attempt and if the patient had not already been dead – that would have finished the patient off …

- Rogue Medic

Deadpool – maybe it only hurts when you laugh, but you laugh anyway


What if you took an extremely sarcastic person and made him a god? You could have a triple R rated success.

Horace Walpole has a great quote, that seems to baffle the sanctimonious –

The world is a comedy to those that think; a tragedy to those that feel.

Jonathan Swift and Lewis Carroll might regret that this movie only skims the surface in its satire, but they had to use satire to avoid prosecution for blasphemy, heresy, and other thought crimes that are trying for a comeback.

Marvel vs. DC. iPhone vs. Android. Fire vs. private vs. hospital. Little-Endian vs. Big-Endian and High Heels vs. Low Heels.[1] Mine is the One True WhateverTM.

Deadpool kneel before Zod sign 1a
Best still of Deadpool at Comic Con



Election season is the perfect time for Deadpool to be in theaters, because the preachers, pundits, and politicians are more absurd and obscene than anything in the movie.

Satire is a sort of glass wherein beholders do generally discover everybody’s face but their own; which is the chief reason for that kind reception it meets with in the world, and that so very few are offended with it.[2]


Deadpool doesn’t even try to fit the right wing or left wing politically correct model. The preachers, pundits, and politicians claim that the greater obscenities they promote are virtues. Perhaps they are so ridiculous, they no longer need others to ridicule them.


Alice laughed. “There’s no use trying,” she said: “one can’t believe impossible things.”

“I daresay you haven’t had much practice,” said the Queen. “When I was your age, I always did it for half-an-hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”[3]


We should soon see an honest emulation among the married women, which of them could bring the fattest child to the market. Men would become as fond of their wives, during the time of their pregnancy, as they are now of their mares in foal, their cows in calf, or sow when they are ready to farrow; nor offer to beat or kick them (as is too frequent a practice) for fear of a miscarriage.[4]


If you work in a medical field, you should have seen enough misery to have an appreciation of a dark sense of humor and an understanding of the fraud of treating others as less deserving because they are in some way different.

A world of collateral damage is a comedy. Some of us keep going for the even bigger laugh of the bigger body count.

A world of starvation is a comedy. Some of us oppose using GMOs (Genetically Modified Organisms) to prevent the even bigger laugh of the bigger body count.

A world of death by preventable illness is a comedy. Some of us oppose using vaccines to prevent the even bigger laugh of the bigger body count.

The truly twisted sense of humor is not the obscenity in this movie, but the sanctimony of those encouraging killing, in the name of whatever, while claiming to be good.


[1] Part I, Chapter IV
Mildendo, the metropolis of Lilliput, described, together with the emperor’s palace. A conversation between the author and a principal secretary, concerning the affairs of that empire. The author’s offers to serve the emperor in his wars.
Gulliver’s Travels into Several Remote Nations of the World (1726)
Jonathan Swift
The University of Adelaide Library
University of Adelaide
South Australia 5005
Chapter IV

For,” said he, “as flourishing a condition as we may appear to be in to foreigners, we labour under two mighty evils: a violent faction at home, and the danger of an invasion, by a most potent enemy, from abroad.


[2] The Preface of the Author
A Full and True Account of the Battle Fought Last Friday Between the Ancient and the Modern Books in Saint James’s Library. (1704)
Jonathan Swift
The Literature Network

[3] Chapter 5: Wool and Water
Through the Looking-Glass, and What Alice Found There (1871)
Lewis Carroll (Charles Lutwidge Dodgson)
The University of Adelaide Library
University of Adelaide
South Australia 5005
Chapter 5

[4] A Modest Proposal for preventing the children of poor people in Ireland, from being a burden on their parents or country, and for making them beneficial to the publick (1729)
Jonathan Swift
The University of Adelaide Library
University of Adelaide
South Australia 5005
Full Text


Why We Need Blasphemy Laws

The people promoting blasphemy laws are telling us that they believe their gods are impotent in the face of criticism.

The gods don’t enforce blasphemy laws, so people have to correct that mistake of the gods.

“We have killed Charlie Hebdo. We have avenged the Prophet Mohammad.” – The claims of one of the murderers of blasphemous journalists. These claims were made while the murderers were bravely running away because their gods cannot protect them.[6]

Does anything mock the gods more than having to get people to kill in the name of the gods?

You can kill people, but you cannot kill ideas.

Charlie Hebdo cover following an attack by criticism of blasphemy – translation – “The Koran is shit at stopping bullets.”

Maybe the message is that the gods no longer care about criticism. Religion changes. We have tens of thousands of variations of Christianity just in America – and we aren’t even the home of Christianity. Many of America’s first settlers were fleeing persecution by Christians for slightly different interpretations of the One True GodTM.


Should Christians emphasize the part of the Bible where Jesus tells us –

34“Do not suppose that I have come to bring peace to the earth. I did not come to bring peace, but a sword. 35For I have come to turn

“‘a man against his father,
a daughter against her mother,
a daughter-in-law against her mother-in-law—
36 a man’s enemies will be the members of his own household.’[a]
37“Anyone who loves their father or mother more than me is not worthy of me; anyone who loves their son or daughter more than me is not worthy of me.
Matthew 10:34-37


Or should we ignore these parts and be more moral than the Bible commands in this and its other bad parts?

Is that sentence an example of blasphemy?

That depends on the reader. When quoting the Bible is blasphemous, is it a problem with the Bible, with the quote, with the intent, with the offense taken by the reader, or with something else?


Which Christians determine what is blasphemy to Christians?

Which Jews determine what is blasphemy to Jews?

Which Muslims determine what is blasphemy to Muslims?

Which Buddhists determine what is blasphemy to Buddhists?

Which Scientologists determine what is blasphemy to Scientologists?

Which Wiccans determine what is blasphemy to Wiccans?

Which Satanists determine what is blasphemy to Satanists?

If the Satanists blasphemy judges conflict with the branch of Christians established as the blasphemy judges for Christianity, can anyone break the tie without violating First Amendment?[2] Which part wins when there is conflict within an amendment?

Which is more important – protecting religion from the same criticism every other adult organization has to face or protecting the expression of ideas? If the ideas are unimportant, there is no need for laws or violence. If the ideas are important, suppression only protects the thoughtless and the willfully ignorant.


Our beliefs need to be protected against criticism, because we might start to think for ourselves.

If we can’t critically examine the tens of thousands of different, and amusingly contradictory, interpretations of the absolute truths of Christianity, how are we supposed to identify the one true version of the absolute truth? Religion is a multiple choice test question in which we are told that there is one best answer, but that those giving the test are not required to explain their answer in order to protect the validity of the testing process.[3]

It probably is the religion our parents raised us to believe, because we were given those parents for a reason.

When faith is weak, it must be protected with laws and violence. When faith is real, it doesn’t need to be petty and vindictive and immoral.

Federalist 10[4], Federalist 51[5]

Blasphemy is a crime in search of victims. Try to claim – I was blasphemed!  If you are not a god, your claim would be a blasphemy.

Blasphemy is a thought crime intended to discourage thinking.

Thinking is bad – Blasphemy laws are good.

Someone considers your freedom of religion to be a blasphemy against their religion. We need to help them impose their blasphemy laws on you. Then we can pretend that blasphemy laws will stop violent people from killing, just as gun laws stop violent people from killing.

12 people were murdered by a bunch of people who ran away, because they knew their gods would not protect them for supposedly defending their gods.

Undaunted by the gunning down of its leading cartoonists, the French weekly Charlie Hebdo plans to print a million copies next Wednesday, almost 30 times more than usual.

French media rallied around the satirical paper on Thursday, a day after militants killed 12 people as journalists held an editorial meeting, to ensure its next edition appears on time by offering funds and office space.[6]


We must impose blasphemy laws to protect ignorance. Ignorance appears to be sacred to the gods.

We must attack blasphemy to increase the circulation of blasphemous ideas.

The legitimate powers of government extend to such acts only as are injurious to others. But it does me no injury for my neighbour to say there are twenty gods, or no god. It neither picks my pocket nor breaks my leg. . . .

Reason and free enquiry are the only effectual agents against error. Give a loose to them, they will support the true religion, by bringing every false one to their tribunal, to the test of their investigation. They are the natural enemies of error, and of error only. Had not the Roman government permitted free enquiry, Christianity could never have been introduced. Had not free enquiry been indulged, at the aera of the reformation, the corruptions of Christianity could not have been purged away. If it be restrained now, the present corruptions will be protected, and new ones encouraged. . . .

Millions of innocent men, women, and children, since the introduction of Christianity, have been burnt, tortured, fined, imprisoned; yet we have not advanced one inch towards uniformity. What has been the effect of coercion? To make one half the world fools, and the other half hypocrites. – Thomas Jefferson.[7]



[1] Matthew 10:34-37
The Bible
New International Version (NIV)
Verses on

[2] First Amendment
US Constitution

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.


[3] Cognitive Examinations
National Registry of Emergency Medical Technicians
About NREMT Examinations

Consensus by the committee must be gained so that each question is in direct reference to the tasks in the practice analysis, that the correct answer is the one and only correct answer that each distracter option has some plausibility, and the answer can be found within commonly available EMT textbooks.


[4] The Federalist No. 10
The Utility of the Union as a Safeguard Against Domestic Faction and Insurrection (continued)
Daily Advertiser
Thursday, November 22, 1787
[James Madison]
Full Text

[5] The Federalist No. 51
The Structure of the Government Must Furnish the Proper Checks and Balances Between the Different Departments
Independent Journal
Wednesday, February 6, 1788
[James Madison]
Full Text

[6] Attacked satirical French weekly to print a million copies next week
by Tom Heneghan
Paris Thu Jan 8, 2015 1:02pm EST

[7] Notes on the State of Virginia.
by Thomas Jefferson.
Edited by William Peden.
Chapel Hill: University of North Carolina Press for the Institute of Early American History and Culture, Williamsburg, Virginia, 1954.
© 1987 by The University of Chicago
Free Full Text at The University of Chicago


Belly flops with cliches, proves he’s a Satirist (You have a dirty mind if you’re thinking what I think you’re thinking this means)


What happens when EMS becomes so distorted that it is embarrassing?

Things get silly.

Image credit.

By silly, I mean the satire starts off simply, but then becomes a multi-layered satire that deserves its own Wikipedia page. There is no page, yet, or is there?

Kelly Grayson started us off with an article about EMS cliches.

From the blank stares I got from all assembled, I realized that none of them had ever seen Bull Durham. So while I educated them in the Tao of Crash Davis, I started thinking about the clichés we spout in EMS. Every cliché has at its root a central truth; that’s how they get to be clichés in the first place.

But nothing is so good as a well-placed cliché as a substitute for real wisdom and knowledge. Just insert one of these babies into a social media comment thread and watch the “Likes” pile up!

. . .

If you learn to use these simple EMS clichés, I guarantee that you will develop a reputation as a paramedic sage in no time. Especially to people who don’t know better.[1]


You’re going to have to read the full article yourself. Polonius would have been skewered several acts earlier if Kelly had been there, but this gets better.

Then Happy Medic turns up the satire by responding to Kelly.


8. “We cheat death.” We do, daily! I have a T-shirt with the Grim Reaper being slapped in the face by a bad ass medic with sunglasses and everything. You are so narrow minded you can’t see how we bring the dead back everyday. Epi works Kelly![2]


Go read the rest, too.

Ridicule is the only weapon which can be used against unintelligible propositions. Ideas must be distinct before reason can act upon them; – Thomas Jefferson.

Finally, Tor eckman takes it to Eleventy!!11!!! in the comments.

I also teach them to think and look for clues on scene, like just last week I got to see the lights come on in this “newb” Paramedic when he wasn’t going to spinal a patient in a MVC until I had him walk down the bank and look at the car, after seeing the mechanism he came back up, told the patient that he was lucky he wasnt paralyzed for walking up the bank. We did a standing take-down right then and there. By the time we got to the hospital the pt had pretty bad back pain, can you imagine if we hadn’t put him on the backboard? lawsuit. So go ahead and make fun of the noobs, I’ll take them and teach them.[3]


I think that someone should Call the Cops for all of this abuse of the witless, because the giggles just keep on coming.

Maybe this is an example of Poe’s law (a legitimate comment from some person who is so blind to their bias that they do not notice the self-parody)?[4],[5]

Maybe, but Tor eckman[6] is a character from Seinfeld. Tor eckman is a ridiculous alternative medicine practitioner, much like our ridiculous EMS providers who do not understand what it means for a treatment to improve outcomes.

Go spend some time reading the comments on social sites and you will see that this might not be satire, but somebody should take credit for it if it is satire – and somebody should be ridiculed for it if it is not satire.


[1] The stupid EMS cliche usage guide – Using phrases like ‘We cheat death’ is so much easier than actually thinking
September 30, 2013
The Ambulance Driver’s Perspective
by Kelly Grayson

[2] Kelly Grayson belly flops with cliches, proves he’s a Noob
Happy Medic
October 3, 2013

[3] Tor eckman’s comment
Kelly Grayson belly flops with cliches, proves he’s a Noob
Happy Medic
October 3, 2013

[4] Poe’s law

Without a blatant display of humor, it is impossible to create a parody of extremism or fundamentalism that someone won’t mistake for the real thing.


[5] Poe’s law

The site’s description of Poe’s law appears to qualify as a parody of extremism or fundamentalism that someone won’t mistake for the real thing. Or is it the real thing that someone will mistake for parody?

Will Andrew Schlafly wait until his mother is dead before he admits that he was just trying to please his mother, just not as violently as Norman Bates? Or is he the real thing that someone will mistake for parody?

[6] The Heart Attack


Blogging and Anonymity

CCC – Captain Chair Confessions writes anonymously.[1] Is that bad?

Are we so incapable of assessing the content of the blog, that it only becomes relevant when we can attach a normal looking name to the blog, no matter how fictitious that name might be?

I don’t put my name on my blog.

Does that change the validity of the research I write about?

What about when I criticize someone? Is that criticism less valid than if I put a name on my blog?

I criticize some big companies. None of them have contacted me about any kind of libel suit, or any kind of slander suit for any of the podcasts I have been on.

My email is right there in the upper right of the blog. I have always has been.

People think that attaching a name to something gives it accountability.

Oprah Winfrey has made a career of giving a stage to frauds – Deepak Choprah, Jenny McCarthy – even Dr. Oz is promoting nonsense. There are plenty of others.

We know their names, but they are frauds.

Where is the accountability for all of the fraud that has come from her show?


Deepak Chopra is one of the highest paid entertainers in the US.

There is a lot of discussion of Mitt Romney and Barack Obama. They use their names. Does anyone think that both of them are trustworthy?

What about Michael Moore and Rush Limbaugh? They are both famous liars, who will distort anything to make a political point. Having their names on their lies doesn’t seem to encourage them to behave ethically.

Requiring a name on a blog is like requiring a medic to make the magic phone call to a medical command doctor. It has the appearance of making things better, but none of the substance.

This is a salve for the people who are not capable of determining what is real – people who think that a good argument for something is, What if somebody sues?

Does the blog identify an employer?

Does the blog portray that employer in a negative light?

Is the blog encouraging people to abuse patients?

There are many similar questions that may be asked.

There are a variety of ways of answering some of these questions.

The most important question is does this blog get me to think about what I do, so that I want to be better at patient care?


The problem is not anonymous blogging.

The problem is people who want to discourage views, but don’t have any valid criticism of those views.

Medicine and EMS are very traditional. We need to destroy those traditions and start doing what is best for the patients.

Organizations that harm patients in order to do what they think protects them from liability need to be criticized.

During the creation of the United States of America, there were plenty of discussions about the way the government should be set up. The Federalist Papers were written under the pseudonym Publius.[2] We still do not know who wrote some of the essays. The contrary position was taken in the Anti-Federalist Papers, written under the pseudonyms Cato, Brutus, Centinel, and Federal Farmer.[3]

If an anonymous blog is not good enough for you, buy some tissues and go whine somewhere else.

I am proud of my fellow anonymous and semi-anonymous, bloggers.

I am embarrassed by people incapable of substantive criticism, who resort to sniveling about anonymity.

It is not about agreement, or disagreement, but about getting ideas out there to move medicine, and EMS, forward.

By the way, I seem to have pointed out that anonymity is traditional. Darn, I wrote something positive about tradition.

Anonymity IS free speech.

Free speech is progress. Obstructing free speech is bad for patients.

Lead, follow, get out of the way, . . . .

Creative destruction is progress.[4] Without creative destruction we would not be communicating with computers (and your cellular phone is often a computer).


[1] A blogger outed
Captain Chair Confessions
September 7, 2012
By the anonymous CCC

[2] Federalist Papers

[3] Anti-Federalist Papers

[4] Creative destruction


Supraventricular tachycardia induced by chocolate – is chocolate too sweet for the heart?

Apparently chocolate, which is an adenosine antagonist, has the potential to cause arrhythmia.

Actually, the methylxanthines in chocolate are the adenosine antagonists (theobromine and caffeine), but it is the theobromine that appears to be what we (I) crave about chocolate. Should I give up chocolate or get an implanted defibrillator? While there is also caffeine in chocolate, only wimps get addicted to caffeine. That headache is just because people are more annoying without caffeine. The caffeine consumption is completely under control.

An otherwise healthy 53 year old woman consumed a lot of chocolate. The amount is stated to be a box, but we chocoholics do build up a tolerance.

Electrocardiogram showed supraventricular tachycardia at 165 beats per minute, which was restored to sinus rhythm after adenosine bolus injection.[1]


6 mg?

6 mg followed by 12 mg?

6 mg followed by 12 mg followed by another 12 mg?

We don’t know.

Image credit.
And throw in a six pack of adenosine,
A man’s got to know his limitations.


My inner woman has an old soul, so we gots to know – are we endangered by the chocolate I am currently consuming in supratherapeutic quantities?

While it may be easy to have too many medics, it is blasphemy to suggest that one can have too much chocolate.

Electrophysiology studies showed atrioventricular nodal reentry tachycardia, which was treated with radiofrequency ablation.[1]

A conduction abnormality that was previously undetected? And it is blamed on just a few dozen pounds of chocolate?

The family stated a box of chocolate, which they considered to be a lot, but the family may be unenlightened, when it comes to chocolate.

There are occasional case reports describing association between chocolate, caffeine, and arrhythmias. A large Danish study, however, did not find any association between amount of daily caffeine consumption and risk of arrhythmia[1]

Clearly this is propaganda paid for by Big Caffeine!

Vitals were temp, 98.0; pulse, 150 beats per minute; blood pressure was 87/57 mm Hg; respiratory rate, 25 breaths per minute. Electrocardiogram showed paroxysmal SVT at 165 beats per minute (Fig. 1).[1]

Click on images to make them larger.

Patient was later transferred to the cardiac electrophysiology laboratory of New York Methodist Hospital. Protocols included decremental pacing and programmed stimulation; AV nodal reenterant tachycardia was easily induced and reproducible.[1]

I suspect that the rhythm was induced without chocolate. While the chocolate may have been a contributing factor, this does appear to be an interesting possibility, rather than a effect that has been demonstrated.

I may be more likely to have palpitations when anticipating chocolate, than after consuming that nectar. After all, I’m just trying to get well.

The authors also mention that research suggests that moderate amounts of chocolate (not enough chocolate) can be good for the heart.

A recent study published in the European Heart Journal showed that chocolate
consumption of about 7.5 g/d was associated with a 3.9% lower risk of myocardial infarction and stroke [1]. The risk reduction was attributed, in part, to lowering of blood pressure. Much of the benefits are attributed to flavonoids in chocolate with release of nitric oxide, lower blood pressure, and improvement in platelet function.


Hello dark chocolate, my old friend.


[1] Supraventricular tachycardia induced by chocolate: is chocolate too sweet for the heart?
Parasramka S, Dufresne A.
Am J Emerg Med. 2012 Sep;30(7):1325.e5-7. Epub 2011 Aug 25. No abstract available.
PMID: 21871761 [PubMed – in process]

Parasramka S, & Dufresne A (2012). Supraventricular tachycardia induced by chocolate: is chocolate too sweet for the heart? The American journal of emergency medicine, 30 (7), 132500000-7 PMID: 21871761


Ray Bradbury Dead

Ray Bradbury died on Tuesday, but we can still listen to him read his most famous book. Fahrenheit 451. This is a wonderful experience in part because he still cared so much for the material so many years later.

This was written several years ago –

Bradbury still has a lot to say, especially about how people do not understand his most literary work, Fahrenheit 451, published in 1953.[1]

We have been missing the point, but what is the point?

HE SAYS THE CULPRIT in Fahrenheit 451 is not the state — it is the people. Unlike Orwell’s 1984, in which the government uses television screens to indoctrinate citizens, Bradbury envisioned television as an opiate.[1]

Bradbury imagined a democratic society whose diverse population turns against books: Whites reject Uncle Tom’s Cabin and blacks disapprove of Little Black Sambo. He imagined not just political correctness, but a society so diverse that all groups were “minorities.”[1]

Not being offensive has become a religion to many. This has resulted in a rebellion by some people of all political persuasions being offensive in large part for the sake of being offensive.

Maybe we do not need to go out of our way to be offensive, but do we need to stop going out of our way to avoid insulting idiots. When people make ridiculous statements, ridicule is appropriate. Pandering to fools is not appropriate.

When we pretend that there is anything too important to be criticized, we ridicule that which we try to protect, whether it is a spouse, a country, a religion, or anything else. Our desire to protect the image from reality is ridiculous.

Here are some samples from Fahrenheit 451. There is an audio book version read by Ray Bradbury, that is certainly worth listening to.

We need to be really bothered once in a while. How long is it since you were really bothered? About something important, about something real?

We must all be alike. Not everyone born free and equal, as the Constitution says, but everyone made equal. Each man the image of every other; then all are happy, for there are no mountains to make them cower, to judge themselves against.

Colored people don’t like Little Black Sambo. Burn it. White people don’t feel good about Uncle Tom’s Cabin. Burn it.

So few want to be rebels anymore. And out of those few, most, like myself, scare easily.

If you hide your ignorance, no one will hit you and you’ll never learn.

the most dangerous enemy of truth and freedom, the solid unmoving cattle of the majority. Oh, God, the terrible tyranny of the majority.

Others die, I go on. There are no consequences and no responsibilities. Except that there are. But let’s not talk about them, eh? By the time the consequences catch up with you, it’s too late, isn’t it,

Books can be expensive, but reading does not need to cost anything. The following sites allow access to free books, including the library, which may have the latest best sellers as well as the classics.

eBooks @ The University of Adelaide

The OnLine Books Page at UPenn

Project Gutenberg

At your local library you can find out how to use a library card to download current copyright protected audio books to a computer or MP3 player. These downloads have a limited life (a couple of weeks) before they are no longer useful.

These books are free to use.

Even I can afford them.


[1] Ray Bradbury: Fahrenheit 451 Misinterpreted – L.A.’s august Pulitzer honoree says it was never about censorship
By Amy E. Boyle Johnston
Wednesday, May 30 2007


Round 2 of Happy Medic’s Rules for Kidnapping

Also see Medic 51, who apparently started this whole topic with the well written Kidnapping Patients.

Happy Medic comments on Happy Medic’s Rules for Kidnapping, in which I commented on Kidnapping – The Cowtipping of EMS

All excelent points Rogue. I think you expanded on my post however. My post refers to the patient who agrees to be seen, yet refuses to be seen at an appropriate facility for their chief complaint. Many would argue that it is a cut and dry kidnapping since I took them somewhere besides their intended destination. If so a number of cab drivers are in for a shock!

If a cab driver tells a person that the cab driver knows where they need to go and the cab driver is taking them there regardless of the person’s ability to make decisions for himself, then it is wrong and probably illegal.

Whether EMS is engaging in kidnapping or some other form of abduction by using our authority to coerce people is for a court to decide.

Agreeing to be treated is not the same as agreeing to be treated by whomever we want to treat the patient, or being treated wherever we decide to transport the patient.

The patient does have the right to give informed consent/refusal to each individual treatment and to transport. Consent to one part of treatment does not require consent to all of treatment and transport.

Consent is à la carte.

I may agree to let you check my rhythm on a monitor, because of an irregular pulse. That does not give you consent to give me amiodarone for couplet PVCs. It may be in your protocol to automatically treat couplet PVCs, but you still need my consent as long as I have the capacity to make informed decisions for myself.

My desire to avoid this treatment and your desire to follow protocol may be at odds, but that does not give you any authority to treat me against my will.

I expanded on my “already transporting” post in a comment where I expanded and mentioned the comments you refer to in large red letters. And I agree with 1/2 of what you have Happy saying. In the event I assess a condition that warrants further evaluation I am the expert in that situation, not the patient. If someone needs to be seen and refuses I make my best effort to convince them. We can all agree that is step 1. Then it’s onto the “seizure, coma death” talk to try to scare them, but that could in some circles be seen as intimidation. Then we do the medical control route and turf the decision to an MD who has no more authority to force a patient to the hospital without court order than I do.

We are the experts. OK. Then we should be able to convince the person, as experts. We should not behave as thugs.

Can we convince the person without resorting to the What if . . . ? stories?

Let me rephrase that – Can we convince the patient with an informed discussion of the real possibilities, without resorting to scare tactics that in EMS are often based on an arrogant misunderstanding of medicine?

If we cannot, is that a sign of a mental defect on the part of the patient, a sign of a mental defect on our part, or a sign of something else – perhaps just a sign of a reasonable disagreement?

What is needs to be seen?

What need?

What evidence do we have that this person does not have a better understanding of what is the best treatment than we have?

So, where does that leave us?

That should leave us at the destination the person requested, unless we have honestly changed the person’s mind.

A person presents with a medical or traumatic condition, they are a patient. I must assess, treat and reassess, transporting when indicated. If the person refuses we do our best to convince them of the best care plan.

As long as the person has the capacity to make informed decisions, that person can refuse any part of, or all of what we are offering.

Offering? That makes it seem as if we are providing a service to people, rather than the people being there to meet our needs.

You mention, “If this is right, why can’t you convince a person, who has the capacity to make informed decisions, that this is a good idea?” Because they are making a financial decision, not a medical one most times (situational dependant obviously).

Maybe some people are making financial decisions. Do our rights have an exemption for people who are considering the financial consequences of their decisions?

Why is a financial decision the wrong decision?

If the pperson is having cardiac chest pain, and is very worried about finances, is it good patient care to increase their stress level by forcing something unwanted on them?

Are we causing more harm than any potential benefit?

If not, on what do we base that claim?

If a patient refuses care but can’t stand, walk, reach a phone and has a condition that warrants further treatment, we are shifting from perceived to actual liability. Gathering a signature and saying goodbye is not in their best interests if we’ve gotten this far.

None of those are mental disqualifications from making an informed decision.

If the person does have the capacity to make informed decisions about his care, then what law permits us to abduct the person against his will?

But it is not kidnapping. That is the point I’m trying to get across.

Does it matter what we call this?

Is this wrong?

A rose by any other name would smell as sweet.

Abduction might not be kidnapping, but that does not make it right.

Continued in –

Round 3
Round 4


Happy Medic’s Rules for Kidnapping

Happy Medic does not like the use of the term kidnapping for taking a person from one place, against the person’s wishes, to a place where Happy Medic believes the person will be better off. The person has the capacity to make informed decisions for himself, but Happy will not have that. Happy knows best.

Is this kidnapping? Maybe, technically, this does not meet all of the criteria to be convicted of kidnapping in a courtroom, but that does not even come close to meaning that abduction of people against their wishes, for purposes that the person believes to be nefarious, is not a crime.

Kidnapping – The Cowtipping of EMS

If what is best for the person is that obvious, then why can’t Happy convince the person?

If the person does have the capacity to make informed decisions, then maybe it is Happy who lacks the capacity to make informed decisions for that person?

We are told not to disobey the patient and do what they say, take them where they want, and 95% of the time that works out just fine. Your stomach hurts? Sure we can goto St Farthest. Your leg itches again? Kaiser patient, not a problem. Trauma patient wants to goto St Farthest? Aren’t we supposed to be patient advocates and do everything we can for them?

That depends on what we mean by doing everything we can for them.

Why is it so difficult to get a person to agree that we are doing everything we can for them?

Why isn’t consent a part of doing everything we can for them?

In the pilot episode of Beyond the Lights & Sirens, I had a conversation with a regular named Val. She presented with chest pain, 10/10, radiating, with history, a mere 10 blocks from an appropriate facility. Her requested facility, 2 hospitals and 25 minutes away was on saturation divert, or no longer accepting patients by ambulance. I transported her, per chest pain protocol, to a hospital that was not her requested facility. No kidnapping charges were filed.

It isn’t a crime, as long as charges aren’t filed and the bosses don’t complain?

It isn’t wrong, as long as charges aren’t filed and the bosses don’t complain?

If this is right, why can’t you convince a person, who has the capacity to make informed decisions, that this is a good idea?

Perhaps we should spend less time worrying about vague definitions that don’t apply and spend more time in the airway lab?

Maybe we should improve our ability to explain to people what might be in their best interest and stop assuming that our patch entitles us to claim that we know more than the person knows about what that person would want if given all of the relevant information.

Almost all of us should also spend more time in the airway lab, but that has nothing to do with obtaining informed consent from a person who does have the capacity to make informed decisions for himself.


Of course, you need a blood-letting. I know what is best for you.


Continued in –

Round 2
Round 3
Round 4