Health,

No one is lying, you said such an article exists, (you have not yet produced the article), I pointed out that the dynamics are different. Comprehension my friend.

With the call volume, you call me a liar, but then say you doubt.. you either know or you do not.

Regarding the multi-tiered system, Is that your opinion or is that the consensus? Does it make sense to tie up an ALS only crew for a BLS call when a different ALS crew has to cover the next call in the area?

The progressive systems have two-tiered systems, such as Kings county medic one, it makes sure that there are adequate resources available at all times, it also makes sure that the medics treat patients that require ALS care instead of being tied up with patients that can adequately be managed by BLS, they can also downgrade the patient to BLS after appropriately assessing the patient, so they are exposed to more higher acuity patients and retain their skills and knowledge.

To put it in context, even on a busy shift, a single tiered ALS truck can respond to BLS only calls, vs a tiered response system would have these medics respond to ALS only calls. Which means more experience and more exposure to sicker patients. As Hatzolah does.

Why would someone say that compassion and dedication is inferior to a small paycheck? in fact, if compassion and dedication are lacking the care is probably watered down.

A lot of healthcare facilities in the areas that Hatzolah covers use Hatzolah as their primary EMS agency in an emergency, they do this by choice.

Health – if you have the article point to it. I highly doubt that there is such an article that discusses the dynamics of Hatzoloh for many reasons.

1) there are no other volunteer ALS agencies.

2) most volunteer agencies have 18 year olds or 70 year olds on the active roster. Hatzolah has middle aged people, many of them having a lot of years of experience.

3) Unlike the majority of volunteer BLS agencies, Hatzolah has a robust system with many of its members that are otherwise involved in the medical industry, including working for other EMS agencies as paid personnel, nurses, PAs and even doctors.

Health, can you explain this better?

Not sure why my post was removed, (had to be visible for some time as CAD responded to it).

Yet I find it weird that one who practices medicine would not know the off label uses for albuterol, its pretty common stuff.

I would think that terbutaline would be given as a tocolytic instead of albuterol.

Not really sure what the issue with this article and video is. It is self understood that when someone enters the race for any political office especially the presidential office their every move will be scrutinized and publicized. Where ever they might be going or whatever they will be doing, there will always be cameras clicking and recording.

Furthermore, she appears to be a bit frail and is not just being helped up to a normal walking position. The video starts off with her already being assisted, after the slip she gets additional assistance and continues the walk while being assisted from both sides, (like a rebbe..).

What would be interesting is to calculate how many generations or years it would take to reach the current world population.

If we believe that we can understand Hashems ways, that would mean we are limiting Hashem to only what our minds can grasp, when in reality its way greater than we perceive.

What might seem like a tragedy might turn out to be for our benefit.

Its not right to poke fun at any community and especially not if Chabad as it is not possible to deny all the good stuff that they do, some of which all yidden are able benefit.

To make a statement to CS about their Chabad house was highly inappropriate regardless if CS is a man or a women, SH pointed that out and he did not play the race card.

Some of the Chabad posters including SH seem to be pretty knowledgeable and provide decent sensible arguments. They did not invent none of this, they are following what they were taught and are willing to discuss this.

A lot of arguments and disputes were provided here, most of them in a very respectful manner. Insults, personal or about any community have no purpose.

No one will change their BELIEFS one way or the other.

The ‘Rebbe’ alive or not, meant/still means a lot to Chabad, to the point that even stuff he didn’t really say, just are able to be nut picked out of his words are considered by a lot to be non negotiable, for them it’s a big deal, regardless of how it can be interpreted.

To the Chabad people, if someone asks you for a source , by pointing them to a Sicha, you will not not accomplish anything, the rest of the world thinks the Rebbe was a big Tzadik, most have high regard for what he was and what he did, but that does not equal Navi, to them these concepts are dangerous and wrong. Did the Rebbe go around proclaiming he is a Navi or he was focused on building Yiddishkeit? Therefore the Sicha to them, is nothing more than a Sicha.

To the others, Chabad is not perfect and so aren’t any other community and chassidus, exposing every minor negative detail that can probably be just as well attributed to others serves no purpose, other than making this entire conversation negative.

I think that the Lubabitch posters have already made it very clear that they meant no disrespect for not including Rav or Harav.

Bashing has no place, this should be respectful discussion or debate. The majority of people hold that the Lubabitcher Rebbe was a Talmid Chachim and Tzadid, and Lubabitch in general does a great deal of good stuff.

I like how most of this discussion, with some exceptions has been civil and respectful.

A few questions,
The notion of the Rebbe being the 7th Rebbe have any source besides for what the Rebbe said?

This question has been asked before, but I will rephrase it. Is it possible for anyone else other than the Rebbe to be Moshiach?

Do you find it hard to understand why most people don’t follow your belief, mainly due to the fact that most of it originates from the Rebbe. While lubabitch considers the Rebbe to be more like a Navi, the rest of the world doesn’t share this belief. Therefore most stuff that explain why the Rebbe was or still is Moshiach, is not taken seriously.

While everyone is using the publicized mass shootings as an argument (regardless of which side of the argument they stand), what about the simple muggings?

Putting aside the argument of having regular people arming up and what public policy should be, what about the individual? is it reasonable for you or me, a regular civilian to carry a weapon?

It might not have prevented some of the publicized shootings, but wouldn’t it make the individual somewhat protected against any violence that might come their way?

Any other credentials other than your user name?

ubiquitin, My information comes from reading the government websites and the very few people that I know that needed surgical intervention.

However, I believe that the doctors, not the patients decide on what is an emergent procedure. From what I understand, once one is in the system they have to wait their turn.

I was involved and familiar with a few cases of which the patients were flown to the US from the UK for more advanced life saving treatments. One of those cases was even done on Shabboss. Over here the patient was able to get the care they deserved while back home they were not.

Is there any situation in which such behavior would be acceptable and appropriate?

Of course I know nothing about this incident and if there is any correlation between this alleged incident and what happened afterward to this girl.

But is there any line that this girl would cross that it would be justified for parents to put their foot down?

Health, the paragraph that you posted directly concerns EHS, not other heat related illnesses. cellular injury and death is only from heat stroke, not other illnesses.

I did not read every post here, but I found this Interesting Letter posted on the AAAAI (America Academy of Allergy Asthma & Immunology) website.

8/27/2013
As a pediatrician and mother of a child with peanut allergy, I have a million questions/concerns as I battle to keep my daughter safe from accidental peanut exposure. Why do allergists not recommend banning peanuts from schools? Being that the mainstay of treatment is avoidance and having epinephrine, it seems to me it is impossible to avoid peanut in our public elementary school environments. I have read that the likelihood of outgrowing peanut allergy is greatest before age 8, so the early elementary years are CRITICAL for peanut allergic children if we are to maximize their chances of outgrowing this allergy.

In my opinion, Allergists are contradicting themselves by recommending strict avoidance but not peanut bans in schools. Allergists claim that banning peanuts would give a false sense of security. I strongly disagree with this reasoning. Young kindergarteners should not be made exclusively responsible for their well-being. They are not mature enough to know where hidden peanut may lay or to keep their hands away from their mouths/faces. I believe it is UNSAFE to throw our tiny kids into peanut butter jars, which is what our schools are, and expect them not to be exposed. No wonder so few kids (15-20%) outgrow their peanut allergy. Where is the evidence-based medicine that proves that banning peanuts from school is not helpful for avoidance? I haven’t found it. I know there will be parents who will not comply with the peanut ban, but most will. Reducing the peanut content in our kids’ environment will still be better than having a huge amount of peanut all over the schools. Peanut bans would not mean letting our guards down, we would still have epis, etc.

I strongly urge the AAAI to reconsider their peanut management recommendations, because the current ones do us a disservice. I am entering discussions with my schools administrators to seek a peanut ban and am having a very tough battle with them. The reason I seek a ban is because their current policies do not work. They do not ENFORCE a peanut-free zone in the classrooms. Posting a sign on the door does no good if parents are still allowed to pack peanut-containing products. No one checks snacks/lunches to ensure compliance. I refuse to accept the current lax policies and will not throw my child into the lions to fend for herself at age 5. If age 5 is considered mature for peanut self-management, then why don’t we teach sex education in kindergarten? Thus, we could start preparing them for the real world as early as possible. That’s ridiculous, right? That’s how I see the attempts to prepare a child for age 5 to manage her peanut allergy. There will be plenty of time to do that later when she is more capable to make decisions. My main concern at age 5 is to keep avoiding peanuts/treenuts strictly so she may have a chance to outgrow it! If she keeps being exposed to peanuts in school, her antibody levels may rise with each reaction and she would never outgrow it. I strongly urge the AAAI and all allergists to consider your stance on this recommendation. Having your strong support in favor of peanut bans would help families seeking strict avoidance if peanut in all environments, home and school. Thank you.

A:
Thank you for your letter.

I clearly understand your position, and from reading your e-mail, I also feel that you have become familiar with the position of experts in this field who have not advised the banning of peanuts. Some of the opinions you expressed make me realize that you are already aware of the rationales that have been employed to justify the opinion that banning peanuts in schools would be inadvisable. This is an issue which has been debated almost endlessly, and there are proponents of both sides of the argument. Both sides are sometimes strongly invested in their own views of this issue, as I can tell you are. Both sides can be argued vigorously.

We have many issues in anaphylaxis that fit into the same category. The reason for the debate is that such issues cannot be answered on the basis of controlled trials, and therefore we have no true definitive supporting evidence for either side of the issue.

One such issue, for example, revolves around when to administer epinephrine in a potential case of anaphylaxis. This occurs when a child, thought to be allergic to a food, ingests the food, but has no symptoms after the ingestion. There are proponents of administering epinephrine immediately and there are other proponents who state that the child should be watched and administered epinephrine only if symptoms occur. There are no clear-cut data to support either side. We will never be able to attain these data because we cannot do controlled trials.

We have no controlled trials to compare outcomes in schools where peanuts are banned versus schools where they are not. I do not think this study will ever be done, in part because of the emotional investment in the issue.

So, I do not think it would do a great deal of good to become, on this website, involved in these polemics. However, we are placing your letter online so it can be reviewed by our readers, many of whom are experts and publish in this area.

Thank you again for your interest in our website, and for the expression of your opinion.

Sincerely,
Phil Lieberman, M.D.

Health – What you are suggesting is not only not practical and dangerous but also not legal, an ambulance is required for patient transport. Not even sure why we are even having this nonsensical discussion.

True, blood is required for and NS or LR is not sufficient, but even blood is not definitive treatment and the patient might require first line drugs to control the hemorrhage or even surgical intervention.

That said, fluids is first step in the treatment.

Gamanit – I will not make believe that I did get the details, I did not, nor was I interested at the time. I do know first hand that emergencies like these do happen, especially in the more chassidishe communities as more childbirths means more OB emergencies. Being that I cannot prove that to you I will leave it at that.

Furthermore, most OB related emergencies occur in the hospital, the ones that do not are usually the very serious ones that require the staff to be fully prepared and rapid transport with early intervention makes a difference in patient outcome.

Gamanit – 1.5% is not second to nill, its a risk that is there and happens to some people, besides this is just postpartum hemorrhage there are a few other conditions that can cause life threatening hemorrhaging such as abruptios which can be life threatening.

There are a few grades of abruption with some being true life threatening emergencies, I am aware of several cases in which the patients life was saved with not much time to spare, these patients needed aggressive volume resuscitation and blood transfusions and of course life saving surgical intervention. I admit that this is not the every day occurrence but its there. Sometimes these can be treated without surgical intervention such as with medication like Pitocin which is even given prophylactically.

I am not familiar with the details of this case other than what was posted here and hearing of it this case at the time.

Health – Who were you quoting right here?

“Are you a Hatzolah guy? It sure sounds like it. Refusing to give information about the call, that doesn’t include private information is not a violation of HIPPA.
It sure sounds like you’re trying very hard to manipulate the public!”

Once again you resort to name calling. This discussion has become very childish not what one would expect from a “medical professional”

Health- “But the best defense is an offense.”
Is that why you very frequently try to offend other posters in many ways, by attacking what they wrote or trying to attack them personally?

Health – I do not think I will respond to any of your posts if you continue to make it personal. For starters would you mind revealing what degree you have in medicine and in which area you practice? I know that you never revealed that despite many questioning your self-proclaimed ‘medical professional’ status. If you yourself mind on offering this information, then please do not ask others to do so, especially when I have never claimed to hold any training or that I even practice medicine. I tried to make my points without making the point that I am in medicine, for all I care think of me as a teenager hitting some buttons on a keyboard, but respond to the context of my posts.

You, on the other hand, use your online persona to validate your arguments. It would be reasonable to ask you to reveal your level of training and certification. If you do not want to reveal this information then fold your self-established personal of a ‘medical professional’ and start making some sense.

I respect everyone else’s opinion and I do not think that everyone else has to agree with what I wrote.

Why are you quoting what you posted earlier, what relevancy does that have to the discussion at hand?

You were the one that decided on what was done and that it was inappropriate intervention, after being questioned you now decided that the details and documented times be provided to you, probably so that you can see if there were any wrong doings. Is there any reason that this should be provided to you?

Health – your feelings are irrelevant, it is the facts that matter. So far there was nothing that would indicate that transport was delayed, I find it puzzling that you are bashing the personnel that handled that patient without even knowing if there were any wrong doings.
If indeed transport was delayed with no appropriate justification, your attacks would have been justified.