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Emergency medical services
Emergency medical services (abbreviated to the initialism EMS in some countries) are a type of emergency service dedicated to providing out-of-hospital acute medical care, transport to definitive care, and other medical transport to patients with illnesses and injuries which prevent the patient from transporting themselves.[1]
Emergency medical services may also be locally known as a paramedic service, a first aid squad,[2] emergency squad,[3] rescue squad,[4] ambulance squad,[5] ambulance service,[6] ambulance corps,[7] or life squad.[8]
The goal of most emergency medical services is to either provide treatment to those in need of urgent medical care, with the goal of satisfactorily treating the presenting conditions, or arranging for timely removal of the patient to the next point of definitive care. This is most likely an emergency department at a hospital. The term emergency medical service evolved to reflect a change from a simple system of ambulances providing only transportation, to a system in which actual medical care is given on scene and during transport. In some developing regions, the term is not used, or may be used inaccurately, since the service in question does not provide treatment to the patients, but only the provision of transport to the point of care.[9]
In most places in the world, the EMS is summoned by members of the public (or other emergency services, businesses, or authorities) via an emergency telephone number which puts them in contact with a control facility, which will then dispatch a suitable resource to deal with the situation.[10]
In some parts of the world, the emergency medical service also encompasses the role of moving patients from one medical facility to an alternative one; usually to facilitate the provision of a higher level or more specialised field of care but also to transfer patients from a specialized facility to a local hospital or nursing home when they no longer require the services of that specialized hospital, such as following successful cardiac catheterization due to a heart attack. In such services, the EMS is not summoned by members of the public but by clinical professionals (e.g. physicians or nurses) in the referring facility. Specialized hospitals that provide higher levels of care may include services such as neonatal intensive care (NICU),[11] pediatric intensive care (PICU), state regional burn centres,[12] specialized care for spinal injury and/or neurosurgery,[13] regional stroke centers,[14] specialized cardiac care[15][16] (Cardiac catheterization),[17] and specialized/regional trauma care.[18]
In some jurisdictions, EMS units may handle technical rescue operations such as extrication, water rescue, and search and rescue.[19] Training and qualification levels for members and employees of emergency medical services vary widely throughout the world. In some systems, members may be present who are qualified only to drive the ambulance, with no medical training.[9] In contrast, most systems have personnel who retain at least basic first aid certifications, such as Basic Life Support (BLS). Additionally many EMS systems are staffed with Advanced Life Support (ALS) personnel, including paramedics, nurses, or, less commonly, physicians.
- History 1
- Service providers 2
- Purpose 3
Levels of care 4
Basic life support (BLS) 4.1
- First responder 4.1.1
- Ambulance driver 4.1.2
- Ambulance care assistant 4.1.3
- Emergency medical technician 4.1.4
- Emergency medical dispatcher 4.1.5
Advanced life support (ALS) 4.2
- Paramedic 4.2.1
- Critical care paramedic 4.2.2
- Paramedic practitioner / Emergency care practitioner 4.2.3
- Wilderness Emergency Medical Technician 4.2.4
Traditional healthcare professions 4.3
- Registered nurse 4.3.1
- Physician 4.3.2
- Basic life support (BLS) 4.1
Prehospital Delivery of care 5
- Strategies for delivering care 5.1
- Models of care 5.2
- Clinical governance 5.3
- Organization in different countries 6
- See also 7
- References 8
- Further reading 9
- External links 10
Emergency care in the field has been rendered in different forms since the beginning of recorded history. The New Testament contains the parable of the Good Samaritan, where a man who was beaten is cared for by a Samaritan. Luke 10:34 (NIV) - "He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him." Also during the Middle Ages, the Knights Hospitaller were known for rendering assistance to wounded soldiers in the battlefield.[20]
The first use of the ambulance as a specialized vehicle, in battle came about with the ambulances volantes designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte's chief surgeon.[21][22] Larrey was present at the battle of Spires, between the French and Prussians, and was distressed by the fact that wounded soldiers were not picked up by the numerous ambulances (which Napoleon required to be stationed two and half miles back from the scene of battle) until after hostilities had ceased, and set about developing a new ambulance system.[21][22][23] Having decided against using the Norman system of horse litters, he settled on two- or four-wheeled horse-drawn wagons, which were used to transport fallen soldiers from the (active) battlefield after they had received early treatment in the field.[22] Larrey's projects for 'flying ambulances' were first approved by the Committee of Public Safety in 1794. Larrey subsequently entered Napoleon's service during the Italian campaigns in 1796, where his ambulances were used for the first time at Udine, Padua and Milan, and he adapted his ambulances to the conditions, even developing a litter which could be carried by a camel for a campaign in Egypt.[22]
In civilian ambulances, a major advance was made (which in future years would come to shape policy on hospitals and ambulances) with the introduction of a transport carriage for cholera patients in London during 1832.[24] The statement on the carriage, as printed in The Times, said "The curative process commences the instant the patient is put in to the carriage; time is saved which can be given to the care of the patient; the patient may be driven to the hospital so speedily that the hospitals may be less numerous and located at greater distances from each other".[23] This tenet of ambulances providing instant care, allowing hospitals to be spaced further apart, displays itself in modern emergency medical planning.
The first known hospital-based ambulance service operated out of Commercial Hospital, Cincinnati, Ohio (now the Cincinnati General) by 1865.[23] This was soon followed by other services, notably the New York service provided out of Bellevue Hospital which started in 1869 with ambulances carrying medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine.
In June 1887 the St John Ambulance Brigade was established to provide first aid and ambulance services at public events in London.[25] It was modelled on a military-style command and discipline structure.
The earliest emergency medical service was reportedly the rescue society founded by Jaromir V. Mundy, Count J. N. Wilczek, and Eduard Lamezan-Salins in Vienna after the disastrous fire at the Vienna Ring Theater in 1881. Named the "Vienna Voluntary Rescue Society," it served as a model for similar societies worldwide.[26]
Also in the late 19th century, the automobile was being developed, and in addition to horse-drawn models, early 20th century ambulances were powered by steam, gasoline, and electricity, reflecting the competing automotive technologies then in existence. However, the first motorized ambulance was brought into service in the last year of the 19th century, with the Michael Reese Hospital, Chicago, taking delivery of the first automobile ambulance, donated by 500 prominent local businessmen, in February 1899.[23] This was followed in 1900 by New York City, who extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride. These first two automobile ambulances were electrically powered with 2 hp motors on the rear axle.[23]
American historians claim that the world's first component of civilian pre-hospital care on scene began in 1928, when "Julien Stanley Wise started the Roanoke Life Saving and First Aid Crew in Roanoke, Virginia, which was the first land-based rescue squad in the nation." Canadian historians dispute this with the city of Toronto claiming "The first formal training for ambulance attendants was conducted in 1892."
During World War One, further advances were made in providing care before and during transport – traction splints were introduced during World War I, and were found to have a positive effect on the morbidity and mortality of patients with leg fractures.[27] Two-way radios became available shortly after World War I, enabling for more efficient radio dispatch of ambulances in some areas. Shortly before World War II, then, a modern ambulance carried advanced medical equipment, was staffed by a physician, and was dispatched by radio. In many locations, however, ambulances were hearses - the only available vehicle that could carry a recumbent patient - and were thus frequently run by funeral homes. These vehicles, which could serve either purpose, were known as combination cars.[28][29]
Prior to World War II, hospitals provided ambulance service in many large cities. With the severe manpower shortages imposed by the war effort, it became difficult for many hospitals to maintain their ambulance operations. City governments in many cases turned ambulance services over to the police or fire department. No laws required minimal training for ambulance personnel and no training programs existed beyond basic first aid. In many fire departments, assignment to ambulance duty became an unofficial form of punishment.
Advances in the 1960s, especially the development of CPR and defibrillation as the standard form of care for out-of-hospital cardiac arrest, along with new pharmaceuticals, led to changes in the tasks of the ambulances.[30] In Belfast, Northern Ireland the first experimental mobile coronary care ambulance successfully resuscitated patients using these technologies. One well-known report in the USA during that time was Accidental Death and Disability: The Neglected Disease of Modern Society. This report is commonly known as The White Paper.[31] These studies, along with the White Paper report, placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. In the USA prior to the 1970s, ambulance service was largely unregulated. While some areas ambulances were staffed by advanced first-aid-level responders, in other areas, it was common for the local undertaker, having the only transport in town in which one could lie down, to operate both the local furniture store (where he would make coffins as a sideline) and the local ambulance service. The government reports resulted in the creation of standards in ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), and the equipment (and thus weight) that an ambulance had to carry, and several other factors.
In 1971 a progress report was published at the annual meeting, by the then president of American Association of Trauma, Sawnie R. Gaston M.D. Dr. Gaston reported the study was a "superb white paper" that "jolted and wakened the entire structure of organized medicine. This report is created as a "prime mover" and made the "single greatest contribution of its kind to the improvement of emergency medical services". Since this time a concerted effort has been undertaken to improve emergency medical care in the pre-hospital setting.[32] Such advancements included Dr. R Adams Cowley creating the country's first statewide EMS program, in Maryland.[33]
Service providers
Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level), whereas others allow quite wide differences between types of operator.
- Government Ambulance Service
- Operating separately from (although alongside) the fire and police service of the area, these ambulances are funded by local, provincial or national government. In some countries, these only tend to be found in big cities, whereas in countries such as United Kingdom almost all emergency ambulances are part of a national health system.[34] In the United States, ambulance service provided by a local government are often referred to as "third service" EMS (the Fire Department, Police Department, and separate EMS forming an emergency services trio) by the employees of said service, as well as other city officials and residents.
- Fire or Police Linked Service
- In countries such as the United States, Japan, France, and parts of India; ambulances can be operated by the local fire or police service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. In some cases this can lead to an illness or injury being attended by a vehicle other than an ambulance, such as a fire truck. In other staffing schemes, firefighting protective gear and basic tools are carried on fire based ambulances and the crews respond to fires and other non medical emergencies in the ambulance. Also, where no private ambulance service exists, fire based EMS units may provide inter-facility transports.
- Volunteer Ambulance Service
- Charities or non-profit companies operate ambulances, both in an emergency and patient transport function. This may be along similar lines to volunteer fire companies, providing the main service for an area, and either community or privately owned. They may be linked to a voluntary St John Ambulance[36] and the Order of Malta Ambulance Corps.[37] These volunteer ambulances may be seen providing support to the full time ambulance crews during times of emergency. In some cases the volunteer charity may employ paid members of staff alongside volunteers to operate a full time ambulance service, such in some parts of Australia, Ireland and most importantly Germany and Austria.
- Private Ambulance Service
- Normal commercial companies with paid employees, but often on contract to the local or national government. Private companies may provide only the patient transport elements of ambulance care (i.e. nonurgent), but in some places, they are contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy. This may mean that a government or other service provide the 'emergency' cover, whilst a private firm may be charged with 'minor injuries' such as cuts, bruises or even helping the mobility impaired if they have for example fallen and just need help to get up again, but do not need treatment. This system has the benefit of keeping emergency crews available all the time for genuine emergencies. These organisations may also provide services known as 'Stand-by' cover at industrial sites or at special events.[38]
- Combined Emergency Service
- these are full service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care, but as a firefighter and a peace officer (police function). They may be found in smaller towns and cities, where size or budget does not warrant separate services. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.
- Hospital Based Service
- Hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital. Most Advanced Life Support (Paramedic) services in the United States are this type of service.
- Charity Ambulance
- This special type of ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals, hospices or care homes where they are in long term care. Examples include the UK's 'Jumbulance' project.[39]
- Company Ambulance
- Many large factories and other industrial centres, such as chemical plants, oil refineries, breweries and distilleries have ambulance services provided by employers as a means of protecting their interests and the welfare of their staff. These are often used as first response vehicles in the event of a fire or explosion.
Emergency medical services exists to fulfill the basic principles of first aid, which are to Preserve Life, Prevent Further Injury, and Promote Recovery. This common theme in medicine is demonstrated by the "star of life". The Star of Life shown here, where each of the 'arms' to the star represent one of the six points, which are used to represent the six stages of high quality pre-hospital care, which are:[40]
- Early detection – members of the public, or another agency, find the incident and understand the problem
- Early reporting – the first persons on scene make a call to the emergency medical services and provide details to enable a response to be mounted
- Early response – the first professional (EMS) rescuers arrive on scene as quickly as possible, enabling care to begin
- Good on-scene care – the emergency medical service provides appropriate and timely interventions to treat the patient at the scene of the incident
- Care in transit – the emergency medical service load the patient in to suitable transport and continue to provide appropriate medical care throughout the journey
- Transfer to definitive care – the patient is handed over to an appropriate care setting, such as the emergency department at a hospital, in to the care of physicians
Levels of care
Emergency Medical Service is provided by a variety of individuals, using a variety of methods. To some extent, these will be determined by country and locale, with each individual country having its own 'approach' to how EMS should be provided, and by whom. In some parts of Europe, for example, legislation insists that efforts at providing advanced life support (ALS) Mobile Intensive Care Units (MICU) services must be physician-staffed, while other permit some elements of that skill set to specially trained nurses, but have no paramedics. Elsewhere, as in North America, the UK and Australia, ALS services are performed by paramedics, but rarely with the type of direct "hands-on" physician leadership seen in Europe. Increasingly, particularly in the UK and in South Africa, the role is being provided by specially trained paramedics who are independent practitioners in their own right. Beyond the national model of care, the type Emergency Medical Service will be determined by local jurisdictions and medical authorities, based upon the needs of the community, and the economic resources to support it.
A category of emergency medical service which is known as 'medical retrieval' or rendez vous MICU protocol in some countries (Australia, NZ, Great Britain) refers to critical care transport of patients between hospitals (as opposed to pre-hospital). Such services are a key element in regionalised systems of hospital care where intensive care services are centralised to a few specialist hospitals. An example of this is the Emergency Medical Retrieval Service in Scotland. In the United States, this is referred to as "Critical Care Transport" and qualifications for this role vary by state and can include an RN, Paramedic and/or EMT.
Generally speaking, the levels of service available will fall into one of three categories; Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) by traditional healthcare professionals, meaning nurses and/or physicians working in the pre-hospital setting and even on ambulances. In some jurisdictions, a fourth level, Intermediate Life Support (ILS), which is essentially a BLS provider with a moderately expanded skill set, may be present, but this level rarely functions independently, and where it is present may replace BLS in the emergency part of the service. When this occurs, any remaining staff at the BLS level is usually relegated to the non-emergency transportation function. Job titles typically include Emergency Medical Technician, Ambulance Technician, or Paramedic. These ambulance care givers are generally professionals or paraprofessionals and in some countries their use is controlled through training and registration. While these job titles are protected by legislation in some countries, this protection is by no means universal, and anyone might, for example, call themselves an 'EMT' or a 'paramedic', regardless of their training, or the lack of it.[41] In some jurisdictions, both technicians and paramedics may be further defined by the environment in which they operate, including such designations as 'Wilderness', 'Tactical', and so on.
Basic life support (BLS)
First responder
A first responder is the first person trained in basic life support who arrives at the scene of an emergency.[42] First responders may be dispatched by the ambulance service, may be passers-by, citizen volunteers, lifeguards, or may be members of other agencies such as the police, fire department, or search and rescue who have some medical training—commonly CPR, basic first aid, and AED use.[43]
Ambulance driver
Some jurisdictions separate the 'driver' and 'attendant' functions, employing ambulance driving staff with no medical qualification (or just a first aid certificate), whose job is to drive the ambulance. While this approach persists in some countries, such as India, it is generally becoming increasingly rare. Ambulance drivers may be trained in radio communications, ambulance operations and emergency response driving skills.[44]
Ambulance care assistant
Ambulance Care Assistants (ACAs) have varying levels of training across the world. In many countries, such staff are usually only required to perform patient transport duties (which can include stretcher or wheelchair cases), rather than acute care. However, there remain both countries and individual jurisdictions in which economics will not support ALS service, and the efforts of such individuals may represent the only EMS available. Dependent on the provider (and resources available), they may be trained in first aid or extended skills such as use of an AED, oxygen therapy, pain relief and other live-saving or palliative skills. In some services, they may also provide emergency cover when other units are not available, or when accompanied by a fully qualified technician or paramedic.[45][46]
Emergency medical technician
Emergency medical technicians, also known as Ambulance Technicians in the UK and EMT in the United States. In the United States, EMT is usually made up of 3 levels. EMT-B, EMT-I and EMT-Paramedic. The New Educational Standards for EMS renamed the provider levels as follows: EMR, emergency medical responder, EMT, emergency medical technician, AEMT, advanced EMT, and Paramedic. Technicians are usually able to perform a wide range of emergency care skills, such as Automated defibrillation, care of spinal injuries and oxygen therapy.[47][48] In few jurisdictions, some EMTs are able to perform duties as IV and IO cannulation, administration of a limited number of drugs, more advanced airway procedures, CPAP, and limited cardiac monitoring.[49] Most advanced procedures and skills are not within the national scope of practice for an EMT-B.[50] As such most states require additional training and certifications to perform above the national curriculum standards.[51][52]
Emergency medical dispatcher
An emergency medical dispatcher is also called an EMD. An increasingly common addition to the EMS system is the use of highly trained dispatch personnel who can provide "pre-arrival" instructions to callers reporting medical emergencies. They use carefully structured questioning techniques and provide scripted instructions to allow callers or bystanders to begin definitive care for such critical problems as airway obstructions, bleeding, childbirth, and cardiac arrest. Even with a fast response time by a first responder measured in minutes, some medical emergencies evolve in seconds. Such a system provides, in essence, a "zero response time," and can have an enormous impact on positive patient outcomes.
Advanced life support (ALS)
A paramedic has a high level of prehospital medical training and usually involves key skills not performed by technicians, often including cannulation (and with it the ability to use a range of drugs to relieve pain, correct cardiac problems, and perform endotracheal intubation), cardiac monitoring, tracheal intubation,pericardiocentesis, cardioversion, needle decompression and other skills such as performing a cricothyrotomy.[53] The most important function of the paramedic is to identify and treat any life-threatening conditions and then to assess the patient carefully for other complaints or findings that may require emergency treatment.[54] In many countries, this is a protected title, and use of it without the relevant qualification may result in criminal prosecution.[55] In the United States, paramedics represent the highest licensure level of prehospital emergency care. In addition, several certifications exist for Paramedics such as Wilderness ALS Care,[56] Flight Paramedic Certification (FP-C),[57] and Critical Care Emergency Medical Transport Program certification.[58]
Critical care paramedic
Recently studies have looked at new level of pre-hospital care.[59][60] What has developed is the critical care paramedic, also called an advanced practice Paramedic in some parts of USA and Canada. These providers represent a higher level of licensure above that of the DOT or respective paramedic level curriculum.[58] The training, permitted skills, and certification requirements vary from one jurisdiction to the next. These providers transport critically ill or injured patients from one hospital to a receiving hospital with higher level of care (ie.. cardiac catheterization, trauma services or specialized ICU services) not available at referring facility.
These Paramedics receive additional training beyond normal EMS medicine. The Board for Critical Care Transport Certification (BCCTPC®) has developed a certification exam for flight and ground critical care paramedics [61][62] Some educational facilities that provide this training are
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- Commons category with local link different than on Wikidata
- Articles with DMOZ links
- Emergency medical services
- Emergency Medical Services at DMOZ
- "Emergency Medical Services in the European Union: report of an assessment project co-ordinated by the European Union"
- World Health Organization: Department of Violence and Injury Prevention "Prehospital Trauma Care Systems"
External links
- Planning Emergency Medical Communications: Volume 2, Local/Regional Level Planning Guide, (Washington, D.C.: National Highway Traffic Safety Administration, US Department of Transportation, 1995).
Further reading
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- ^ "Hennepin County Emergency Squad". Retrieved 2007-06-18.
- ^ "South Plainfield Rescue Squad". Retrieved 2007-06-18.
- ^ "Nottingham Ambulance Squad". Retrieved 2007-06-18.
- ^ "Scottish Ambulance Service". Retrieved 2007-06-18.
- ^ "Valhalla Volunteer Ambulance Corps". Retrieved 2007-06-18.
- ^ "Sardinia Life Squad". Retrieved 2007-06-18.
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- ^ "EU document on European adoption of 112 emergency number". Retrieved 2007-06-29.
- ^ "Crouse-Irving NICU". Retrieved 2008-08-09.
- ^ "Strong Memorial Burn Center". Retrieved 2008-08-09.
- ^ "Avera Neurosciences Institute". Retrieved 2008-08-09.
- ^ "NYS DOH Regional Stroke Centers". Retrieved 2008-08-09.
- ^ "Cath Labs". Retrieved 2008-08-09.
- ^ "NHS Heart Hospital". Retrieved 2008-08-11.
- ^ "AHA Cath Lab Definition". Retrieved 2008-08-09.
- ^ "Maryland Shock Trauma". Retrieved 2008-08-09.
- ^ "EMS Special Operations". Town of Colonie EMS. Retrieved 2007-06-29.
- ^ "Knights Hspitaller's". Retrieved 2008-08-20.
- ^ a b Skandalakis PN, Lainas P, Zoras O, Skandalakis JE, Mirilas P (August 2006). "'To afford the wounded speedy assistance': Dominique Jean Larrey and Napoleon". World Journal of Surgery 30 (8): 1392–9.
- ^ a b c d Ortiz, Captain Jose M (October–December 1998). "The Revolutionary Flying Ambulance of Napoleon's Surgeon" 8. pp. 17–25.
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- ^ "Cholera carriages". Retrieved 2008-08-09.
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- ^ Nicholas Genes (2005-09-02). "Disasters and Emergency Medicine". Medgadget.com. Retrieved 2012-04-05.
- ^ "Traction splint history" (PDF). Retrieved 2008-08-08.
- ^ Kuehl, Alexander E. (Ed.). Prehospital Systems and Medical Oversight, 3rd edition. National Association of EMS Physicians. 2002. @ ch. 1.
- ^ "Miller-Meteor History". Miller-Meteor. n.d. Retrieved 23 February 2007.
- ^ Kouwenhoven WB, Jude JR, Knickerbocker GG (July 1960). "Closed-chest cardiac massage". JAMA 173: 1064–7.
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- ^ "Dept. of Labor EMT Job Description". Retrieved 2008-08-20.
- ^ "NYS EMT-B Job Description" (PDF). Retrieved 2008-08-20.
- ^ "North Dakota EMT-B Scope of Practice" (PDF). Retrieved 2008-08-20.
- ^ "NHTSA EMT-B Scope of Practice" (PDF). Retrieved 2008-08-20.
- ^ "EMT-B additional skills" (PDF). Retrieved 2008-08-20.
- ^ "Colorado EMT-B IV Certification" (PDF). Retrieved 2008-08-20.
- ^ "Paramedic: Job description". Retrieved 2008-08-20.
- ^ Editors of Salem Press (2008). Paramedics. Magill's Medical Guide, 4th Rev. ed.. Salem Press. Retrieved from http://elibrary.bigchalk.com
- ^ "HPC - Health Professions Council - Protected titles". Retrieved 2008-08-20.
- ^ Schmidt TA, Federiuk CS, Zechnich A, Forsythe M, Christie M, Andrews C (August 1996). "Advanced life support in the wilderness: 5-year experience of the Reach and Treat team". Wilderness & Environmental Medicine 7 (3): 208–15.
- ^ "Flight Paramedic Certification". Retrieved 2008-08-20.
- ^ a b "CCEMTP". Retrieved 2008-08-20.
- ^ Paquette, Anthony John. "The Feasibility of the Advanced Practice Paramedic.". UCHC Graduate School Masters Theses 2003 - 2010. University Of Connecticut Health Center Graduate School. Retrieved 29 September 2011.
- ^ "Critical Care Paramedic Position Paper". International Association Of Flight Paramedics. Retrieved 29 September 2011.
- ^ "Report of a National Study of the Certified Critical Care Paramedic". The Board for Critical Care Transport Certification. Retrieved 29 September 2011.
- ^ "Board Of Critical Care Transport Paramedic". The Board for Critical Care Transport Certification. Retrieved 29 September 2011.
- ^ "CCEMTP Course". University Of Maryland Baltimore County. Retrieved 29 September 2011.
- ^ "South Western Ambulance Service NHS Trust". Retrieved 2008-08-20.
- ^ Hawkins, SC (Winter–January 20122012). "Wilderness EMS Medical Director Course". Wilderness Medicine 29 (1): 24–25.
- ^ "Blazing a Trail". Journal of EMS. Retrieved 2012-03-30.
- ^ "Landmark Learning". Retrieved 2012-03-30.
- ^ "SOLO". Retrieved 2012-03-30.
- ^ "Aerie Backcountry Medicine". Retrieved 2012-03-30.
- ^ "Wilderness Medical Associates". Retrieved 2012-03-30.
- ^ "Wilderness Medicine Institute of NOLS". Retrieved 2012-03-30.
- ^ "Appalachian Center for Wilderness Medicine". Retrieved 2012-03-30.
- ^ "Wilderness EMS Institute". Retrieved 2012-03-30.
- ^ "Roane State Wilderness First Responder". Retrieved 2012-03-30.
- ^ "University of Utah Wilderness and EMS Fellowship". Retrieved 2012-03-30.
- ^ "Carolina Wilderness EMS Externship". Retrieved 2012-03-30.
- ^ Melby V, Ryan A (October 2005). "Caring for older people in prehospital emergency care: can nurses make a difference?". Journal of Clinical Nursing 14 (9): 1141–50.
- ^ Wulterkens D (2005-12-06). "EMS in the Netherlands: A Dutch Treat?". Journal of Emergency Medical Services.
- ^ Suserud B (2005). "A new profession in the pre-hospital care field: the ambulance nurse". Nursing in Critical Care 10 (6): 269–71.
- ^ Bom A (Feb 2012). "International EMS system Design: Sweden". EMSNEWS. Retrieved 2012-08-29.
- ^ . BOE, 2012, n. 137"REAL DECRETO 836/2012, de 25 de mayo, por el que se establecen las características técnicas, el equipamiento sanitario y la dotación de personal de los vehículos de transporte sanitario por carretera" (PDF) (in Español). Retrieved 2012-07-06.
- ^ "Infermier Sapeur-Pompiers (French govt website)" (in Français). Retrieved 2012-08-29.
- ^ "The SMUR of Nice". Retrieved 2012-08-29.
- ^ a b c "Bundesärztekammer - Notfall: Notkompetenz I (German Federal Board of Physicians: Directives regarding emergency powers for Paramedics)" (in German). Bundesaerztekammer.de. Retrieved 2010-07-29.
- ^ "Londons Air Ambulance". Retrieved 2007-06-18.
- ^ "Surrey Air Ambulance". Retrieved 2007-06-18.
- ^ "UK NHS Ambulance Service Information". Retrieved 2007-06-02.
- ^ "Fire Service Based EMS advocates ruffle some feathers!". Retrieved 2008-08-09.
- ^ "Patrol Division Nassau County Police Department". Police.co.nassau.ny.us. Retrieved 2010-07-29.
- ^ "Hillside Fire Department". Retrieved 2008-08-20.
- ^ "Why does a fire truck come to my house when I call 911 for an ambulance?".
- ^ "Our lazy firemen must make a radical change". Retrieved 2008-08-09.
- ^ "Success hat-trick underlines firefighters community commitment". West Sussex County Council. 2007-07-26. Retrieved 2008-08-09.
- ^ "British Red Cross Voluntary Ambulance Service". Retrieved 2007-06-02.
- ^ "Order of Malta Ambulance Corps". Retrieved 2007-06-02.
- ^ "Volunteers on hand for flood help". Retrieved 2008-01-21.
- ^ Kay, Marcia Hillary. "40 Years Retrospective: It's Been a Wild Ride" Rotor & Wing, August 2007. Accessed: 8 June 2014. Archived June 8, 2014 at the Wayback Machine.
- ^ Accidental Death and Disability: The Neglected Disease of Modern Society, (1966), National Academy of Sciences (White Paper)
- ^ Nallamothu BK, Bates ER (October 2003). "Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything?". The American Journal of Cardiology 92 (7): 824–6.
- ^ Bogaty P, Buller CE, Dorian P, O'Neill BJ, Armstrong PW (October 2004). "Applying the new STEMI guidelines: 1. Reperfusion in acute ST-segment elevation myocardial infarction". CMAJ 171 (9): 1039–41.
- ^ "UOHI - Heart Attack". Ottawaheart.ca. Retrieved 2010-07-29.
- ^ Cantor WJ, Morrison LJ (May 2005). "Guidelines for STEMI". CMAJ 172 (11): 1425; author reply 1426.
- ^ Dick WF (2003). "Anglo-American vs. Franco-German emergency medical services system". Prehospital and Disaster Medicine 18 (1): 29–35; discussion 35–7.
- ^ "SAMU de France website". Retrieved 2008-09-19.
- ^ "What Does a Super Paramedic Do? (BBC News website)". 2005-06-30. Retrieved 2008-09-19.
- ^ British Paramedic Association, College of Paramedicine
- ^ Cooper S, Barrett B, Black S, et al. (September 2004). "The emerging role of the emergency care practitioner". Emergency Medicine Journal 21 (5): 614–8.
- ^ O'Meara, Dr. Peter. "Expanded-Scope Paramedic (ESP) role for rural ambulance services". Commonwealth of Australia Productivity Commission. Retrieved 29 September 2011.
- In case of emergency, a programme that enables EMS workers to identify victims and contact their next of kin to obtain important medical information
- Public utility model, a model for organizing Emergency Medical Services
- Battlefield medicine
- Wilderness medicine
- Mass Gathering Medicine
- Good Samaritan law
- The White Paper (Official title "Accidental Death and Disability: The Neglected Disease of Modern Society" - a 1966 report that prompted the development of organized EMS in the United State)
- Medical amnesty policy
See also
- Emergency medical services in Austria
- Emergency medical services in Australia
- Emergency medical services in Canada
- Emergency medical services in France
- Emergency medical services in Germany
- Emergency medical services in Hong Kong
- Emergency medical services in Iceland
- Emergency medical services in Iran
- Emergency medical services in Ireland
- Emergency medical services in Israel
- Emergency medical services in Italy
- Emergency medical services in the Netherlands
- Emergency medical services in New Zealand
- Emergency medical services in Norway
- Emergency medical services in Poland
- Emergency medical services in Portugal
- Emergency medical services in Romania
- Emergency medical services in Spain
- Emergency medical services in South Africa
- Emergency medical services in Sri Lanka
- Emergency medical services in Ukraine
- Emergency medical services in the United Kingdom
- Emergency medical services in the United States
Organization in different countries
In some parts of the world, those in the paramedical professional role are only permitted to practise many of their advanced skills while assisting a physician who is physically present, or they face cases of immediately life-threatening emergencies.[84] In many other parts in the world, most notably in France, Belgium, Luxembourg, Italy, and Spain, but also in Brazil and Chile. All MICU skills in the pre-hospital setting are performed by physicians and nurses and an On-line Permanent medical supervision is done by the SAMU. In certain other jurisdictions, such as the United Kingdom and South Africa, paramedics may be entirely autonomous practitioners capable of prescribing medications.[107] In other jurisdictions, such as Australia and Canada, this expanded scope of practice is under active consideration and discussion.[108]
Paramedics in Anglosaxon countries normally function under the authority (medical direction) of one or more physicians charged with legally establishing the emergency medical directives for a particular region. Paramedics are credentialed and authorized by these physicians to use their own clinical judgment and diagnostic tools to identify medical emergencies and to administer the appropriate treatment, including drugs that would normally require a physician order. Credentialing may occur as the result of a State Medical Board examination (U.S.) or the National Registry of Emergency Medical Technicians (U.S.). In England, and in some parts of Canada, credentialing may occur by means of a College of Paramedicine.[106] In these cases, paramedics are regarded as a self-regulating health profession. The final common method of credentialing is through certification by a Medical Director and permission to practice as an extension of the Medical Director's license to practice some medical acts. The authority to practice in this semi-autonomous manner is granted in the form of standing order protocols (off-line medical control) and in some cases direct physician consultation via phone or radio (on-line medical control). Under this paradigm, paramedics effectively assume the role of out-of-hospital field agents to regional emergency physicians, with clinical decision-making authority using standing orders or protocols.
Clinical governance
In this model, patients may still be treated at the scene up to the skill level of the attending crew, and subsequently transported to definitive care, but in many cases the reduced skill set of the ambulance crew and the needs of the patient indicate a shorter interval for transport of the patient than is the case in the Franco-German model.
The second care structure, termed the Anglo-American model, utilizes pre-hospital care specialists, such as emergency medical technicians and paramedics, to staff ambulances, which may be classified according to the varying skill levels of the crews. In this model it is rare to find a physician actually working routinely in the pre-hospital setting, although they may be utilised on complex or major injuries or illnesses. In this system, a physicians involvement is most likely to be the provision of medical oversight for the work of the ambulance crews, which may be accomplished in terms of off-line medical control, with protocols or 'standing orders' for certain types of medical procedures or care, or on-line medical control, in which the technician must establish contact with the physician, usually at the hospital, and receive direct orders for various types of medical interventions. In some cases, such as in the UK, South Africa and Australia, a paramedic may be an autonomous health care professional, and does not require the permission of a physician to administer interventions or medications from an agreed list, and can perform roles such as suturing or prescribing medication to the patient.[105]
The Franco-German model is physician-led, with doctors responding directly to all major emergencies requiring more than simple first aid. In some cases in this model, such as France, paramedics, as they exist in the Anglo-American model, are not used, although the term 'paramedic' is sometimes used generically, and those with that designation have training that is similar to an U.S. EMT-B.[104] The team's physicians and in some cases, nurses, provide all medical interventions for the patient, and non-medical members of the team simply provide the driving and heavy lifting services. In other applications of this model, as in Germany, a paramedic equivalent does exist, but is sharply restricted in terms of scope of practice; often not permitted to perform Advanced Life Support (ALS) procedures unless the physician is physically present, or in cases of immediate life-threatening conditions.[84] Ambulances in this model tend to be better equipped with more advanced medical devices, in essence, bringing the emergency department to the patient. High-speed transport to hospitals is considered, in most cases, to be unnecessarily unsafe, and the preference is to remain and provide definitive care to the patient until they are medically stable, and then accomplish transport. In this model, the physician and nurse may actually staff an ambulance along with a driver, or may staff a rapid response vehicle instead of an ambulance, providing medical support to multiple ambulances.
Although a variety of differing philosophical approaches are used in the provision of EMS care around the world, they can generally be placed into one of two categories; one physician-led and the other led by pre-hospital specialists such as emergency medical technicians or paramedics (which may, or may not have accompanying physician oversight). These models are typically identified by their locations of origin.[103]
Models of care
The aim in "Scoop and Run" treatment is generally to transport the patient within ten minutes of arrival, hence the birth of the phrase, "the platinum ten minutes" (in addition to the "golden hour"), now commonly used in EMT training programs. The "Scoop and Run" is a method developed to deal with trauma, rather than strictly medical situations (e.g. cardiac or respiratory emergencies), however, this may be changing. Increasingly, research into the management of S-T segment elevation myocardial infarctions (STEMI) occurring outside of the hospital, or even inside community hospitals without their own PCI labs, suggests that time to treatment is a clinically significant factor in heart attacks, and that trauma patients may not be the only patients for whom 'load and go' is clinically appropriate. In such conditions, the gold standard is the door to balloon time. The longer the time interval, the greater the damage to the myocardium, and the poorer the long-term prognosis for the patient.[99] Current research in Canada has suggested that door to balloon times are significantly lower when appropriate patients are identified by paramedics in the field, instead of the emergency room, and then transported directly to a waiting PCI lab.[100] The STEMI program has reduced STEMI deaths in the Ottawa region by 50 per cent.[101] In a related program in Toronto, EMS has begun to use a procedure of 'rescuing' STEMI patients from the Emergency Rooms of hospitals without PCI labs, and transporting them, on an emergency basis, to waiting PCI labs in other hospitals.[102]
The strategy developed for prehospital trauma care in North America is based on the Golden Hour theory, i.e., that a trauma victim's best chance for survival is in an operating room, with the goal of having the patient in surgery within an hour of the traumatic event. This appears to be true in cases of internal bleeding, especially penetrating trauma such as gunshot or stab wounds. Thus, minimal time is spent providing prehospital care (spine immobilization; "ABCs", i.e. ensure airway, breathing and circulation; external bleeding control; endotracheal intubation) and the victim is transported as fast as possible to a trauma centre.[98]
The essential decision in prehospital care is whether the patient should be immediately taken to the hospital, or advanced care resources are taken to the patient where they lie. The "scoop and run" approach is exemplified by the MEDEVAC aeromedical evacuation helicopter, whereas the "stay and play" is exemplified by the French and Belgian SMUR emergency mobile resuscitation unit or the German "Notarzt"-System (preclinical emergency physician). The use of helicopters was pioneered in the Korean war, when time to reach a medical facility was reduced from 8 hours to 3 hours in World War II, and again to 2 hours by the Vietnam war.[97]
Strategies for delivering care
Many colleges and universities, especially in the United States, maintain their own EMS organizations. These organizations operate at capacities ranging from first response to ALS transport. Campus EMS in the United States is overseen by the National Collegiate Emergency Medical Services Foundation.
There are also private ambulance companies, with paid employees, but often on contract to the local or national government. Many private companies provide only the patient transport elements of ambulance care (i.e. nonurgent), although in some places these private services are contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy or to respond to non-emergency home calls. Private companies are often contracted by private clients to provide event specific cover, as is the case with voluntary EMS crews.
Some charities or non-profit companies also operate emergency medical services, often alongside a patient transport function.[94] These often focus on providing ambulances for the community, or for cover at private events, such as sports matches. The St John Ambulance.[36] and the Order of Malta Ambulance Corps.[95] In some countries, these volunteer ambulances may be seen providing support to the full-time ambulance crews during times of emergency, or simply to help cover busy periods.[96]
Ambulance services can be stand alone organisations, but in some cases, the emergency medical service is operated by the local fire[88] or police[89] service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. This can lead, in some instances, to an illness or injury being attended by a vehicle other than an ambulance, such as fire truck.[90][91][92] In some locales, firefighters are the first responders to calls for emergency medical aid, with separate ambulance services providing transportation to hospitals when necessary.[93]
Most developed countries now provide a government funded emergency medical service, which can be run on a national level, as is the case in the United Kingdom, where a national network of ambulance trusts operate an emergency service, paid for through central taxation, and available to anyone in need,[87] or can be run on a more regional model, as is the case in the United States, where individual authorities have the responsibility for providing these services.
The most basic emergency medical services are provided as a transport operation only, simply to take patients from their location to the nearest medical treatment. This was often the case in a historical context, and is still true in the developing world, where operators as diverse as taxi drivers[9] and undertakers may operate this service.
Depending on country, area within country, or clinical need, emergency medical services may be provided by one or more different types of organisation. This variation may lead to large differences in levels of care and expected scope of practice.
Prehospital Delivery of care
This 'hands-on' approach is less common in the United States. While one will occasionally see a physician with an ambulance crew on an emergency call, this is much more likely to be the Medical Director or an associate, inducting newly trained paramedics, or performing routine medical quality assurance. In some jurisdictions adult or pediatric critical care transports sometimes use physicians, but generally only when it appears likely that the patient may require surgical or advanced pharmacologic intervention beyond the skills of an EMT, paramedic or nurse during transport. Physicians are leaders of medical retrieval teams in many western countries, where they may assist with the transport of a critically ill, injured, or special needs patient to a tertiary care hospital, particularly when longer transport times are involved.
There are many places in Europe, most notably in France, Italy, the German-speaking countries (Germany, Switzerland, Austria) and Spain where the model of EMS is different, and physicians take a more direct, 'hands-on' approach to pre-hospital care. In France, Italy and Spain, response to high-acuity emergency calls is physician-led, as with the French SMUR teams. Paramedics do not exist within those systems, and most ALS is performed by physicians. In the German-speaking countries, paramedics do exist, but special physicians (called Notarzt) respond directly to high-acuity calls, supervising the paramedics ALS procedures directly. Indeed, in these countries paramedics are not typically legally permitted to practice their ALS procedures unless the physician is physically present, unless they face immediate life-threatening emergencies.[84] Some systems - most notably air ambulances in the UK.[85][86] will employ physicians to take the clinical lead in the ambulance; bringing a full range of additional skills such as use of medications that are beyond the paramedic skill set. The response of physicians to emergency calls is routine in many parts of Europe, but is uncommon in the UK, where physicians are generally tasked to high priority calls on a voluntary basis. Within the UK a sub-speciality of Pre-Hospital Care is being developed for Doctors, which would allow training programmes and consultant posts to be developed in this one area of practice.
The use of registered nurses (RNs) in the pre-hospital setting is more common in countries that have a limited EMS infrastructure in place. Some European countries such as France or Italy, which do not use paramedics as they are intended in Anglo-Saxon countries, also use nurses as a means of providing ALS services. These nurses may work under the direct supervision of a physician, or, in rarer cases, independently. In some places in Europe, notably Norway, paramedics do exist, but the role of the 'ambulance nurse' continues to be developed,[77] as it is felt that nurses may bring unique skills to some situations encountered by ambulance crews. In North America, and to a lesser extent elsewhere in the English-speaking world, some jurisdictions use specially trained nurses for medical transport work. These are mostly air-medical personnel or critical care transport providers, often working in conjunction with a technician or paramedic or physician on emergency interfacility transports. In the United States, the most common uses of ambulance-based Registered nurses is in the Critical Care/Mobile Intensive Care transport, and in Aeromedical EMS. Such nurses are normally required by their employers (in the US) to seek additional certifications beyond basic nursing registration. In Estonia 60% of ambulance teams are led by nurse. Ambulance nurses can do almost all emergency procedures and administer medicines pre-hospital such as physicians in Estonia. In the Netherlands, all ambulances are staffed by a registered nurse with additional training in emergency nursing, anaesthesia or critical care, and a driver-EMT.[78] In Sweden, since 2005, all emergency ambulances should be staffed by at least one registered nurse since only nurses are allowed to administer drugs.[79][80] And all Advanced Life Support Ambulances are staffed at least by a registered nurse in Spain.[81] In France, since 1986, fire department-based rescue ambulances have had the option of providing resuscitation service (reanimation) using specially trained nurses, operating on protocols,[82] while SAMU-SMUR units are staffed by physicians and nurses[83]
Registered nurse
Traditional healthcare professions
Some paramedics and EMTs, known as Appalachian Center for Wilderness Medicine [72] and the Wilderness EMS Institute,[73] military branches, community colleges and universities,[74][75] EMS-college-hospital collaborations,[76] and others.
Wilderness Emergency Medical Technician
In the United Kingdom and South Africa, some serving paramedics receive additional university education to become practitioners in their own right, which gives them absolute responsibility for their clinical judgement, including the ability to autonomously prescribe medications, including drugs usually reserved for doctors, such as courses of antibiotics. An emergency care practitioner is a position sometimes referred to as a 'super paramedic' and is designed to bridge the link between ambulance care and the care of a general practitioner. ECPs are university graduates in Emergency Medical Care or qualified paramedics who have undergone further training,[64] and are authorized to perform specialized techniques. Additionally some may prescribe medicines (from a limited list) for longer term care, such as antibiotics. With respect to a Primary Health Care setting, they are also educated in a range of Diagnostic techniques.
Paramedic practitioner / Emergency care practitioner
. chest tubes and arterial lines, central lines, surgical airways), Umbilical Arterial Catheter), UACs (Umbilical Venous Catheter monitoring. Depending on the service medical direction, these providers are trained on placement and use of UVCs (pacemaker (IABP) and external Intra-aortic balloon pump, mechanical ventilators to name just a few. Some examples of skills include, but not limited to, life support systems normally restricted to the ICU or critical care hospital setting such as Blood products and Blood, Propofol, Dobutamine, Dopamine have developed 'in-house' advanced practice paramedic providers. These providers have a vast array of and medications to handle complex medical and trauma patients. Examples of medication are


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subset: commoncrawl


text:
After a few days of panic, my four year old has been returned. Unharmed, as if nothing had happened. The only thing that suffered during the ordeal…my nerves. Not knowing what was going on, what was going to happen. Thinking of the worst case scenario, over and over and over…
According to a comment from my new, favorite Facebook employee:
This was a technical issue on our part and is now resolved. These Pages should go back to normal when the fix gets pushed out. Thank you! -Nicci
No, Nicci, thank YOU!
Even better, the Community Page now includes a "Did you mean UWGB?" link that goes to our official page. THAT is a wonderful surprise. Sort of like the kidnapper took my kid for a haircut before returning him. Looking good, son!
A huge thanks to the higher ed community for not remaining silent — not waiting for things to get better on their own — tweeting, blogging, attempting to get an answer. Writing on the castle's wall with the hope that the king would venture out and notice. Did it work? It remains a mystery, but it definitely didn't hurt.
And Nicci, I dedicate this song to you! I didn't want to go the Bette Middler "Wind Beneath My Wings" route, so the metaphor gets a little sketchy. I'm Jennifer Love Hewitt, you're Enrique and the role of "naughty" Facebook is played by Mickey Rourke. Thanks for not only fixing the problem, but for taking the time to leave a comment. I now feel a little less alone… you're my hero.


text:
Neither lipstick nor lip gloss, this matte lip cream is a new kind of lip color that goes on silky smooth and sets to a matte finish. Soft Matte Lip Cream is surprisingly durable and unlike some matte lipstick formulas also moisturizing.
Always refer to the actual package for the most accurate information


text:
CLEARWATER, Fla. -- Just before 11:30 on a Friday morning, Bernard Reedy gets a buzz on his phone with an address. It's for a client who needs Reedy to pick him up.
The 25-year-old Reedy climbs into a large white van and heads down U.S. Highway 19. It will be the first of several pickups for a rather unique offseason job for an NFL wide receiver: working as a driver for Care Ride, a Tampa-area company providing wheelchair and ambulatory transport.
Care Ride is similar to Uber and Lyft, but for people with wheelchairs. Drivers must receive special training to operate lifts in the vans and properly secure patients. They must be first-aid and CPR certified, and undergo sensitivity training.
Reedy, who is trying to stick with the Tampa Bay Buccaneers after a stint with the Atlanta Falcons, pulls up to a quiet mobile-home park in Largo. He greets his first client of the day, Carlos Velez, who is waiting under a carport.
Velez, 70, served in Korea and Vietnam and is now confined to a wheelchair. He still has some walking ability, but he fell last year and suffered a hematoma, forcing him to undergo brain surgery. A wheelchair helps him get around safely.
"Is that your motorcycle?" Reedy asks as he gently pushes Velez toward the van.
Velez responds, "I used to have one, but I sold it because of my vision." He points to his right eye. "I'm legally blind."
Reedy says, "I like motorcycles. ... You ever rode a dirt bike?"
Velez responds, "Back home in Puerto Rico when I was young. I always had a Honda. The last Honda I had was a 1300."
The two have ridden together in the van before. Their conversations are usually centered around the weather, politics, restaurants and how Velez is feeling physically. Sometimes Velez airs out his frustrations with the Department of Veterans Affairs.
Despite their many conversations, Velez forgot that Reedy is an NFL player. Most of his clients have no idea. And why would they? Most NFL players don't have side jobs like Reedy's. Only a few of his Bucs teammates know about his other gig that pays him $11 an hour.
"All my other teammates that I know that I personally talk to, they all caked up -- they all got money, a whole lot of money," says Reedy, who has a $465,000 base salary with the Bucs for this season, but it's not all guaranteed. "When I get to that tax bracket with them, I'm going to continue to work here during the offseason. ... You always want to be grateful."
Getting a job 'so I could continue to live'
When the Falcons waived Reedy in 2015 and he had trouble landing with another team, he moved to St. Petersburg, right outside Tampa, and back into his childhood home. It helped ease the burden of having to pay rent, and it allowed him to continue to train while looking for work.
"The money in your savings is only going to last so long. I had to go out and get a job so I could continue to live," Reedy said. "You want to always have something you fall back on. If you don't work, you don't have any more income, so it's just decreasing. You've gotta go find a way to make some money."
As an undrafted free agent out of Toledo, Reedy had spent the entire 2014 season on the Falcons' practice squad, earning $108,600, according to NFLPA records. But in 2015, because he took part in only OTAs, he made $6,240 from football. That's how unpredictable the NFL can be for a player like Reedy.
He spent the entire 2015 season at Care Ride, working eight-hour shifts, five days a week, including Sundays. He didn't listen to NFL games on the radio because that was too hard. He listened to gospel music instead. Faith is what kept him motivated.
In February 2016, he signed a futures contract with the Bucs, reuniting with head coach Dirk Koetter and defensive coordinator and former Falcons coach Mike Smith. Reedy suffered a torn meniscus in the preseason and was waived/injured. He re-signed with the Bucs' practice squad after he healed in December and was on the 53-man roster for two games, earning $85,879 for the season, according to NFLPA records. That figure does not include an injury settlement.
"When I get to that tax bracket with [my teammates], I'm going to continue to work here during the offseason. ... You always want to be grateful." Bernard Reedy
Through it all, Care Ride has been accommodating with his NFL schedule, allowing him to work three days a week when the offseason begins. Now that the Bucs are into offseason conditioning, he's at the team facility four days a week and cuts back to once a week or every other week with Care Ride.
When it's the regular season, the focus is 100 percent football. But if football isn't in the picture, he can work more shifts.
"They know that my other job is like a dream come true, so that comes first," Reedy said of Care Ride. "They understand. A lot of them like sports that work there.
"I could still see me doing this [after football]. I'm financially stable enough now that I could be OK if I didn't do this, but why sit home after you're done working out, going over your plays and stuff? Why sit home when you can come out and make you some more money and help people on top of that? And I'm talking about really helping people, helping people who can't help themselves."
Football isn't entirely forgotten when Reedy is on the job. If there's a lull between pickups, he said he'll pull over to study his playbook or read the Bible. He also turns the van into a portable gym at times.
"I'll put my feet up on the [seat] and do some incline pushups and then I go and do dips," said Reedy, who also tries to find a large parking lot so he can get out and do sprints.
Finding perspective and making connections
The NFL is a brutal business and Reedy knows it. You can get injured or cut at any moment, but it pales in comparison to the hardships many of his clients have endured. That keeps Reedy grounded.
"A lot of people ... you may think you're sacrificing a lot until you hear somebody else's story," Reedy said. "And when you pick up the same people every week, you get attached to them."
That makes it difficult when they pass away. He still thinks about Michael Banks and Robert Latoza.
"[Michael and I] used to talk about muscle cars. He used to build engines," Reedy said.
Latoza, who died a year ago, "was my dog. That's what we called each other. That was my dog."
He left cards at their doorsteps after they passed, sharing some of the stories he was told on their trips together.
It's that level of compassion that endears Reedy not just to his clients but also his co-workers.
"He was one of the youngest employees we've ever hired," manager Vince Cocks said. "He's done a wonderful job for us."
The two have known each other since Reedy was 16, when Cocks and his wife would attend Reedy's games at Lakewood High School. He remembers the time Reedy won the game against Countryside High in 2009, when he ran back a kickoff 96 yards for a touchdown.
But there's much more to Reedy than just football, and Cocks makes that clear. Even though sometimes he has to bolt off to practices and can't work for months at a time, Reedy is an asset to them.
"He's very personable. We get calls from our clients just saying how good and polite and safe [he is]. And he takes the time with them," Cocks said. "We hope he does well over there [with the Bucs]. Naturally, we'd like to have him here, but we want him to play football."


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Sunday Sweets: Gamer Goodness
As you Epbot readers know, I've been playing Ghostbusters and generally geeking/freaking out (once again) about all things Ghostbusters-related this week. Which is why when I saw this first cake I knew today's post would have to be game-themed, just so I'd have an excuse to post it.
Made by Lyndsay Shrubb of Ontario
Don't worry; I have more goodies, too.
Here's a cute Companion Cube from Portal:
Last month I downloaded the free version they made available for the Mac, but I haven't played it yet. Tell me, gamers, is it better on the PS3? Seems like it'd have to be, but I'd love your opinion if you've played it.
Some day I also really want to try Scribblenauts - and not just because this cake is so stinkin' adorable:
Although I admit the cake is helping. ;)
How about a little BioShock?
This cake is especially inspirational because it's only the 4th fondant cake the baker ever attempted! Yep, futurestar101 is not a pro at all, but look at the amount of detail she achieved in the vending machine. Just amazing.
Here's one for you WOWers:
One of the best World of Warcraft cakes I've seen. I love the 3D lettering.
And finally, something from one of John's favorite games, Halo:
By Mike's Amazing Cakes
It takes a master chef to make a master chief! ;)


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UFC February – No real title(s) this month
(No real thread, either)
Memento's last month's thread is Here.
January had four UFC cards, but relatively little happened.
At Fight Night: Stevens vs. Choi, Jeremy Stevens beat up our beautiful boy for a violent second-round TKO after losing the first, Paige VanZant lost a decision to an Australian jobber with a face tattoo, Kamaru Usman looked underwhelming in victory, and Darren Elkins continued his ongoing Homer Simpson impression with a submission victory. Uriah "no J" Hall had a seizure while cutting weight, cancelling his fight with Vitor Belfort, and bringing more good evidence for the need for weight cut reform in the sport.
UFC 220 saw Stipe Miocic defeat Francis "most powerful striker in the world" Ngannou by a 50-44 fatweight gasfest margin to become the only man to defend the UFC Heavyweight championship more than twice. Daniel Cormier put away Volkan Oezdemir pretty easily to defend his title, and Gian Villante took a big poo poo in between seeing Calvin Kattar and Rob Font establish themselves as violent contenders in Featherweight and Bantamweight respectively.
The rest of the month had action. None of it was important, but some of it was cool. Fight Night Jacare vs Brunson 2 had Jacare TKO Derek Brunson, and a Gregor Gillespie established himself as a significant prospect. More importantly the card had multiple body shot KOs.
Fight Night Machida vs Anders saw several Brazillian decisions, including in the main event, and Mario Yamasaki allow Valentina Shevchenko to rack up a bloody 217-1 strike differential in her RNC choke victory over a UFC newcomer. There were some cool body shots on that card, too. Oh, and a good fight was cancelled because of a weight cutting problem, and Desmond Green lost a decision to a fighter who entered the cage 28 pounds over the divisional limit. loving fix weight cutting, people.
If someone has some gifs handy, I'll throw them in.
February has three cards, and they're all underwhelming as the thread title suggests.
February 11th's UFC 221 was supposed to be Bobby Knuckles's first title defense, but he hurt himself and now we have an interim title fight between Yoel Romero and Luke Rockhold. Mark Hunt is returning from too much brain damage to be allowed to ethically fight to face Curtis Blaydes. Heavyweight prospect Tai Tuivasa will be making an appearance, as will perennial fight of the night contender Li "The Leech" Jingliang.
February 18th has Fight Night Cowboy vs Medeiros, offering a headliner that has equal chances of being bloody loving awesome fight of the year potential or of being really depressing. Derrick "Best Social Media Presence" Lewis fights Marcin Tybura (who replaced Lewis in his last scheduled fight and lost a turd of a decision headlining what I voted for as worst card of the year). Sage Northcutt is on the card, and former Invicta champ Livia Renata Souza makes her UFC debut.
Last, on February 24 UFC on Fox Emmet vs Stephens Jeremy Stephens makes a quick turnaround to face concussion distributor Josh Emmet. This is one of those (*in Joe Rogan voice*) these guys hit so hard that someone is definitely going to sleep fights, so expect a turd of a decision as in every single time that has been said about Jeremy Stephens. The coheadliner is my girl Jessica Andrade vs also but not quite as much my girl Tecia Torres. Ovince St. Preux fights Illir Latifi in a fight which I'm amazed hasn't already happened, and Platium Mike Perry returns to face a nobody, so that will probably produce a good KO. Renan Barao returns to face his nemesis at Bantamweight, the bathtub. There are quite a few reasonably good names on this card, actually, even if few of the fights offer obvious fireworks.
There you go – a month with three cards and not one of the organization's 13 champs is fighting.
UFC News
Uh... Anderson Silva's drug test results were revealed as containing piles of synthetic testosterone and other bad stuff, lining him up for an 8 year suspension.
The UFC is planning a three-superfight champion vs champion card for July, so pretty much every other card this year is going to suck in terms of titles.
A bunch of bullshit came into the news with Mayweather posting instagram vids of him playing touchbutt in an MMA cage. I didn't watch them because I assumed they were r-word and meaningless, but people were talking about them.
Your Current Champions
Men's Heavyweight Champion - Stipe Miocic (19-2)
Stipe Miocic won the Heavyweight title in May of 2016, stopping Fabricio Verdum in front of his countrymen in a single round. He backed this feat up with another first-round stoppage of the most decorated Heavyweight of all time, Alistair Overeem, in Miocic's home town of Cleveland in September. He tied the defences record with a KO of Junior Dos Santos, and then secured it for himself with a 50-44 decision over Francis Ngannou in January at UFC 220. He looks to face Daniel Cormier in the "every champion fights every other champion" orgy in July.
Men's Light Heavyweight Champion - Daniel Cormier (19-1-(1))
Daniel Cormier won the belt initially in May of 2015 against the heavy-hitting Anthony Johnson by rear-naked choke in the third round. Cormier defended his belt against Alexander Gustaffson in October of 2015 in a split decision. A planned rematch against Jon Jones was scheduled for UFC 200, which was called off after Jones tested positive for banned substances. Cormier went on to fight Anderson Silva in a non-title bout on three days' notice. Cormier was slated to fight Anthony Johnson in a rematch for the belt in December, a match which did not took place due to Cormier suffering a groin adductor injury. The bout took place at UFC 210 in April, with Cormier defending the belt in under two rounds and Johnson riding off into the sunset with a surprise retirement. The rematch against Jon Jones finally took place at UFC 215 and Jones managed to keep his poo poo together for a grand total of 24 days. Then he tested positive for steroids and had the fight result overturned and the title stripped, and it is now back around the waist of Cool MMA Dad Daniel Cormier. Cormier's beat as Volkan "No Time" Oezdemir, at UFC 220. He next expects to face Stipe Miocic in a champions superfight in July.
Men's Middleweight Champion - Robert Whittaker (19-4)
Whittaker rode a seven-fight winning streak, including shutting down the deadly takedowns of Ronaldo "Jacare" Souza to slot himself into an Interim Middleweight championship match against Yoel "Soldier of God" Romero. The canny Australian showed incredible heart in taking it to the Cuban Olympic silver medalist over five rounds, and even with a severe knee injury coming in the first he managed to outpoint his opponent to take the unanimous decision. With Georges St-Pierre vacating his belt in early December 2017, Whittaker has now been promoted to Undisputed Middleweight Champion. Having now unsuccesfully rehabilited the knee he injured in his match with Romero (correction, it's a staph infection that has him out now), he will look on from the sidelines as Yoel Romero fights for an interim title against Luke Rockhold at UFC 221 in Perth, Australia, in February 2018.
Holy poo poo there are a ton of champions.
Men's Welterweight Champion - Tyron Woodley (17-3-1)
Woodley was promised a title shot against the Welterweight champion 17 months before the fight took place. After Robbie Lawler put in Fight Of The Year performances against Rory MacDonald in July 2015 and Carlos Condit in January 2016, Woodley went into their fight in July of 2016 as a significant underdog. This meant nothing, with Lawler going down to strikes in the first round. Woodley defended his belt against Stephen "Wonderboy" Thompson, putting on an incredible fight that ended in a majority draw at UFC 205 in New York in November 2016. A rematch for this fight was held in March month at UFC 209, with Woodley again the winner in a stilted affair. He defended the title again at UFC 214 in late July 2017 against Demian Maia, following a conservative but sharp gameplan that saw him stop all 22 of the Brazilian Jiu-Jitsu ace's takedown attempts. Rafael dos Anjos has been talked up as the next challenger with his decisive win over former champion Robbie Lawler, but nothing is booked at this stage, with Woodley possibly about to take time off for shoulder surgery.
Men's Lightweight Champion - Conor McGregor (21-3)
Easily beat Eddie Alvarez at UFC 205 in November, becoming the first ever UFC fighter to hold the belts in two divisions at the same time. Several fights are being talked up for Conor at the moment, including Nate Diaz for the LW belt, Khabib Nurmagomedov for the LW belt and even Tyron Woodley for the WW belt. Conor has also talked about taking some time off. The featherweight title was either stripped from Conor, or he relinquished it, following the injury to Daniel Cormier leaving UFC 206 without a title fight for the main event. Conor then took a ton of time off to go fight the biggest-money boxing match of all time, and is now looking for a piece of the promotion action before coming back to MMA. Extra-curricular activities that have landed him in various types of hot water have been the order of the day for McGregor at the moment.
Interim Lightweight Champion Tony Ferguson (26-3)
Tony rode an impressive 9-win/8 bonus award UFC streak to be booked against Khabib Murmagomedov at UFC 209. Unfortunately, Khalabeeb decided he would rather get into a losing fight against a plate of tiramisu and failed to make it to the match. A match against Kevin Lee was announced for UFC 216, with Lee nearly losing to tiramisu before the weigh-in. Ferguson used superior cardio and grappling and the fact he wasn't trying to overcome a staph infection to win by triangle choke late in the 3rd round. Logic dictates his next fight will be against Conor McGregor, but logic has nothing to do with what happens next with that Irishman. Instead, he plans to fights Khabib at UFC 222 in April.
Men's Featherweight Champion - Max Holloway (19-3)
Holloway put together a 9-fight win streak, with several Performance of the Night bonuses, before answering the call to contend for the Interim Featherweight Championship at UFC 206 in December 2016. Taking out Anthony Pettis with a body kick and punches late in the third round, he has set himself up for a unification bout against Jose Aldo at UFC 212. At that event in early June 2017, he defeated Aldo in the third round with focused ground and pound, and unified the belts. Frankie Edgar was announced as Holloway's first defense, but with Edgar out with a broken face, the rematch with Jose Aldo Jr took place at UFC 218 in early December 2017. It was a carbon copy of the first match, with Aldo unable to weather the combinations of The Blessed One, being stopped in the third round. He was attached to a title defense at UFC 222 vs Frankie Edgar, which had been cancelled already due to an Edgar injury, but this time Holloway got injured, so that's all up in the air.
Men's Bantamweight Champion - TJ Dillashaw (18-3)
When he was announced as the coach on The Ultimate Fighter: Redemption against then-champion Cody Garbrandt, the outcome was planned to be a fight between the two for Garbrandt's Bantamweight championship. While the fight between the two was originally announced for July 8 2017 at UFC 213, Garbrandt dropped out with a back injury during May, and it was re-booked for UFC 217 in November. Dillashaw started a slight underdog, but got the job done in the second round with a solid right hook and follow up ground and pound. With his second title reign starting, Dillashaw is presently attached to a superfight vs Demetrious Johnson, and not to a short-notice rematch vs Cody Garbrandt to fill out the UFC 222 card which Holloway's injury has left barren.
Men's Flyweight Champion - Demetrious Johnson (27-2-1)
After winning the Flyweight Championship in September 2012 in a split decision against Joseph Benevidez, Johnson has amassed a 10-fight streak against the best that the division has had to offer. He has been so dominant that the UFC held an entire Ultimate Figher tournament to find his next challenger. The culmination of this was that Tim Elliott came back out of the MMA wilderness to lose a competitive match against Johnson in early December 2016. Johnson easily defended his title against Wilson Reis in April, tying the all-time title defense record held by Anderson Silva. His next was scheduled to take place at UFC 215, with Ray Borg the chosen recipient of a life-altering mauling, but Borg pulled out with an unspecified illness. This match was re-scheduled for UFC 216 on the 7th of October, which saw Johnson soundly beat Borg for four and a half rounds. The champion then casually threw his opponent over his shoulder and grabbed his arm on the way down for a submission win. With TJ Dillashaw now the Bantamweight champion, a superfight between the two for Johnson's Flyweight championship has been mooted for the fight week card in July
Women's Featherweight Champion - Cristiana Justino (19–1 (1))
With the vacating of this championship by Germaine de Randamie in May 2017, a match was set up for UFC 214 between Justino and Megan Anderson. Anderson pulled out of the fight in late June, and was replaced by current Invicta FC Bantamweight Champion Tonya Evinger. The significantly larger fighter on the day, Justino dominated a one-sided affair and won the fight in the third round with brutal knee strikes. Justino defended her championship against Holly Holm at UFC 219 in December 2017, again being the much larger fighter and keeping Holm at bay to take a comprehensive decision victory. There's talk of her fighting Amanda Nunes in July.
Women's Bantamweight Champion - Amanda Nunes (14-4)
Nunes headlined UFC 200 in July of 2016, putting a vicious beating on Miesha Tate and securing a rear-nake choke victory in a little over three minutes. She backed this up with a brutal 48-second TKO victory against former Women's Bantamweight Champion and WMMA pioneer Rounda Rousey in late December 2016. Nunes was slated to take on Valentina Shevchenko in a rematch of their March 2016 fight, with that match being moved to UFC 215 last month. Nunes retained by a razor-thin split decision, and no future contender is announced at this stage, as consensus #1 contender Raquel Pennington is injured, though Nunes may go up to 145 to face Cyborg in a superfight which nobody asked for.
Women's Flyweight Champion - Nicco Montańo (4-2)
After amassing a 5-0 record as an amateur, Nicco turned pro in late 2015. Going 3-2 before signing up to The Ultimate Fighter: A New World Champion, Nicco used her tenacity and solid striking game to garner three decision wins in a row on the reality show. Originally slated to face Sijara Eubanks at the TUF Finale, she ended up taking out a hard-fought decision victory over Goon favourite Roxanne Modaferri to become the first UFC Women's Flyweight champion. No defense is announced at this stage, though pretty much everyone expects Valentina Shevchenko to get the fight shot, in which will likely be a terrifying mismatch in the challenger's favour.
Women's Strawweight Champion - Rose Namajunas (10-3)
After cleaning out the Women's Strawweight division, Joanna Jędrzejczyk seemed to have no more mountains to conquer. After beating Michelle Waterson by rear-naked choke in April 2017, Namajunas was announced as the next contender for want of any other new challengers. In a massive upset, Namajunas beat Jędrzejczyk by TKO in the first round of their championship fight at UFC 217. She'll be giving Joanna a well-deserved dominant-champ-upset rematch at UFC 223.
Other poo poo Which I'll fix later because I just want to get the post up
Thanks very much to LobsterMobster and Fentry for putting together the awards threads for this year. Go to the (link needed) administered by Fentry to refresh your memory on what has been considered by your fellow PSP-MMA posters as the best (and worst) of the MMA world last year.
Thanks also go to LobsterMobster for putting together both iterations of the UFC Fightpass Thread
UFC Fight Pass Playlists and Collections
The NEW UFC Fight Pass Collection Thread
Shout out to DumbWhiteGuy for providing details for the MMA IRC channel.
irc.synirc.net #mma
Join your fellow MMA fans in discussing all things MMA in a place probably secure against nuclear armageddon - IRC has been around for so long I'm not convinced anything could kill it.
More thanks go out to Unfunny Poster for putting together a new UFC Fight Pass Thread - Earning Your 3rd Degree Blackbelt In MMA Posting. This thread is being updated approximately every week with information on new and upcoming additions to the streaming service, and is good for general banter about old fights.
As with Memento, let me know where I hosed something up, and you too could win the No-Prize!
CommonShore fucked around with this message at Feb 5, 2018 around 05:47
|# ? Feb 4, 2018 15:22
|# ? Sep 23, 2019 04:56
Good op but it's a lil short
|# ? Feb 4, 2018 15:28
Skip My Posts posted:
Good op but it's a lil short
Thanks, and yeah you're right. I slapped it together in about 25 minutes. I'll expand it when I get a chance.
|# ? Feb 4, 2018 15:30
Daniel Cormier is gonna beat the greatest heavyweight in UFC history
|# ? Feb 4, 2018 15:31
CommonShore posted:
Thanks, and yeah you're right. I slapped it together in about 25 minutes. I'll expand it when I get a chance.
eh, no need to put in too much more effort than the UFC did setting up their February cards.
|# ? Feb 4, 2018 15:35
Just watched the schevchenko fight and mario was horrible. Fight could have been stopped in the first, multiple times during the second, and then the fighter has to tap three different times to the RNC before yamasaki ends it.
|# ? Feb 4, 2018 16:06
Does anyone want a treatise on why Machida won that decision
|# ? Feb 4, 2018 17:01
I didn't watch the fight and hearing it was another bad machida fight I'm not gonna read it, but I mean if you want to post it,
|# ? Feb 4, 2018 17:06
I would read it, and enjoy it, because learning is Great. teach me mewse
|# ? Feb 4, 2018 17:06
I didn't care about the fight but I want this yes
|# ? Feb 4, 2018 17:08
Machida kicked and punched more than Anders so he won.
|# ? Feb 4, 2018 17:36
The best thing about UFC is the more titles they add the more champions get injured.
|# ? Feb 4, 2018 17:44
Tezcatlipoca posted:
Machida kicked and punched more than Anders so he won.
This is basically it. Someone commented yesterday "Anders didn't realize he was fighting a points fighter".
It's true Machida got wobbled once every round but that was like the only effective aggression coming out of Anders, and almost KOing someone doesn't count as much on the scorecard if the other guy is dictating the tempo for the other 4m30s. There's an argument that splitting Machida's forehead open was significant but that's just scar tissue opening up, judges aren't supposed to score with stockton rules.
Somewhere in the middle of the fight Anders looked like he was mesmerized by Machida's movement because he wasn't throwing anything and just letting Machida circle around the outside of the canvas. His coach was screaming "jab" for half the round, and that was the only good advice I saw from his corner, because it was looking like the kinda fight you get when two counterpunchers circle each other and wait for something to happen.
Later in the fight during Anders' bursts of power he would throw 2-3 punches and then shoot on Machida and then get shucked off. It was infuriating to watch because if you are lighting a guy up on the feet, why are you shooting on him and not completing the takedown (he did complete one in rd5). Later we saw between rounds his coaches were actually telling him to do that and that "it doesn't matter if you don't actually take him down". I guess what they were aiming for was for Anders to lean against him on the cage Randy Couture style for the majority of the round, which can win rounds but isn't what was happening in this fight.
What was happening was that Machida was landing more strikes than Anders. This is from fightmetric:
Brazil is using the new unified rules, and here is what the new rules have for judging criteria:
The document clarifies that an MMA fight should be judged on a single criterion: Effective Striking/Grappling. Only if Effective Striking/Grappling is 100% equal, would a judge move to the second criterion (Plan B) of Effective Aggressiveness. And only if Effective Aggressiveness is 100% equal, would a judge move to the third criterion (Plan C) of Cage/Ring Control.
So as a judge you have one criteria to evaluate the fight: effective striking/grappling. The audience sees Anders' power and thinks that's more effective, but judges tend to go with quantity of strikes. This is a thing that was a big problem in amateur boxing with computerized scoring. Anders didn't really do enough grappling to overshadow the amount of strikes that Machida was landing. Since striking wasn't 100% equal, they don't even consider the criteria of aggressiveness or ring control.
And it was Brazil. The fact that Anders' coaches thought he had it in the bag is loving sad.
|# ? Feb 4, 2018 18:17
Interesting fact: Machida has never lost
|# ? Feb 4, 2018 18:36
Bundt Cake posted:
Interesting fact: Machida has never lost
i seem to recall someone with the unconscious machida after bones dropped him for an avatar for a long time that indicates this is incorrect.
|# ? Feb 4, 2018 19:02
After I wrote all that out there is more clarification about what effective striking means
Effective striking/grappling is defined with the word "damage" removed from the previous proposal. "Impact" is the substitute for "damage." The definition is meant to train judges' attention towards effectiveness over things like flashiness or top control without - dare we say - any damage.
Since Anders' strikes had potential to end the match they should've scored more heavily than Machida's output, so really it was whoever the judges wanted to win and lol Brazil
|# ? Feb 4, 2018 19:06
|# ? Feb 4, 2018 19:08
Mr. Nice! posted:
i seem to recall someone with the unconscious machida after bones dropped him for an avatar for a long time that indicates this is incorrect.
It was Photoshopped.
|# ? Feb 4, 2018 19:13
Mr. Nice! posted:
Just watched the schevchenko fight and mario was horrible. Fight could have been stopped in the first, multiple times during the second, and then the fighter has to tap three different times to the RNC before yamasaki ends it.
lots of people talking about how the ufc should kill the women's divisions but only mario has the balls to do it
|# ? Feb 4, 2018 20:02
What's the biggest underdog a champ has been? Nicco Montańo is going to get murdered as soon as they let her defend against
Valentina. I'm not convinced that Valentina couldn't beat the cast of the W125 TUF season back to back over a long weekend.
|# ? Feb 4, 2018 20:53
I wouldn't be surprised if Nicco dropped the belt and took off running ala Randamie.
|# ? Feb 4, 2018 21:58
Nicco couldn't really get beat any worse, or have any shorter of a title reign, than Joanna vs Carla
|# ? Feb 4, 2018 22:14
Chris James 2 posted:
Daniel Cormier is gonna beat the greatest heavyweight in UFC history
I very much hope not < >
|# ? Feb 4, 2018 22:19
Chris James 2 posted:
Daniel Cormier is gonna beat the greatest heavyweight in UFC history
It's very unlikely that DC gets a superfight with Brock after he beats Stipe, so I doubt it and frankly I'd pick Brock in that one if it did happen.
|# ? Feb 4, 2018 22:50
Travis Browne's name has vanished from the rankings.
|# ? Feb 4, 2018 23:04
good. it's My Main Man Tim Johnson's time
|# ? Feb 4, 2018 23:20
Did you see his mustache? Just delightfully quirky. Man. What a guy.
|# ? Feb 4, 2018 23:55
BELEM, Brazil — Priscila Cachoeira will be forced to go under the knife following a rough UFC debut.
|# ? Feb 4, 2018 23:55
"She was in pain, she got hurt in the first exchange, and told me in between rounds that she hurt her knee but I told her to shut up."
Consistent with the amount of a poo poo her corner gave about her well being throughout the fight.
|# ? Feb 4, 2018 23:59
Dan Didio posted:
Travis Browne's name has vanished from the rankings.
Tiki themed turd golem has some untapped potential as a WWE gimmick.
|# ? Feb 5, 2018 01:55
cool. cool cool cool
|# ? Feb 5, 2018 02:22
Dr. Abysmal posted:
Tiki themed turd golem has some untapped potential as a WWE gimmick.
Browne: I'm not very good and I gently caress up a lot. Oh also I'm 6'7"
McMahon: You're my new World Champion!
|# ? Feb 5, 2018 02:42
Pretty happy to see Johny Hendricks turn his career around and get a coaching job with the Patriots
|# ? Feb 5, 2018 02:45
The announcer yells "he's got a case of the Brownes!" whenever he goes for his finishing move
|# ? Feb 5, 2018 02:49
Andy Dufresne posted:
Pretty happy to see Johny Hendricks turn his career around and get a coaching job with the Patriots
Fuuuuck. I watched the game with two other people who also know and hate Johnny Hendricks and none of us thought of this.
|# ? Feb 5, 2018 03:47
He can't poop
|# ? Feb 5, 2018 03:57
Consistent with the amount of a poo poo her corner gave about her well being throughout the fight.
That comment is made even worse by
"'Pedrita' is fearless, she would never quit. She never considered quitting. The world hasn't seen the real 'Pedrita' fight.
If she never quits, why the gently caress are you telling her to shut up when she is saying her knee is hosed?
|# ? Feb 5, 2018 04:34
I thought Whitaker couldn't fight because of a staph infection not his knee still playing up.
|# ? Feb 5, 2018 05:43
Scapegoat posted:
I thought Whitaker couldn't fight because of a staph infection not his knee still playing up.
You're right. I had forgotten about that. I was just playing with memento's text.
|# ? Feb 5, 2018 05:48
|# ? Sep 23, 2019 04:56
He says he pulled his hamstring, got staph then got chicken pox. Whoever put the curse on him knew what the gently caress they were doing.
Tezcatlipoca fucked around with this message at Feb 5, 2018 around 05:52
|# ? Feb 5, 2018 05:49


text:
Empire Keeway
Logotipo de Empire Keeway de Venezuela
Download the vector logo of the Empire Keeway brand designed by in Encapsulated PostScript (EPS) format. The current status of the logo is obsolete, which means the logo is not in use by the company anymore.
- Designer:
- unkown
- Contributor:
- Richard Durán
- Vector format:
- eps
- Status:
- Obsolete
- Vector Quality:
- No ratings
- Updated on:
- Fri, 03/01/2013 - 17:38


text:
Sony's legal attacks on the hackers behind the recent release of the PlayStation 3 master keys and custom firmware have only begun, but a California judge has raised questions about where the case should be tried. Sony argued that California courts have jurisdiction due to the use of a Paypal account and George Hotz agreeing to the Terms of Service on the PlayStation Network, but San Francisco district court judge Susan Illston didn't think the issue was that cut and dried.
"If having a PayPal account were enough [for California to have jurisdiction], then there would be personal jurisdiction in this court over everybody, and that just can't be right," she stated, as reported by GamesIndustry.biz. "That would mean the entire universe is subject to my jurisdiction, and that's a really hard concept for me to accept."
The ruling on where the case should be tried has been pushed back, and no specific time frame for a decision has been given. Sony has asked for a temporary restraining order to keep the data off the Internet. It also wants the computer equipment used to crack the system and create the firmware, as well as monetary damages. The arguments for the case to be tried in California, not to mention the case for injunctive relief and monetary damages, are based on somewhat shaky and untested legal ground. This is not a good start for the consumer electronics giant.


text:
Carl is an a Player, However No New Funds
Fund: Enterprise Partners Venture Capital
Posted by Anonymous on 2008-02-20
It is public knowledge that EPVC has suspended efforts to raise their next fund, which impacts interactions with entrepreneurs. Carl Eibl is clearly an A player trying to make the best of the current circumstances. Carl is a highly intelligent executive and a valuable contributor to any board of directors. I would welcome the opportunity to work with him again.PRIVATE: Members Only (368 Characters)


text:
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text:
Jackie Stevenson is the founder and CEO of Spirit of Leadership LLC. She is a consultant, coach, therapist and educator. Jackie is an adjunct professor at the Mandel School of Applied Social Sciences at Case Western Reserve University. She is on the faculty of the Gestalt Institute of Cleveland where she teaches in the International Coaching Federation Gestalt coaching certificate program. She is a past Director of the Mandel Jewish Community Center of Cleveland and of the Clinical Center of the Gestalt Institute of Cleveland.
Jackie is a Lake Erie College Entrepreneur-in-Residence and founder and director of the Lake Erie College "Experiential Learning with Horses": Developing Human Potential for Positive Change professional development certificate program.
She is the founder of "Wolf Creek", a wilderness based leadership and personal development program for women. Over 100 women have participated in this year long training program exploring the teachings of nature and the power of personal presence.
Jackie teaches and lectures within the U.S., the U.K., Turkey, Israel and Mexico. She integrates emotional intelligence, Appreciative Inquiry, embodied awareness, best coaching practices, "experiential learning with horses and nature" into her strength-based coaching services.