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Im aplying for a paremedic program at Pittsburgh Center for Emergency Medicine, is it a okay program, anyone taken it ??

I was born and raised in Pittsburgh and I live here now,I been an EMT for 9 years here in PA. "The center" as its called by the students has a more evasive medic program, they schedule all your ride time and hospital time and only the center can you precept with STAT MEDEVAC and Pittsburgh EMS. CCAC is the community college that offers the medic program and actually has a poor passing rates as compared to the center who has a higher rate and costs more but well worth it. I have heard alot of good things about the center medic program. Good luck buddy! Anymore questions, private message me on here.....

And that's why the U.S. continues to have low wages in EMS. Why pay well, when people will do it for free. New Alberta provincial wage starts at $29/hr for Paramedic ($40 after 8 yrs), $5 shift differentials on weekends/evenings, 2X Overtime..... must I go on.

There is no reason an ambulance system can not establish a denial protocol. There is no state law that requires transport of all callers. Yes you may have a protocol that does not allow but no one has ever produced a state law saying we must transport all callers though I have asked multiple times. There would have to be many checks and balances to be successful including making it harder than transporting that way the lazy medic would choose transport over not transport.

One thing you never say is WHY. Why do you feel that these patients should not be transported by EMS? Do you see yourself as some sort of gatekeeper for the EMS service? What do your protocols say about you playing "alternative transport coordinator"? Are these patients not getting an ALS assessment because you're shoving them all into private vehicles? Is pain management being neglected? Sounds pretty stupid to me, to be quite honest. You're putting yourself, your service, and your municipality at enormous risk for.... what? What's the benefit to the system as a result of your actions, and more importantly, what is the benefit to the patient?

I agree with the 'Herbmeister'. Make sure that all your policies are clear and that you understand them fully. The biggest thing is that you do not offer medical advise, but as stated to inform the patient of the potential risks of refusing medical care. Don't you make the decision that an ambulance is not needed, And finally, document everything with signatures. One little piece of jargon I always use with refusals after the patient is informed is that 'patient acknowledges understanding......"

First, I would not worry about whether or not the local transport agency was getting short changed- it's supposed to be about what's in the patient's best interests. Issues like that are for policy makers to hash out. I would be very careful about your policy. First, how do your approach these nontransport calls? What do you tell the person? How do you evaluate them- V/S, lung sounds, EKG, pulse ox, glucose, etc? The patient will always ask something along the lines of "Will I be OK to go by car, and not an ambulance?" That's a loaded- and very dangerous question, which requires an honest answer. Obviously the situation depends on their chief complaint, but often times their stated problem is only the tip of the iceberg, and they have underlying problems that DO require immediate evaluation. We simply do not have the diagnostic tools or training to rule out many problems. Blood work, Xrays, CT's, ultrasound, etc. You may be putting your license-and your employer- on shaky legal ground by encouraging or implying a person does not need an ambulance. Obviously someone with a hand laceration where bleeding is easily controlled does not need an ambulance. They may need sutures, a tetanus shot, or even an XRAY, but someone with a vague complaint like abdominal pain can be anything from gas to a ruptured appendix. I do understand your concerns- especially in this economy. Ambulance service is EXPENSIVE, not everyone's insurance will cover it- especially if it is deemed not an emergency, but that is NOT our call. If you are willing to wait with a family for them to arrange a car transport, then clearly this is not an issue of getting back into service quicker and not wait on an ambulance. Anyone who refuses transport needs to be advised fully of potential risks(however remote), as well as the costs. It HAS to be the decision of the patient and/or their family. As long as they are fully informed- and not coerced into making a decision- then you should be OK as long as you accurately document and converse with medical control. You will never get in trouble for encouraging transport, but you CERTAINLY can if you do not transport someone who turns out to be very sick. Example: Years ago, I had a patient(round 30 y/o) who's family called because she was complaining of a head ache all day, and was just laying on the couch. The patient had no idea the family called us, wanted nothing to do with us, and was angry at her family for calling us. Her vitals were normal, although she was a bit photophobic, so I said she could have anything from a simple head ache, to a migraine to a CVA. I told her we would take her to the ER- it was literally about 6 blocks away. She refused, said she would call back if needed or have her family take her to the ER. Documented the run, called it in, and never gave it a second thought. A few hours later, we received a call from another crew who was at the local ER. They heard this patient's family in the ER, extremely upset- apparently her head aches got worse, they brought her in via private car, and she promptly had a seizure at the ER and went into a coma. Turns out she had a subarachnoid bleed and died later that night. We covered our arses, but of course the ER's first question was why we did not transport earlier. We arrived later at the hospital with another patient, I explained to the staff what happened, and they understood. Would the patient's outcome have changed if we transported earlier? The doc at the ER said probably not- it may have simply delayed the inevitable. Point is, sometimes the simplest things can turn BAD, which means encouraging people NOT to use an ambulance can have very serious- and unexpected- consequences.

I work for a first responder agency. we do not transport, we have our local ems agency transport all patients. Lately I have been making all effort to NOT have to result in a patient being transported unless their life is in danger. For example I wanted on scene for about 30 minutes waiting for a patients family to come get them and transport the patient their self. I think I did the right thing, but by doing that am I cheating the local ems agency out of runs? your thoughts please