scratrat

Um no. Protocols are GUIDELINES. If a patient is CAO x4, guess what? Your protocols don't mean jack. My protocols say I give NTG to someone with CP. What if they refuse? After I determine they are CAO x 4, I'd make sure to explain why declining NTG is not in their best interests. Then, guess what? They don't get it. If they tell me no, it's assualt to do anything otherwise. You cannot force your protcols on anyone who is not incapacitated. And yes he can be guarenteed to not be altered. Do you know your name, age, location, present events, year, month, etc. etc. Is he NOT under the influence of alcohol or drugs? If you can answer them correctly, guess what? You're CAO x 4. Not to start an argument, but if you took this guy to the hospital he didn't want to go to, you're now charged with kidnapping.

Here's my shot in the dark. A single long bone fracture isn't necessarily a trauma. Any hospital with a orthopedic surgeon can fix it. The only other problem is, how can you be absolutely sure he doesn't have any other injuries? He could have c-spine issues. And if that hospital can't handle those injuries, then we have a problem. But if he is transported to the local hospital of his choice, it's better then nothing. Maybe they can fix his leg, then convince him of the need to be shipped elsewhere. That said, Id explain the risks of going to XYZ hospital vs. ABC hospital. Then if he still wants to go to XYZ hospital, then that's his wish. Just because he has an injury doesn't mean you can force him to go to the hospital that your 'protocols' says. For example, it is state law that we transport to the only certified stroke center in the area, if pt presents with possible CVA. However, that pt, or their PA, can request the other hospital. They are informed of the ramifications, and must sign a form signifying that they understand that the other hospital cannot properly manage them, and they may die. Then we transport them. Until they are unconscious or confused, then you have no say in where they be transported.

Both of our hospitals are cardiac centers with a cath lab. Only one is a certified stroke center though. And by State law, we are required to bring any suspected stroke to that hospital, regardless of what the pt wants.

I have to agree and disagree with you on this one Dust. First, I came from a two tier system. The most frustrating part was going on calls that BLS could not figure out that we were not needed. The upside was, in general, we saw only sick people who those who required ALS intervention. Burn out did happen a lot in this system because most of the medics were tired of dealing with idiots. Every call was BS until proven otherwise. Now I am in an all ALS system where I work with an EMT or a paramedic. So now, I have to go on every call just like before, only now I get the drunks, the toothaches, the "I've been sick for 3 weeks and at 3am I think it's an emergency", etc. Both systems have pros and cons. But I liked the two tier system better. I got more experience there in one week than I have for the past 6 months here!!!

Yes, it is fraud. How they don't get caught is beyond me. If they are not billing the pt's for co-pays, they risk losing Medicare reimbursements. Medicare REQUIRES, read REQUIRES, they every pt be billed for their applicable co-pay, usually around $25.00, I believe. It does not, however, say that the pt is required to pay. Most squads, send the pt 3 bills, then write it off. But even after Medicare pays the bill, the pt is still responsible for the co-pay. You cannot bill the pt $300 though, and then bill Medicare for the same.

And another thing referencing education/training.... I will be the first to admit that after 2 years in paramedic school, and 7 years on the street as a paramedic, I am still learning. I don't think I put two and two together until my field internship. I was taught about everything. But until you practice it in the field, it doesn't matter. To me, all that education made sense once I saw real people and began to come up with treatment modalities. Reference the above post, that person went to school for 2 years, has been a paramedic for 4-5 years, give or take, and is still a retard. I think it falls more into how well you can equate your education into field use. That goes for everyone. EMT's can't function if they don't understand what they were taught and put it to field use. Paramedics, nurses, doctors, all the say. I don't care what letters follow your name. If you can't figure out how to translate that information into field use, you are useless. A nurse can have a MSN after his/her name and still not function in an emergency setting. I have no idea what all that had to do with anything in this post....

I love reading some of these replies. I don't think this will answer any questions, but I try my little input. Basics are good for managing none life-threatening calls. Where I came from, we had ALS seperate and responded in Ford Explorers and such. We met up with BLS if it was needed. The reason I like this approach, is because my time is watsed on calls like a stubbed toe. There is no reason that a BLS provider cannot handle that call. Now, I run with either an EMT or (my full time partner is a paramedic) paramedic. If it's an EMT, they treat the calls that are BLS. If it's a dual medic truck, we alternate calls but still go on everything, including that stubbed toe. I know that doesn't quantify why basics are important, per se, but I think they have a role. I try not to forget where I started. EMT first, then paramedic school after I got some experience under my belt. As a side note, I just have to share this because I almost fainted. My PARAMEDIC partner and I were having a discussion and my continuing education. We went on a call to an office where drugs reps were present. I said, that's what I should do. Big money. My question was, at the time, I don't understand why you need a drug rep to represent albuterol and Zoponex. *That's what they were pushing*. I said, they are basically the only two fast acting inhalers widely in use, save for Atrovent, but that's still usually mixed with albuterol. Her reply to me was, "Well, there's also Proventil." I almost fainted. I had to fight with her to get her to understand that Proventil and albuterol were the same damn thing. So, that being said, I couldn't care less if my partner is a medic or EMT. Some medics scare me, frankly, and I don't see the difference between an EMT and a paramedic who doesn't recognize albuterol and Proventil. She's also competent enough to administer NTG to EVERY single CP no matter what the origin of that CP. I don't see the difference. And this is someone with supposedly 4-5 years of experience at the medic level.

No.

Would it help if we developed the twang so y'all could understand us?

I knew I loved you for a reason!! HAHA. I've done some of those.... uh oh. :shock:

I don't know about the rest of you, but I now fear for my job security. With the pending tax cuts, I fear there will be layoffs. Massively, statewide! No matter what Crist says, I think we're about to get screwed. There is no way they can cut that much tax revenue without massive cutbacks. Sheriffs office is probably the highest budget in most counties, and I'd venture to say fire and EMS is next or close to it. I live in Tallahassee and my taxes are $300 a year on a value of 103,000. This will probably go up slightly because we just it, and it wasn't taxed correctly. Still, it will probably go to only about $1k a year. I came from New Jersey. On a tax assessment value of $65k, I paid over $3k in taxes and it rose to $4500 when we sold. Floridians don't seem to realize how cheap our taxes are down here. No offense if this affects some of you, but it seems to me that the people who pay out the nose for taxes, live in a $300-500K house, live in a resort area, live in a large area like Tampa, Miami or whatever. They also make a whole hell of a lot more than firefighters and EMS does. What they should be complaining about is their homeowners insurance. I paid $700 a year in New Jersey and pay $2000 a year here. I understand we deal with hurricanes but that is a ridiculous amount of money. I also don't think people realize that the money cut from local budgets will have to be made up somewhere. Added sales tax, added sales tax to things that weren't taxed before, higher vehicle registration fees, higher fees hidden here and there. Our sales tax is already obnoxious at 8%. If they cut taxes by the amounts they are talking, where do you think that's going to come from? Here, they have talked about closing libraries, lowering animal control, and others, but still that only amounted to about a quarter of the deficit that will be created. They are going to go after the bigger spenders after that! IE, sheriff offices, fire departments, EMS departments.... I came down here for two reasons, cheaper cost of living (for the most part), and since I work for the county, I get the FRS. New Jersey offered me nothing for retirement. That's why I'm here. I love the area and don't want to leave, but I don't know what I'm going to do if I get laid off. Anyone else in fear for their job right now? And if anyone has any other discussions to steer me away from my rationalized fear, let me hear it!! I just have this feeling we are going to get screwed in January and want to know if you feel the same way.

I have heard that too. ruffems.. I don't put the blame on anyone but the hospital. BUT.....they could walk outside and call 911. EMTALA might be a problem, I'm not the legal expert. It's been done and as far as I know, we've never received any flack. I'm not saying that makes it right though. Even though I feel wholeheartedly that this hospital is to blame, I still have problems with the dispatch end of it. First, the hospital should be fined big time or closed. They should also be sued. As much as I am against frivolous lawsuits, this one doesn't fit that bill. At least not in my mind. On the dispatch end of it, someone called 911 and asked for help. If someone calls 911 and says they want police, fire, EMS, etc., you cannot just say no. Some one has to respond. You can't just tell the person no. I think they are going to get successfully sued for this one, big time. All the family needs is a few doctors who state that given her present condition, if she would have received proper care at XYZ hospital in XYZ amount of time, she'd be alive today. Thats it. I don't think it's going to be a far stretch from that point, to go after negligence. Think about this one, someone calls 911 because their big toe hurts after they stubbed it. Is this an emergency? No. Does it warrant evaluation by an ER physician? No. Probably not. Can you legally tell this person that it's not an emergency and refuse to respond? I'm going with no. Granted, this scenario didn't include calling from an ER. But I still believe they should have covered their butts and sent what was requested.

We've been dispatched to the hospital grounds before. You CANNOT refuse action when someone calls 911. That's called negligence. We've had people call 911 and step outside the doors and state they want to go to another hospital for treatment. They sign out AMA from said hospital and we transport. You can't tell them no as long as they sign out from the first hospital.

Hey stranger!! How's the North, eh? We used EMS Desktop at Underwood. I loved IT!! If you treated someone before at that particular medic unit, it would bring up all their old information, if you wanted to use it. All those frequent fliers you have makes for an easy report. That charting system was the best I've seen so far. We use something called Emergency Pro 3.5 and it sucks. Miserably. Once I got the hang of it, it was east to use, but the print out looks like a simple hand typed chart. It just looks unprofessional to me. The Underwood one, had their patch on it, and it lists everything very professionally. I would recommend that one to anyone. I have no experience with emscharts.

I can't even comment... Good articles though. Makes me glad I don't live there.

Status Hispanicus x 2 million? no thanks.

There is a federal statute somwhere, just not sure where. If you are performing your duties as a firefighter, EMT, or paramedic, you are considered LEO for the purposes of an assualt. Assaulting you is the same as assaulting a police officer with the same punishment. Also, as a side note, if you assault a K-9 dog, it is also considered assaulting a police officer.

I'm going with pseudo-seizure given her PMH. Either that or petit mal. Her presentation sounds like a seizure. I've had plenty that are awake and able to speak somewhat while they are having seizures on one side, or in the face, or whatever. Valium solved it. And I tried my best to ensure they weren't seekers either. That's my story, and I'm sticking to it.

Um, no, he apparantly is not, in fact, a "good medic". That's piss poor pt care. And if you follow his advice like you listed above, then you are also providing piss poor pt care. What the hell are they teaching you people these days? I'd invest in malpractice insurance at HPSO.com if I were you.

All I can say is wow. This is exactly the mentality that forced me to leave New Jersey. Amongst a few other reasons. So, less than 3 minutes and emergency care is started? By whom? A first responder? A police officer who is also an EMT? Without getting into an argument about who's better than who, what may I ask is a first responder going to do for a sudden onset stroke? How about an acute MI? Oxygen. Thats it. And while that is important, the pt will be dead if not gotten to definitive care immediately. I don't care if it's by BLS or ALS. That's another debate. But the fact remains, that even if medics are on scene, if they can't transport in a timely fashion, then that's a seriously flawed system. If my family member waits, by your own admission, 28 minutes while suffering from an acute MI, and then dies, rest assured I'd own your little town. I'm not sue happy, but there comes a point that a hostage must be shot. And in this case, the hostage would be your service. Or whichever service failed to respond. Somewhere, on paper, by law, there is a written agreement, that any squad will respond to a call within XYZ timeframe. Problem is, no one enforces it. I think it should be the State's job. Whenever a crew is not RESPONDING with a FULL CREW, not just one EMT and a first responder, then that service gets fined. After XYZ number of fines, the squad gets shut down, disbanded, and a someone else takes it over. Whether it be a PAID service through the state, county, city, whatever. I may be wrong, but I haven't found ONE county thus far in Florida that does not have at least one 24 hour service covering them. If one state can do it, so can everyone else.

Sounds like a good idea...

hahahahahahaha

[web:8cb8dc652e]http://www.insidebayarea.com/oaklandtribune/localnews/ci_5989654[/web:8cb8dc652e]

I guess that's like "smoking a fag"? But, pissed as in angry because they went there earlier and the women refused transport. Then they were called back in the wee hours of the morning.

[web:b00cc58f57]http://www.hudsonreporter.com/site/news.cfm?BRD=1291&dept_id=523585&newsid=18389834&PAG=461&rfi=9[/web:b00cc58f57]