spenac

Come on guys play nice as I mentioned to Dust lets ignore the door. Hows this you meet patient on curb and patient only enters ambulance if you politely invite and assist them. Darn it I did it again I put to much into the scenario and ya'll are going to beat me up for it. Mommy :violent1: :crybaby:

Here is a good site that sells the bougie under the name of Tube Introducer 15 F Coude Tip. https://securesite.nittanylink.com/AirwayCa...t/Products.aspx EMP also sells the bougie. I am aware of numerous medics that carry one with them and they get the airway when others including the Doctors don't. I have only recently began practicing with them and have them at one of the services I work for and will order for the other service soon. From what I have seen they do a lot less damage than the medics that just keep unsuccessfully trying to intubate.

Cool a locked door, whats that? OK lets not get distracted by the door. In my part of the world I'm probably the only person that locks my car or house. I forget that some of you have to deal with junkies stealing your happy meds or terrorist wanting to use your vehichle to send people to the happy hunting grounds.

A recent scenario I did got some interesting responses, discussion and arguments, but really makes me want to see how things are done in different areas. Are all callers actually transported or was what went on in the other scenario the result of the distractions of the scenario. So this scenario will not have any misleading info to distract from the goal of seeing if transport by ambulance is always required. I will try my best not to go into a rant. Thank you for honestly answering the poll on this and for your responses. Scenario: You are at your current station. You are dispatched by 911 (or other emergency number for your area) to a person that just said "send the ambulance" and hung up. It is 1 block from your station to caller. Upon arrival you find a clean healthy 30 year old person. Before you and your partner can exit the ambulance the person has already entered the box by the side door. You enter and ask what you can do to help and get this reply, "You can hurry up and drive me to the hospital before the lunch special ends". Patient becomes agitated that you want vitals and tells you "Do not touch me just get me to the hospital before the lunch special ends". Only thing you know is ABC's and that the patient is alert and oriented as gives name, birthday, address, what day is it "it's discount hamburger day at the hospital", when asked complaint "I'm hungry", asked when complaint began "about half an hour ago", what makes it worse "you making me miss the lunch special, now get to driving". What do you do based on your services policy, protocol, orders, etc.?

Thanks, enjoyed it to. I actually do have a lot of respect for medics in the city's. Your minds and bodies have to run constant, I get most times a 90 mile drive or ride back home to unwind, but you guys go pick up drop off and pick up again again again. The endless running and from what others post sadly many are not a real emergency and then still always geared for the real one. I actually envy sometimes the thought of not being alone to make the critical decisions based on a few pages of paper and knowing there is no help for more than an hour and no one to call for advice. But it also makes me work to continue my education because we are years if not decades from getting a hospital in our immediate area so it will continue to be up to those of us in EMS to provide the best care we can. It is rewarding and in some ways more difficult at the same time on the long transports. We have time to learn about our patients, their family's, their pet's, their beliefs etc. But that also makes it harder to deal with knowing they are about to die but you hope at least by being there with them you brought them some comfort. Often times the ones that were not dieing (which is most as most really just need the doctor not the ambulance or ER) will see us in town and introduce their family's to us, give us hugs or a warm hand shake. You know like everyone I have a lot I can gripe about but really I could not see doing EMS any where else. And I can not see leaving EMS. The hardest part is making changes to become more Professional. There is no one size fits all. Education is vital I agree but is not all that is needed. I see many ways it could be improved here but if I required those same changes in your area might make it worse there. And if you go with what benefits the majority, the people in areas like I serve lose.

You have me there, yes I have to live by a protocol, but a protocol requires you to use your education to even know where to begin. We have very progressive protocols. Thankfully as I have mentioned elsewhere it does allow us to think a little rather than none. I will not argue a point that is already been discussed to death it is obvious that we work in different environments and have to operate in the way that our medical directors deem best. I will continue to work from my part of the world for people to view us as professionals and I hope you do from yours.

Thank for well thought out Professional response maybe that will keep me from my going back to ranting. Actually this occurs within a mile of the border. This child in the scenario is one of the babys you speak of. Mother wants a way past the check point 50 miles inland. If the child actually had a need that required transport we would hall her right away with the mother, no problem with that. Child has legal family they have already taken her out of the USA and back today and are happy to take the child again this one point that is being missed by many and maybe I should find a way to reword is "You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA." I should not have used the is there some other concern maybe if I just asked the first question of what is the reason for your 911 call and then had her reply " "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA." We do not worry about a persons legal status we are not law enforcement, if there is a real or even a decently faked emergeny we transport. We deny very few as yes there is to much at risk to be wrong. Again the reason for this denial is mothers only reason for ambulance is being illegal per her. Again thank you for the professional reply.

I will not waste my time on all the points you have missed but number one the mother in scenario said there was no medical concern the only reason for the call was she the mother cannot legally get past the check point. "You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA." Also read all the post mother is illegally in the USA. She is on the USA side of the border. She is wanting to get past the checkpoint 50 miles north. She is not at the border patrol asking for help. She had family take the child to Mexico for care and they brought her back to the USA. Now the mother calls from where she is illegally staying. Mothers legal status only is in play because that is only reason she gives for wanting the ambulance is to further break the law. read all the posts. "You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA." The only reason the mother has requested the ambulance in her own words is she can't pass the check point!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I am sorry you work with incompetent medics, thankfully I work with professionals. Thankfully I work with a medical director that lets us operate as professionals. If you and your fellow medics can't tie your shoes as you say may I suggest side zip boots. Glad you do not work with me since as you say you don't believe in protocols, I do not want a law suit for ignoring a higher educated persons instructions. What I do is within the scope of practice of my protocol. Please read the posts and you find many points you wrongly state already dealt with. People with your attitude that you transport everything without using your brain were the cause of my taxi um ambulance driver rant yesterday.

OOPS I violated protocol and transported against the medical directors instructions I've therefore exceeded my scope of practice. At a later comment I gave the statement that our protocol allows denial if no current medical complaint and this clearly shows mother is not requesting us because of the child therefore no transport. Thanks for your input and your local protocols do proably require you to transport all callers even if they just want a ride to eat at the hospital. Our protocols allow us to weed out some things but not many we still transport most that request it.

Thanks for all the responses. This is a tangled web for which there is no completely right answer other than follow local protocol. The local protocol allows us to deny a request for transport in some situations and no medical complaint is one of those so this patient and her mother will not go up by our ambulance. So we explain the reason to the mother do tons of paperwork and go get the next one. The legal status is something that was done to complicate this case and is something we face regularly here but we do not ever allow a persons legal status if known to change our way we treat them. We treat everyone Professionally and with compassion, but that does not mean we have to transport them if they do not need it. Will we ever be properly staffed? No not going to happen but we are fighting for improvements. But even if better staffed I can never see a way to justify this caller being taken to the hospital, but if your the lead medic here when we get one like this it's your call, I'll back you on the transport. Now if your lead and your wanting to deny a transport to someone I feel needs to go, I just took over as lead medic and we're transporting, thats part of the process. Denying requires both medics of any level agreeing or the patient goes. Hope this has some of you thinking that there may be more than one right way to be Professional. What works here may not work there, but it does not make it wrong. I definitely do not agree with some of the posts I've read since joining but I am not working where you work so I can not say you are wrong.

Rid, you seem to miss the point of my rant. My point is that if we have to transport every caller regardless that they have no medical or trauma complaint we are acting as a taxi driver. Come on is there any way you can say we are professional if we drive the caller that wants to go eat at the hospital but has no medical complaints, by taking a person to eat we are being taxi drivers. I am not asking that we choose to deny somebody with a medical complaint. In another post I mentioned someone that clearly stated they just needed the ambulance to get them past the border patrol checkpoint and people were saying we should take her even though we had no current medical complaint. To transport her we would be a taxi driver. Now as to us providing other services there are taxis available. In Texas if person has medicaid they can get receive funds from the transportation division to travel to doctors, they can even receive money for airplane tickets, hotels, and meals. There is no reason for the ambulance to take a person with no medical complaint. We do try to educate the public. My rant is over on taxi cab I just hope it gets people to realize not all services have the benefit of more ambulances to take over coverage. In the city transport and paperwork would be shorter. Paper work on denial of transport is more complex and takes longer so probably not worth it in the city. I hope did not step on toes. I am glad I work in an area where I can think though at times it would be nice to pick up the phone and let a Doctor decide for me. The city and even most rural areas have more services available than the area I am in, but I still am sure theres bound to some even in more remote areas than us. A key for all of us to remember is that what works in your area may not be practical in my area and vis a versa. There should never be a complete firm no more no less nationwide protocol developed. I can see benefit of having a minimum nationwide protocol that expands everyones capabilitys but allows medical directors to expand the scope of practice of their people to fit the environment worked in. To all my fellow EMS Professionals have a great day and keep stretching our way of thinking.

Good night be safe hope havn't stepped on any toes. Ranting done for the night.

Your medical director would not issue a protocol to refuse transport to someone that has no medical complaint at all!!!!! That shocks me. As far as more education, I do agree we need a more standard requirement for education and should be higher than most current programs. Don't fully agree with 4 year degree especially if still just transporting everyone and not using our brains, sadly even if we were all 4 year degreed paramedics most directors still can not or will not risk use of free will. As far as leaving EMS not going to happen. Still love doing it. I used to own my own business made more money but wasn't happy. I am despite what my rants today sound like very happy working EMS as I do get to make a difference in peoples lives. Really hope my rants today make others think, and work to get where they can think. Even with all the levels medical directors could sign off to only allow certain levels to work for them. In my part of the world the expression is quit pissing into the wind, because when you do piss in the wind you only take one problem and turn it into a bigger messier one. You know I agree most are not just taxi drivers but it illustrates the point. Be proud of what we do but lets work to change for the better. Talk with your directors might find a few that are confident in their paramedics ability to think at least a little. Until the worlds aperfect place we'll keep doing our job here at the end of nowhere to.

BEorP sorry if any posts seem like a personal attack don't mean it that way. I guess if I worked in a city where it was only 10 minutes to hospital on long transport and we had lots of ambulances maybe this would not get to me. But from my end of the world I see no value in wasting ambulance time and limited resorces to transport any and all 911 callers. The taboo word common sense comes in and says hey I should be able to use my brain to say no to someone with no medical complaint. I just cannot see us being looked at as professionals as long as we have no ability to use good judgement. Hope we're good no offense meant just on a rant rampage today.

BEorP did you forget to check yes on the poll? Because based on your responses we should not be allowed to think, we should just be taxi drivers or ambulance drivers as seems to be correct name.

I know I'm in a completely different environment but come on city medics you are saying that you are not willing to make the effort required to become professionals. You are satisfied being taxi drivers. While I'm sure that you can do cpr does it not insult your intelligence that you can not deny a person with no medical complaint transport. Even with protocols that allows denial of some 911 callers being transported I start feeling like a taxi driver. Why not work with your medical directors to make changes. I personally don't want to hear anything about education to be professional unless it will allow EMS members to start using their brains. Why should I go to school for 4 years just to drive a taxi, the same thing we already do. My rant meter is running probably about to break my piggy bank.

By your theory it would require staffing one taxi um I mean ambulance at every house. Not going to happen. What happens when all your taxis are out transporting where are more coming from. If you continue to allow people to abuse the system you are saying all we are are taxi drivers. No way we can ever be considered truly professional when we have no use of our brains, I will not lower myself to that standard. Thankfully I have one of the few good directors that realizes that we can be educated to realize not all callers need transport. Even if we had another ambulance to cover, which we don't, not a perfect world, I would still prefer to be available to assist them in saving a real patient rather than transporting a person that has no medical problem.

Since we cannot think and therefore we must transport everyone as we are taxi drivers, a question to ponder, will we feel anything if our loved one dies while we transport the person that coughed once and thinks they now have some deadly disease they saw on House?

Your taxi's here welcome to the USA.

ridryder -50 for saying that dirty word or words -"common sense" can not have it either. We can not think. We all must just load up everyone that calls including the guy that just wants to go eat at the hospital because he called 911 saying his stomach hurts. Ok I understand that we work under the medical directors license. Again there has to be a reasonable point of balance that would help stop this abuse. Again if not then all we really are taxi drivers. Law changes may be in order to make this happen but it is needed or we can never be considered Professionals by anyone but ourselves. Again if the medical director doesn't trust the person fire the person or require them to work under another medic you trust until they earn your trust. If schools are turning out people that can not think and should not be out there close the schools. But if the other changes don't happen whats the point we're just taxi- ambulance drivers. more ranting later bear with me.

Was she doing the bills? Did her husband say no to buying something she wanted? Did she get bad news? Sounds like if eveything else checked out a simple case of HFS. OOPs I forgot to call medical control to see if I could think I better leave and come back later.

Medical directors should set protocol as to when not to transport. If medical director does not trust their medics to think maybe they should refuse to allow the medics to work under them or just maybe the medical director is not one that is right for EMS. A medical director needs to be able to let go of some of the power if EMS is going to turn around and have it's people looked at as Professionals. If you are a medical director that tells your medics how many sheets of paper they should use to wipe their butts you are part of this problem. You need as a medical director be able to set some guidelines that allow the EMS members to think, to do, and to become Professionals that can be respected by the public and other healthcare providers. More rant later

More waste of tax payer money another reason we are not looked at as professionals.

It is easy for them to get the medical pass to even take and go up POV if the child is USA citizen as was in this scenario. Mother is already here illegally and does not want to risk going back to Mexico and then be denied re-entry to USA. I wish we could get Border Patrol to respond to all our calls even if they never check papers. Many have first responder training and could just show up to help us load patients. They would probably be accused of strong arming, intimidation.