BVESBC

In my Haste I was not clear, NO I Don't think its a joke, I have never taken part in anything like this nor will I ever. Tell everyone working EMS that was just put in harms way, that it was a joke just harmless hazing, and see what their reaction is. EMS has gotten enough black eyes, I hope these individuals cant find a job in EMS, we don't need or want this type of behavior associated with us!

Lucky Just Damn Pure Lucky, As someone who is at the U everyday this scares me! Not only are they lucky they were not they were not physicaly harmed while in public but the public may percieve that all the U employees have similar latent views. Does anyone here think that the U security or Newark PD could quell a large (party)at the ER entrance? The answer is YES of course with respect to a appropriate amount of time. JOKE my ass tell that to the next U employee that is asaulted, heckled, harassed, etc. That it was just a joke, harmless hazing.

What a great cause! Save the junkies, give them more drugs, that will further the already stressed system! And if they survive long enough to get TRUE medical care, imprison them and move the burden to the tax payers YEA GREAT IDEA!!!!!!!!!!!!!!!!! In case you didnt already figure it out BAD IDEA!!!!

THANK YOU I think I made my point! skills - S = kills

You can always tell who has money to waste, if its not the size of the rig, start counting the light bars. If they have more than two light bars on one rig its bad juju isnt it? I dont know who said it but give me a beat E350 and I would be just as happy, it also avoids the deep pockets theory / impression.

This thread has shown that the macho culture of suck it up and don't do anything about it, is alive and well. Care for yourself first and you will be a better practioner! I have learned quite lot about this recently and will continue to but this thread is FUBAR. Alot of us are here to learn new things and personal afronts serve no progress. KILL THIS THREAD PLEASE!

I would rather have a medic who was on neither one of those. Why do our patients have to choose between levels of impaired providers?

It's not like there is a gross shortage of ambulance drivers, where we have to settle for the less impaired provider instead of simply hiring non-impaired ones.

Dust, you wrote AMBULANCE DRIVERS, I thought that term was retired!! LOL

I spoke to the hemo monkeys about a hour ago the pt expired no other info. I really wanted to know what they found, oh well i guess that's the way it goes sometimes. Everyone brought up some interesting ideas on this one, I'm leaning towards a multi system event here.

Asysin2leads,

My only true interest in the possibility of asthma was the sudden onset w/ cold air, you are right, lungs CTA all fields rules that out. What are the chances of a pt having a cardiac event w/o atypical presentation CP radiating, diaphoresis, and only dyspnea as a symptom? I had not really considered cardiac as she was not typical cardiac presentation. (tunnel vision on my part towards Respiratory) Maybe I'm over analyzing this, there is obviously nothing I could have done at the BLS level that I didn't do.

Well it is a week later and I don't know the outcome of the pt so I suspect that either she was admitted or she expired.

Scaramedic,

No EKG, I was on a BLS truck, all of our dialysis pt's are transported BLS on the premise that any pt needing higher level of care will be admitted to hosp. Weakness / numbness not able to assess fully, pt was in to much distress to communicate effectively. I had not yet considered hyperkalemia.

AnthonyM83,

I had not even considered returning the pt to the dialysis facility. Even though the dialysis facility is in part of the hosp. The pt care had been transferred to me and I believe that they would have said not our problem take her to the ER. Although was it a proper pt transfer of care? Without proper documentation and facility with held pertinent pt information That is another issue all together.

VentMedic Wrote,

"Rarely do we even get baseline vitals because it was just a "routine".

OMG.. the family is on the phone with Dewey Cheatem and Howe, can you say complete failure to assess?

CBEMT,

L & S saved us about 10 min in this urban mecca of non driving morons! Yes one block! As for remembering all of the DX, RX, Alg, it is a perdiem job in three years I MIGHT have seen this pt once before. I don't think that any providers memory should be substituted for a proper pt transfer of care. This facility has a long history of refusing pt info even on obviously altered pt that can not provide any HX or RX info. The service provider has informed us not to even try to get info from anyone but the pt. I just document that they refused to provide info and have the nurse initial next to it when they sign our run sheet.

I'm not sure if it could be a need to feel in control, I see that a lot of depression Pt's report feeling that they can't control their life / events. I think that everyone wants to feel like they are in control of their body and mind. Theory, that is why we practice medicine and the same reason they call fishing, fishing not catching. I am still learning about this and there is a ton of research material available. Thanks for the posts!

Did your sup. give any other explanation? I dont see how this is illegal, it is totaly up to your supervisor or management to schedule shifts. Do any of the shifts run consecutively with yours? I mean would you be working 24 hrs a day for the whole week?

:shock:

Are you serious?

For those unionheads out there, what are your current dues? I've never paid a union due in my life. And I have very few friends who ever have either, so I honestly don't know what kind of money they are sucking out of people.

Yup very serious Dust, UTU (United Transportation Union), Burning the money would have had the same outcome. Never ever as long as I live will I ever again be associated with a union!

You mean that the hospital knows you are coming? We have a system but I have never seen anyone use it! Even w/ a full code.

THIS IS ANTI UNION IF YOU DONT LIKE THAT STOP READING

This is my OPINION if you want a union, go mine coal, shuffle cars in a rail yard, or whatever it is that laborer's do. The only union I ever belonged to was a total and complete waste of money (110.00 per month), If you want better pay get a better EDUCATION and learn to negotiate for yourself. Don't like it, to bad thats my OPINION.

Yea, I think everyone else covered the most appropriate responses to your post Get a EDUCATION! I dont think anyone mentioned that.

Sometime's you just have to take what pay's (transfer jockey) It is definitely not the golden handcuff. Continue your education and get any CE that you can afford!! For me it was a few years before I got a decent opportunity for a livable wage with benefits, and I still work a second job just to keep building a cushion in the bank. Unfortunately we don't have a pension or other plan. I believe that it is my responsibility to plan for my future not the goverment's. Don't you get tired of the goverment trying saving us from ourselves?

I don't think that this will apply to those working in the field, but those working in a hosp may find it usefull. (Edited for content)

************************************************************

Med Law.com E-Bulletin March 21, 2008

Stephen A. Frew JD, Publisher

************************************************************

------------------------ ---------------------------------

New CMS Notice Requirement and EMTALA

Effective in October 2007, CMS requires that Critical

Access Hospitals and other hospitals that do not have

physicians on duty 24/7 must provide the patient written

notice of that fact and what the hospital's plan is to deal

with emergencies when a physician is not on the premises.

The rule was primarily aimed at specialty hospitals that

typically did not have medical staff on premises 24/7 and

increasingly were coming under criticism for transferring

patients in the middle of the night to general hospitals

if patients deteriorated. Critical Access Hospitals fell

under the rule because they often do not have 24/7 on site

physician coverage.

Recently, we received a question about whether EMTALA might

be violated if a patient were advised that there was no

doctor on duty 24/7 and the patient chose to leave, resulting

in a failure to provide a Medical Screening Exam.

I just received verification on my answer from a regional

CMS office as follows:

The appropriate time to provide the notice would be after the

completion of the medical screening examination, following

stabilization, during the admission process.

Giving the notice prior to that might be considered a

denial of services by the patient, resulting in an

unintentional EMTALA issue.

If the patient is intended for admission, but after receiving

the notification that a physician is not present 24/7

decides they wish to go to a hospital with 24/7 physician

coverage, there are additional EMTALA implications.

1. This would be a patient initiated transfer, and it will

be necessary for the hospital to complete the necessary

patient initiated transfer forms and arrange an appropriate

transfer. Patient initiated transfers, however, are not

viewed as "higher level of care" transfers under EMTALA

acceptance rules, and receiving facilities are not mandated

to accept. Additionally, insurance or Medicare may deny

payment for ambulances because the transfer is not deemed

medically necessary. If the receiving facility refuses

acceptance, the hospital must continue to render care while

attempts to find an accepting destination are pursued.

2. If the patient refuses ambulance transport, it will be

necessary to obtain a written refusal of ambulance. If the

patient refuses to sign the refusal of ambulance or attempts

to leave on their own, the hospital must document all of the

reasonable efforts they made to obtain the patient's signature

to the written refusal forms.

3. These situations are prone to confusion and to complaints,

so attention to complete documentation is critical. Be sure

to document that the notice precipitated the patient's

request and that the notice was provided as required and the

time of admission. Document all efforts to effect the

requested transfer and any refusals.

Best wishes,

Stephen A. Frew JD, Publisher

PO Box 15665

Loves Park

Illinois 61132

United States

Dust, I'm with you on this one I worked at one of the so called sports venue (Nascar) It was a totaly diffrent thing with very min. call volume. Sometimes it's better to have no experience than misguided or unguided experience. Not a Volley bash it can happen anywhere.

:shock: Despite the fact that we have rivers here, that is a new one to me, (put your car in the river) LOL thanks for all the posts on this!

My second job presented me with a interesting situatation the evening/ morning what ever it was it went like this.

Disp, for scheduled transport for pt s/p hemodialysis, Pt presented A & O x 3 w/o complaint Pt HX, CRF, ESRD, NIDDM, + Hep C, two failed kidney transplants and Blind (bilat). Pt was moved to cot via sheet lift, covered w/ blankets & secured w/straps x 3. Pt was moved outside (cold air) to ambulance where pt spontaneously c/o I.........Cant..............Breath, I admin O2 @ 15 L do a quick set of vitals, BP 148/78 HR 104 Resp, shallow & labored & 24-26 per min. Lung sounds CTA sitting upright. This was obviously not a evanescent problem, the pt is obviously in a good deal of distress and not improving w/ our Tx. We go L & S to the other side of the block to go to the ER. O/A I give the charge RN a quick run down of the incident and my findings. Her response was, "So why didn't you take her back to the dialysis unit?" My partner heard her say this and realizing that I was completely stunned said " are you refusing to treat her?" She said "Bed 12" and we promptly transferred pt and left.

In retrospect we had very little info on pt, as the hemodialysis facility (in hospital) refuses to give out any info and pt was poor historian, the PMH was probably partial at best and when asked about medications she responded "lots" and denied any allergies.

1. Would anyone take her back to the dialysis dept?

2. Sudden onset dyspnea, my thought was either, asthma excerbated by cold air, or could their have been a acid/ base issue s/p hemodialysis, would it present itself suddenly or would it be slower onset. Is there any indicators that would be noted in the field as opposed to say labs?

3. Is there other etiology that you would consider?

Asthma is the obvious easy answer, I don't know the outcome of the pt (yet)

I'm partial to our uniforms:

quote]

Yea, they are somewhat distinctive, Not what I see around here......The conifers may be a hard sell though. LOL

This was to far off track for the last thread about antidepressants and their use by providers.

The following was posted by VirginaNPP

Clinical Depression is hereditary ( think like a physical illness) and truly a chemical imbalance (I hate that phrase its so over used). It will not really respond to these lifestyle changes. I know I did psychotherapy for years with some of these patients, so frustrating for me and them.

Another comment, when someone is truly having a major clinical depression they literally cannot do these things, they cannot force them selves to make changes or "pull themselves up by their bootstraps". It is not a matter of weakness of character or lack of trying. It is a DISEASE with a biochemical cause (may be worsened by many factors) But there are true brain changes in persons with depression.

Major depression can and does result in psychosis (really !!!) and suicide. It is a horrible disease, worse then many physical illnesses.

Again the real problem is misdiagnoses and overuse of SSRIs. They do not work with sadness, personality disorder (another whole story) anger, and lots of other things they are prescribed for.

One of the reasons I think it is difficult for so many to accepting clinical depression as a disease is that we all like to believe we can use our mind to control our mood, other wise we feel out of control ! Oh Well, sorry but this can be true.

Ok enough already, hope I have convinced some.

Virginia

Virginia Duffy PhD Psychiatric NP

BVESBC,

What can causes the chemical imbalance? Are the chemical imbalances the same for different kinds of depression? (Situational, Anaclitic, Postpartum, Manic Depressive Psychosis) Are there any obvious heriditary marker's other than the obvious PMH of family members? Can the body compensate for the imbalances, similar to a heart rate increasing to compensate for loss of volume untill they crash? From the responses, I can conclude that orthomolecular treatments are the general consensus here.

I'm interested to see what other companys out of my area use for uniforms. We until recently used polo's (the shirt) with all of the identifying paraphernalia and Navy Blue Uniform pant's, No wacker AKA/ BDU's No Dickies. We decided recently that we wanted a more professional looking uniform and settled on Class A white short sleeve uniform shirts and kept the pants the same. I'm just looking for others opinions on this and I'm interested in what they use.

Sounds like this is common practice, We are very liberal with absences as long as you call! The reason that I posted the topic is because we had a employee that did not show up for several consecutive shifts. No one bothered to even try calling him, incidentally he was found expired in his apartment, two days after his first missed shift. He was also employed in another town's EMS Dept. His regular partner their called PD in the town he lived in and asked them to do a welfare check. I doubt that even a call after the first missed shift would have changed the outcome, but does the practice of not having regular partner contribute the attitude of "I don't care" possibly contributing to higher attrition rates and increased absences? Does anyone feel obligated to not only call their employer, but also their regular partner to let them know they are going to be out for the day? How many of us would call a regular partner if they were unexpectedly absent?

We have a Policy that dictates that any employee that willfully does not show up for work is remediated in the following manner.

First Offense, Written warning in file for 6 mos.

Second Offense, Within 6 mos, Immediate termination, w/o possibility of rehire.

Does anyone else have same policy or have something different? I have felt that at times it is very harsh, but I have also used this to cut free some deadwood. I guess my thought is that unless you have been kidnapped you should pick up the phone call Disp, to at least let someone know you are not coming to work. Is this a work ethics issue or is it common not to let your employer know your not going to show up?