Just Plain Ruff

sounds like this is a system rife with abuse and fraud. The taxpayers should be pissed off and rightly so. Doesn't getting a new job automatically cut off the disability payments? I mean common sense says that if you can work as a nurse you aren't really disabled are you? I wonder how they will work this story line in to the new show Chicago Fire.

Yep, not a illegal search and seizure. Heck I can break into a persons house, see some evidence of a crime. leave the house and call the cops and they can get a search warrant and enter thehouse and arrest the person. That's not illegal. So the phone thing, not illegal search.

so you have a bunch of wiseacres who ruined it for all of you. I may have worked for your company at one time or at least a replica of your company. I'll bet your supervisor got so frustrated with those dumbasses making fun of the policy that he said to himself "Screw them, they don't get anything now" That'll teach em. I'm glad I don't work there anymore.

Well in Dwayne's defense, he can't even get porn

I just finished Chicago Fire this morning on ON-demand and it didn't fail to disappoint Yes it is as bad as I thought it would be but YES I do understand that it's hollywood and it's entertainment only. 1. I did notice that there are no fat firefighters - only buff sexy chicks and studs 2. Not one firefighter was seen sitting around the television in a recliner 3. The female paramedic is quite cute 4. The same female paramedic did a pericardiocentisis which is out of protocol/scope for her and at the end of the episode she was told on a phone call that she is being investigated(rock on) 5. Every call was a spectacular call. NO run of the mill granny runs for this show 6. The generic angst and relationship problems inherent in every television show. 7. NO SEX on this first episode. AMAZING just amazing 8. no one got admitted to the code 1 club 9. Both patients in the trauma (one being the one getting the pericardiocentesis) were removed from the car without spinal precautions 10. floor collapse, one firefighter has a collapsed lung, same paramedic who did the procedure in number 9 also got to needle the chest. Wow, two life saving procedures that many of us have never done in the field, this medic got to do in one shift. I wonder when she will get to amputate a leg or do field surgery to close off an artery. AS for next week, the calls just seem to get better and better. It seems like that they are taking all the most spectacular calls (true to life though) and are going to use them for their episodes. One in particular is a out of control warehouse fire and there is a man inside. They go into attack mode and leave him inside. How does the new probie deal with it. Now this is all hollywood but seriously, how many times do producers and networks have to use the same formula and see the same types of shows only last one season. I don't give this show much chance either. I don't see the producers having learned from the past.

Then your policy needs to be rewritten. IT sucks and is a stupid policy. When a policy states you cannot even accept a glass of water that's a STUPID policy. If I offered you a glass of water and you told me you couldn't accept it but you could accept a monetary gift but it has to be sent to the department I'd be offended and PISSED Off. Your policy writer needs a lesson in diplomacy. And your department should have returned the gift basket because it broke your said policy of not being able to accept food or "anything" but of course they didn't return it.

Why is this an issue? Why would anyone have a problem with taking food offered from a patient or their family? I've been offered everything from a drink of water to a sandwich to a slice of chocolate cake. Our ER has been brought candy, sodas, cakes, pastries, full dinners, thanksgiving dinners and we gladly partook in those provisions. I worked in a fire house where a family brought us Christmas dinner because one christmas the crew on duty saved the family's home and their beloved dog from carbon monoxide. If if comes from the heart, why does anyone have an issue with partaking in food with a patient. Sometimes the meal that you eat with the patient may be the only meal that the patient will get or it might be the only companionship that patient may have that day.

Wait, was I too rough on him. Wasn't trying to be. Just want him to understand that to transport this guy against his will is something that is really dangerous to the patient as well as to the provider. if the patient is refusing to go and will become violent in the ensuing trying to force him to go then thats a bad thing. But it's also dangerous to the provider in the long term in terms of their livelihood. Take too many people against their will and your cert and your livelihood will be on the line because youwill eventually be sued. You could also be arrested for assault and battery or even kidnapping (worst case though). And Doc is absolutely correct. my emt class andmedic class had a total of 3 hours devoted to legal mumbo jumbo. Since then, I've had about 10 more hours of it but I've also talked to attorneys beyond those hours so I know what the law is in missouri and in Kansas. I would urge you to ask your service to bring in an attorney who specializes in EMS Related law and have a yearly inservice on just this type of issue. Have the crews ask the lawyer questions. Have the lawyer be available to the Service for these types of situations in order to be able to face them sooner rather than later. Sadly, most services do not have this type of resource available to them, the proactive and good ones do. If you arm your providers with the info that they need and the knowledge that they need to face these types of situations, less of this issue will come up. We provide them with top of the line cardiac monitors, CEU's that keep them up on the cutting edge of cardiac knowledge and trauma care, why not keep the providers in your service up to date with the most recent case law and court decisions and understanding of the legal issues surrounding the care of the sick and injured? Most of this is common sense but sadly a lot is not. Maybe JP can come in on this thread and give us some better legal info.

WOW JUST WOW. Where to begin. I can't seem to get a handle on where to begin because there is so much to digest in this well thought out and intelligent post. But then I read Biebers post and he said it all. But Mike, I suggest you re-read your emt book chapter 1, and then go talk to an attorney about this thread and see what they tell you. You might be extremely surprised to find out that if you were to transport this patient against his will that you would be on the wrong end of the nasty stick of a lawsuit and that EMT cert that you worked so hard to obtain, well it was no longer valid in your state. Psych consults don't necessarily mean that you are incompetent. And doctors orders mean jack shit if the patient refuses transport. The doctor is going to come back and say if you tell him that the patient is refusing to go "well if he's refusing to come then I can't force him". A doctors order is really nothing more than a piece of paper that authorizes transport or a certain procedure to be done. It works really well for insurance because if you don't have the order then it doesn't get paid. The doctors order can't force me to be transported against my will unless there is a whole bunch more paperwork accompanying that order such as a 96 hour hold or a court order. Just because the doctor says transport doesn't mean that you can force the patient to go. Otherwise we'd be forcing many of our patients against their will every single day. AS for the jumping from the moving vehicle, that was 2 days ago, he may have been suicidal then but suicidal thoughts and ideations come and go, he may not be suicidal now. If he isn't suicidal now, then the episode two days ago is just a red herring. It can be used for past history in obtaining the 96 hour hold papers but it cannot be used to confine him right then and there based on that episode. IF so, when I was suicidal 20 years ago, they could confine me today based on that logic. So your thought process and your willingness to transport this patient against his will really scares me, and makes me wonder if you really know the rules of EMS engagement when it comes to this type of patient. It also calls into question how many patients you have tranpsorted against their will just becuase you can. If I was your supervisor and saw this post of yours, I would be in discussion with you behind closed doors trying to figure out whether you had any future at our EMS agency. It also calls into question how many patients who refused care that you transported to the ER against their will who were not suicidal simply because the doctor ordered it. Those being nursing home patients. Do you see what I'm getting at. If a patient says NO i'm not going and they are competent then they don't go unless you can change their mind. Youdon't force them to go like you alluded to in your post. Time for remediation Mike

This is the best one I could find for you C1. http://www.google.com/imgres?num=10&hl=en&biw=1152&bih=696&tbm=isch&tbnid=e41rzTviLl0E_M:&imgrefurl=http://www.kayfabenews.com/mcmahon-unveils-even-more-humiliating-kiss-my-face-club/&docid=zJ5M_1b461Y8zM&imgurl=http://www.kayfabenews.com/wp-content/uploads/2012/04/vince-mcmahon.jpg&w=406&h=313&ei=8jV0UO6QNOrDyQG9-YDQDw&zoom=1&iact=hc&vpx=347&vpy=371&dur=5275&hovh=197&hovw=256&tx=173&ty=113&sig=114199016925210059354&page=2&tbnh=142&tbnw=184&start=15&ndsp=23&ved=1t:429,r:1,s:15,i:131

"After testing the venom on mice, the experts observed that the effects were as strong as morphine, but the side-effects were conspicuous by their absence" The side effects were conspicuously absent because the mice didn't live long enough to make it to the side effects ha ha ha ha

Put yourself in the public's shoes. Joe public sees the restaurant giving a free meal to an entire table of firefighters, the donut shop giving an entire dozen donuts to the cop, the quicky mart giving sodas and stuff to the ambulance crew. Joe public doesn't care that the store owner is doing this as a thank you to the public safety person, joe public see's it as a freebie to a cop or a medic or a firefighter and most joe publics won't give it a second thought but if you have ever been a supervisor, I can tell you that there are weekly phonecalls that I got as well as the other sup's got that were from concerned Joe Publics that were complaining about just such a practice. Just like they complain about our driving too fast, our sleeping in the ambulance, our taking too long to get to the scene and our taking too long to do our jobs. You get enough of these concerned Joe Publics together and that becomes a huge problem as there is strength in numbers. So be careful how you (some of you who feel entitled to the free lunch) treat the free lunch/soda's etc etc. People are watching you.

I think this was posted a while ago here but this is sickening. If I had my kids at this daycare there would be no barrier that could keep me from kicking those daycare worker asses especially if my child was hurt. This is disgusting. Plus they are the dumbest and most stupidest people in the world to tape this. But the scary thing is, these three yahoo's will be re-employed somewhere because some other daycare will not have heard of what they have done and they will be hired again. The state will probably not take away their license to provide daycare I would bet. Most states do a HORRIBLE job in protecting our kids.

See this is the problem with new medics working for strictly transport services. You have all this knowledge and skills and as a new medic you don't get to use those skills. This is not a bash of transport services, as they serve a purpose but putting a new minted medic in a strictly transport service is doing that medic a significant disservice. Skills left unused, knowledge left unused will decay at a pretty quick pace. I know the argument that you can get a lot of good assessment skills trained while doing transfers but that's really a load of hogwash. I have trained/evaluated many medics/emt's who came from a transfer service and their skills and knowledge were less than let's say par. Not to say that there weren't good medics/emt's out of those services but most of those crew members needed much more time to acclimate to 911 calls than those who had been in a service that did both. This was not unexpected. So I'm not a advocate of someone if they don't have to work for a transfer service if they don't have to. If you can get on with a service that runs 911 calls go that route. I think that doing transfers all day every day, makes you a worse provider rather than a better provider when it comes to keeping your knowledge and skills up. Others may disagree. PSK, just keep your head on straight, take two deep breaths, remember this isn't your emergency, rely on your preceptor until you get comfortable running the call. Don't be afraid to come here to run one of your calls through. We really don't bite hard. Suggest that you review your medic book again, at least the parts that you feel you need to review. Where do you think that you are weak in, and review those parts. Don't hesitate to step back and regroup, the patient might do better in the end with a regroup or as I like to call it - A Reboot. Never feel bad with using your field guide. Use a calculator if you need to, especially if its a pediatric drug dosage that you are NOT comfortable with. Look both ways, If the scene doesn't look safe or feel safe, it probably isnt'. Never stand where the door opens, Stand to the side of the door. and one more thing. NEVER NEVER NEVER let the patient get between you and the only way out. Always have a 2nd way out. and one more thing. The little ankle biter of a dog that is growling under the chair behind you, Will, not maybe, but WILL bite you. remove him from the room or have your nitro spray ready for any other size dog.

Many times you find out about this in your orientation. For many people it's a deal breaker and they have to quit or choose between one service or the other. Your primary responsibility is to your full time job. Your 2nd job is just that, your 2nd job. If all your jobs were part time, then this wouldn't be a issue I don't think. But your primary responsibility is to your full time job. So if your full time job calls you and says they need you to cover a shift and you are already signed up at your part time job, you can only do that so many times before you begin to possibly see your full time job turn into a not so full time job anymore. I think that another reason your employer puts this kind of policy in place is that they want to be able to count on you to work. If you aren't working for a 2nd job then you are available to them to cover open shifts. And seriously, if your service needs you to work, then it's most likely an overtime shift and you are probably going to make more money on the OT shift than you would working your part time gig but maybe not. If you don't like the policy, then there is always the front door, you can choose to not abide by the policy and hope you won't get caught but that's a pipe dream as everyone usually knows where everyone else works. It's a small EMS community no matter where you work. So best advice I have Don't sign any paperwork that an employer puts in front of you until you understand what it says. Take it to a lawyer if you have to. To not do so is operating at your own peril. Second, if you disagree with the policy of not being able to work for a competetor, then either don't or quit. But one more thing, you need to have them define what a competetor is. If they only do 911 calls then can they truly call "Ethels medical van transport service" who only does transfers a competetor? If they only do transfers can they call a service who does strictly 911 calls a competetor? I would get that definition out there. Maybe there is some common ground to make up in that arena. You never know

NO I would not do it again, this was when i was a fairly new medic and did not have the experience, I believe, to make that leap that relocating the knee would possibly cause me to lose my license. I've over the years, 15 years have passed, developed a education and a view of EMS that is much different than what I had back then. I was a new medic(relatively) and I was 10 feet tall and bullet proof. I took chances and those were stupid decisions. Not to say I took a lot of chances but let's just say, my perspective in 15 years has changed quite a bit and what I would have done back then, is completely different from what I would do now. So no, I would not do it again. As for what if the procedure would have gone wrong, I do not even want to go there. What if the medic in quesiton's procedure had been successful, well he'd be lauded as a HERO and lifesaver and probably get a medal and a beer summit at the white house, but seriously, even if it did go right, the outcome from the state should be the same. If they are going to Yank his license for this abortion of a call, they should also be ready and willing to yank his license if the call turned out with roses and accolades. Going outside the rules like he did, no matter if he saved the life or not, should not make any difference to the State on his punishment. But we all know that it would. They have to make an example of this guy in terms of what he did, he went outside his scope of practice, his actions may have led to the death of this patient and they need (my thoughts only) they need to show that they mean business when you break the rules. Had he have saved the guy, I can bet that the outcome of this medic's license, we would be discussing a different tune.

I find that makers and writers of stupid policies often don't ask the right questions when they write them. They often just write the policy and disseminate it out to the crews and expect that to be the end of it. Here is what you do. You can't leave the hospital per policy until you get the equipment off the patient. Well next time you get a trauma and you take them to the trauma center, you let the patient get to surgery before you can get to the patient to take off the piece of equipment you can't "afford" to leave behind. You then put yourself out of service for awaiting of equipment. Don't leave the hospital until you get that equipment. It might be an hour or two before you can get the equipment back. That will leave you one ambulance short for coverage. Let dispatch know you are delayed due to equipment retreival. When you get back and you get called into the supervisors office, which you know you will, make sure you have the policy in hand and say "You were only following policy" and that you did bring the equipment back with you. Throw the policy back at them and say that it delays coverage and delays your getting back to help out with system coverage. You do this enough times, and make sure all the other crews do the same, and that policy will be a thing of the past. This is a stupid policy. One other thing, when you transport your idiotic moronic policy writer with fractured femur and a traction splint or whatever, make sure you expend every effort in getting that equipment back. Make sure that you take the equipment off them and exchange it with what the hospital has. I'll bet the policy will be a thing of the past if you do that as well.

Actually yes ArcticCat, by my own logic yes, and if that was the decision of the state bureau, then so be it but it wasn't. But my relocating a knee is not a license revocatable action, at least it wasn't 17 years ago. I'm not sure if it is now or not. But if the state had wanted to pull my license, sure, they could have. But I'd have really been pissed but I'd have appealed and if unsuccessful, then I'd be doing something else workwise. I don't know the statutes I was merely guessing but I would not be surprised if there is some sort of language that does say that revocation is the only penalty. Am I advocating for this medic to lose his license, I don't think I've said it either way, If I have I don't remember, but I'm saying that if there is remediation, it better be significant. Maybe his license suspended for 6 months or a year but isn't that taking away his livelihood anyway? Suspending someone from working in their field of choice is taking away their livelihood don't you agree? It might not be a permanent thing but for that period of time, he can't work in EMS so he's effectively out of work. So whats the difference between a suspension and a revocation when the medic can't work as a medic, it's still a career death sentence, just one is longer than the other. I'm not arguing any of your point's Cat, just seeing it from a different perspective.

Yeah, it's the brain that should make your decision. You know you can do the skill, yet do you have the balls to do it? Do you have the skills to make sure that you do it right? Sure I have the balls to do it, I relocated a knee in the field one day, out of scope for me as a medic, sure, but lots of extenuating circumstances, 30minute hike to the ambulance with a patient on a board and just me and my partner and 3 volunteer firefighters. was guided by medical control via phone. so yes I had the balls to do it. and it worked. Would I have done it if I was in any other circumstances other than the ones I was in, no freaking way but this procedure saved the guys leg, even the trauma surgeon said so after we got him to the trauma center. Backstory if you want it via pms. But it was calculated, followed up by a strong willed ER doctor who trusted me and my partner and a patient who was all for it. But my brain was working on overtime saying, holy crap holy crap. I could really get reamed for this. In the end I realized that this was in the patients best interest. I did get questioned by the state but with the trauma surgeon and local ER doc who was the one who walked me through it, the state dropped the investigation, stamped it closed - procedure warranted or something like that.

NO I disagree on the licensure thing Arctic, There were not one but two issues in this particular call. Let us not just focus on the pericardiocentesis, let us remember that there was a medication component in this as well. I believe that the medications used to control the airway were not approved medications either. So this is two instances. So let's say that we use your comparison of the criminal. He goes to jail for a long time. Well maybe the medic in question needs to go to jail so to speak. He needs to be re-trained but what does that require. We revoke licenses for medics and health care professionals who abuse painkillers and if they steal the meds then they likely get their licenses revoked. He broke 2 of the states rules that are punishable by the revocation of his license. If doing that skill and practicing out of scope punishment is revocation of licensure then there is no middle ground. You can't give him remediation for a act that the states only remedy is revocation of licensure. I don't know if that's the case but if it is then the rules are written and there should be no middle ground, no special treatment or they need to rewrite the rules. Which maybe they do? I don't know.

Fab I agree with you to a point but there is no patient where my livelihood is worth giving it up for. YOu say that you have to have the balls to do what's necessary but that patient in the end is not going to help me pay my mortgage, keep my kids fed and do what I need to do to survive. I'll do what in necessary for the patient but you paint with a broad brush. Have you been in a situation where you put your livelihood on the line for the patient, all the while knowing that you might not have a job coming the next day? I'm not going to do that for any patient. This is an extreme case and I'm sure there are other cases not so extreme but when it comes to feeding my family and keeping a roof over my head, I'll choose family any day. You can bet that the ambulance service you work for isn't going to cover for your ballsy move if it affects them negatively. You can bet that thehospital isn't going to come out and help you out for making that Ballsy move I can also say that that patient aint about to come and help you out after the fact, after you've lost your livelihood and your house and can't feed your kids, I can bet my next paycheck (it comes this friday and is pretty big) that the patient in question where you "had the balls to do what had to be done" is not about to come help me out after the fact. So I may be in the minority here but if doing something for a patient will ultimately affect my ability to provide for my family, and I know that I could feasibly lose that ability to provide for my family, well too bad so sad, I'm sorry but that patient will have to wait till I get to the hospital. I worked too damn hard to get where I am and I'm not going to knowingly(emphasis on knowingly) put myself in jeopardy like that medic did. Tell me, have you followed your own advice and had the balls to have to do what's necessary no matter what the cost???? Because that is what you are telling us here to do. That we should have the balls to do whatever is necessary no matter the cost. To be totally blunt and to the point - that is a bunch of horseshit.

To get rid of the bias and favoritism of the preceptors, you need to use a completely neutral preceptor which at many services that's nearly impossible to do as preceptors talk. If you cannot get away from the bias then I would suggest contracting out or putting together an agreement with another similar department near you, to have one of their preceptors (FTO's) come out and do the evaluation. That would eliminate all the bias that your department has to offer. You would have to pay for that FTO's time and travel. YOu could do a reciprocal agreement with that agency as well. But if you are having that much problem with Bias, then you have a deeper problem with your FTO problem than you think.

Arctic - I've been on just that call. But I'm sorry, the error is just too great in this circumstance. No matter how you cut it the state has the rules for a reason. They say no pericardiocentesis - then you just don't do it. I don't think they are trying to make an example out of this guy though. There are certain rules that any place has that if you break them, you're gone. Many workplaces have rules about not bringing your gun to work, or watching porn on the company computers - most places you will be fired for that. The state has the rule that NO pericardiocentesis by a medic as it's WAY WAY outside his scope of practice in Vermont and when you do that procedure you will lose your license. Simple as that. So remediation might be acceptable to some in this case, obviously to Vermont, it was not a viable alternative. It truly sucks that he lost his livelihood, and in the heat of the moment, when the shit is hitting the fan and you are working to save the life of a patient, that's usually not in the forefront of your mind (it must have been for him though). He even said "I may lose my license for this" so my thought is that he was ready and willing to lose his license but I'll bet that he never thought the state would go that far. But with so many witnesses and doctors who were probably pissed they didn't get to do the procedure, I'll bet the patient wasn't even to the morgue before someone at that hospital was on the phone with his company and another person was on the phone to the state of Vermont EMS bureau. But let's not lose sight of the most important thing here, A cascade of events presented itself to this medic and crew that quickly escalated to the point where in the end, a man died. Did the medic cause his death? I don't know but the delay to definitive care which admittedly was only a block away, did not help. One would hope that if this guys appeal is successful that he would take the lessons learned from this fiasco of a call and use them to re-evaluate his practices and make himself a better provider. NOt saying he's already not a great provider but this can be a way to turn around and be better. From adversity comes strength I believe I heard said one day. But if his revocation is overturned, might he say "I got away with it once, I can do it again" and do something not so bright again?

I can imagine that this was a case of tunnel vision going into a collapsing tunnel. You go down a path and come hell or high water you are completing that journey. Once you go down the road there may have been no turning back in the mind of the medic and he wasn't listening to anyone but the voice inside of his head that said "do it do it, save the life, just do it" Who knows what the medic was thinking but I have to agee that he probably thought that the patients life was worth more than his license. Well unfortunately he is realizing what his stand is costing him. What a painful and expensive lesson for this guy to learn.

The cesarean section may have actually been a partner of mine Richard. I was not there but I know the entire story and it's outcome. As for the out of scope, unfortunately a patient died as a result of (at least partially) the medics actions and although we don't know the entire story, we know enough to say that the medic was a proximal cause of this patients death. The trauma is really what killed him but could he have been saved had the medic not have tried this procedure, not one time but twice (if I read right). The hospital they were going to was very close, I believe they could see it. And remediation, is possible but seriously, this is a horrible outcome that is not redeemable in the eyes of the state of Vermont. They aren't throwing him under the bus so to speak, he still has his license in the other state. But I'm not sure if he's going to have any Ass to move when he gets done with court. This is more than likley a career ending decision, all based on "I might lose my license" thought lines. I'll bet he's a good medic, but yes, one bad decision can be the deal breaker. One bad decision can sometimes, and sometimes it should be the deciding factor of making a career change. Who's to say he won't have the attitude if he "I got away with it that one time, I can get away with it again"