PRPGfirerescuetech

*SPIN off from another thread* *private 911 EMS sector only* It seems that EMS has gotten away from being strictly for "patients in life threatening condition". But many providers also seem to be concerned about "misuses and abuses". Should EMS be used strictly for emergencies? Or do we simply have to provide a billable service to customers who request us, regardless or malady (or lack thereof?)? I personally believe that EMS provides a billable service to whoever needs it. If you need a taxi ride, and are willing to accept the responsibility for a 900 dollar bill, then who are we to complain? Thoughts? Im curious...

1. Hypoglycemia 2. Psychiatric 3. Head trauma 4. altered mentation of unknown origin 5. CVA or head bleed with an odd presentation 6. Goofy old man looking for a ride. These are the first 6 possibilities that cross my mind. He likely is just looking for a ride, but he could be a goofy old guy who isnt telling you everything. Again, hes requesting a service, so you take him. I would politely remind him that his insurance wont cover the bill, and make sure he understands this ride is on him. As long as he knows that, then why not?

Ill accept that. Professionalism is the ultimate goal, your 100% right. Please understand that much of my frustration comes from a poor educational standard across the US which ill prepares any of us for what we are facing daily. From your posts prior, and posts today, you present yourself as a well spoken and intelligent EMS provider. I look forward to further debates with you.

You have contradicted yourself several times since the beginning of this post. Protocols are designed for medics who cant think on their own. Good luck with your protocol driven "monkey see-monkey do" future. The mother may have no concern for her childs well being, however I was addressing your ptotocol which stipulates "no medical complaint" (your words). The scenario you have presented is a violation of the protocol as you have defined them, regardless of the mothers "no concern". Everyone in this post has gotten far too tied into the immigration status of the mother. This holds NO bearing on the care of the child. 1. No EMT or Medic in the US is adequately educated to the level appropriate to determine a need for transport. We arent adequately educated in many things, and feel free to peruse the thousands of posts on this topic. Your "professionalism" or feelings of "competency" aside...your education is NOT adequate enough to make this decision while avoiding liability. 2. Since you mentioned so frequently this discussion "ignoring protocols it should be restated that your protocol actually allows for flexibility for determining transport, and requires both medics to agree not to transport someone. That means if you do the right thing and transport, you havent broken these magical protocols you continue to spout about. Finally, I find it interesting that you continue to spout about these protocols of a "mindless" nature which seem to be ironclad in your view. Yet you call me a mindless ambulance driver for saying that you need to transport everything. So, im mindless for knowling the huge liability for refusing transport and stating the truth, and your the intelligent medic for blindly following protocols? Get bent. This is simple. Your ignoring the patient. Regardless of the purpose of the mothers initiation of 911, you have a US citizen with a reported medical complaint and incomplete medical care, and a mother who is requesting the patient be transported to a medical facility. We have a responsibility to this child.

My statements had NOTHING to do with protocols actually, but im not a strong believer in protocols really. This is a simple answer. Where is your biggest liability when dealing with a request for service? Transporting every patient who requests your service? Or allowing your crews to determine who needs to be transported? Considering the level of competency of EMS providers in America, im happy when we can tie our shoes before coming to work. Actually allowing EMS providers at their current level to determine who is capable of transport in potentially disasterous at best in our liability based field. Now, in regards to your scenario, your wrong. 1. Child has 1/10 dull pain. 2. A medical doctor has determined a potential need for surgery. 3. You cant read X ray films. 4. The child has not been evaluated to determine need for surgery at medical facility of her primary caqre physicians request. 5. Soooo, her entire medical care has not been completed, and she has a "complaint". Considering these facts, you have a 1/10 arm pain child who has been determined to be a potential surgical canadate by a physician with much more education than you. This child has been treated partially, and you see fit to not transport? You have treated this child inappropriately. Now, i bode to you two questions. 1. Explain your statement above regarding that mother "obviously not calling for the child". Why do you say that? She didnt get over the border. She even went through the effort of driving her child to a border point to initiate american EMS for transport, and get her child to an american hospital, at the request of her physician. Exactly what do you feel is occuring inappropriately here? 2. Since I have explained why this patient should have been transported, now tell me why she should not have been. Simple question. Im open to discussion here.

Transport. No other acceptable answer. You received a call for service. You provide that service, REGARDLESS of how much you agree with the need for the service.

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A step too far with this level, but I get what your driving at. Anything below the Paramedic level does not have adequate education to be properly equipped to treat any/all patients in the pre-hospital field. This statement is fact, and not negotiable. The fact that we have providers with less than this education is one of the primary reasons why we get laughed by EVERY other facet of medicine. These additional levels were created because the people above us believe were too stupid to complete proper education standards, thus they give us these BS education programs that includes the skills we need without the knowledge as to why we do them. Demand more! Encourage others to strive higher! Before were left behind by the progressions of our peers in every other facet of medicine. *now return to your regularly scheduled debate*

Dwayne, your smarter than this response. I never spoke of VS's purpose, just of the result. He may have the desire to stir up BS on a regular basis, however these discussions do make people think about their faith. They dont change their opinions, but they do debate them, and debate is a necessity in life. and at no point did i suggest that. When referring to you, I will use the words "you, dwayne, or you sir", the word "Christian" defines a whole group of people with a similar ideaology. at no point was a question posed to answer. However, my point was a more "broad" one. VS points out that the legal system is using the personal faith of the leadership to jam their religious beliefs and morality down the throats of others. His bringing it up has been ridiculed by the christian membership here. That same inability to accept other opinions led to those same deaths. Also, refer to my response to Rid. Grandstanding? He is sharing his opinion, and your being intolerant. His presentation of his point is deplorable, however your unaccepting of someone elses opinion on a topic, then stating your faith should be accepted. Get back on subject. This has nothing to do with this discussion. Simply stated, Christians want people to be tolerant, yet many members of the faith use their faith to guide "morality" in the country. Lawmakers do this everyday in defining laws which guide those who dont believe in their faith. Yet you want tolerance from others? That step begins Christian tolerance of differing opinion. Thats all. For the record, I respect everyones faith, i just dislike its use in the political forum. Religion, politics, and law should NEVER cross.

Who defines morality? Who defines what is right? If the state defines it as legal, they why isnt the buck stopping there? Now we have a goverment who uses their personal religious beliefs in the definition of law for all people, even those who dont share those beliefs. It strikes me as a reverse of the religious persecution of yore. I cant argue that. I love ya too bro, in an extremely platonic way :wink: , and your absolutely right in every example, but your missing the point. All of your examples are some of the many human injustices this planet has had to endure, and christian wars in the name of religion are just the same Agreed Agreed 100% I dont disagree with the fact that watching a gay pride parade is like watching a circus event anymore. You have a group who states that they want to be treated like everyone else parading down main streets in "everytown" us, juggling sex toys. That culture has to be held responsible as well. There is a line, and its been crossed of late. Agreed. VS always has an agenda. Agreed. I would never want to. Your beliefs are yours, regardless of my opinion of the opinion of anyone else, you need to do what is right for you. However, morality is defined by the people who practice it, and your version of moral SHOULD NOT stand for the morals of others. Simply stated, acceptance is key. For you to be upset at the immorality of others and be upset that VS critisizes the christian beliefs is hypocrasy. You want to be left alone in your beliefs, yet you want to push your beliefs on others? Questionable friend. Good. Never accept criticism, stand strong in your beliefs. Amen to that. However, acceptance of differences is what defines the human race. Word.

He has a belief too. This same belief causes him to make people think through discussions like this one. Yet Christians dont like it? But Christianity is the faith that has killed millions of non-believers over thousands of years... So, in reality, what is he doing different? Our mistake is, allowing ourselves to not be accepting of the differences. To discuss and profur points regarding any topic is wonderful, but to get upset when one offers points back is closed minded and rather sad. Kumbyyah, James

Congrats AK! Good Luck! It is a "she" right? We always wondered about you...

Get a 8.5x11 piece of white paper. Type at the top "resume" Type this verbatim. "Im willing and able to learn" Attach EMT and cpr card. Hand out to potential employers. You'd be suprised. :wink:

1. If you get a check for your time served, guess what? Your career! Your just willing to do it for well below minimum wage.

Sorry it took me so long, heres the end of the call....almost a year later...lol. It seems i forgot i even posted this... Mitigation EMT from MICU establishes command, dedicates 2 radio channels to the assignment, and begins triage. Everyone on scene in a trauma patient, and mitigation of the incident is completely intrinsic on making sure you come to this conclusion. Triage evaluations: Trauma patient #1: (bleeding man by truck) Male, 50’s approximate, was driver of white pickup now in 2 pieces. Alert but not oriented with +LOC. Chest and abdominal pain, denies head / neck / back Trauma patient #2: (moaning bush) Female, late teens, altered conciousness (AVPU-P) Heavy facial trauma but self maintaining airway upon EMS arrival. Noted small metal shard impaled R lower abdomen, with full abdominal evisceration. Trauma patient #3: (girl at the end of the blood trail) Female, 20’s, heavy facial and upper chest trauma, facial anatomy change, JVD, flail chest, HR: 28, RR 4, grey in color. Trauma patient#4: (guy walking around) Male 40’s, trauma to the hands and lower arms. Patient was a pedestrian and put his hands up to avoid being hit by the rolling white pickup truck, and was struck on the arms as it flipped past him. No LOC with full memory of the incident, denies spinal pain/deficit, but several large lacerations to the hands and a likely R wrist fx. JEEP in water: All subjects still alive inside vehicle, unable to make access to patients. Radio room advised. Triage findings: Jeep: Not considered until access could be made. Patient priorities: #1: Yellow #2: Red #3: Red #4 Green All patients immobilized due to trauma with exception of #2. #2 left to self maintain airway due to lack of manpower. Radio dispatch contacted, 6 ALS requested. Of the 6, 2 were local (within 10 minutes) and the other 4 with various ETA’s, up to 30 minutes. Radio dispatch contacted, flight services checked to see if willing to land at lighted air strip. 1 helocopter accepts, other 8 decline. Helicopter in air, willing to accept two non critical, or 1 critical. ASSISTING MICU #1 arrival MICU#1 given red level trauma #3. Transports to local community hospital. Moved to patient #2, secured to spineboard, abdominal eviceration covered and impaled object secured. Medication assisted intubation utilized, medic continues ALS care with patient, moved patient to 1st arriving trucks litter. Moved patient #1 to benchseat, primary assessment and o2. ASSISTING MICU#2 arrival Assisting MICU paramedic gets into truck with 2 trauma patients, EMT from assisting truck drives 2 paramedics, and patients #1 and #2 to airstrip for flight service. Trauma patient #4 left on scene with EMT from primary truck #1. 12 minutes later, ASSISTING MICU #3 arrives. “trauma” patient #4 moved to litter, crew ground transports patient to trauma center. Arrival of rescue company, with a group of well trained “rescuemonkeys” CHIEF of another EMS service arrives to assist. (and thank Christ for this…because I was out of paramedics…) 2 patients inside jeep, one DOA on fire department access, another in respiratory arrest. Respiratory arrest extricated after windshield cut out Downturns to cardiac arrest. EMT and Chief from other service transports arrest to local community hospital. DOA released to FD until arrival of state police. *lessons* 1. Always bring your easy button 2. Debate asking for resources from local medical command facility. This call actually was the focus point of the region expanding their MCI plan. Thoughts from all?

Lets simplify. If you use AOx4 and you list patient is AOx3, could your patient be construed as "without neuro deficit" Just like, if you list your patient as AOx3, could he be construed as not being aware of the "event" that took place, even if you meant he was perfectly normal? Simply stated... "Patient was alert to person, place, time and event" Now back to your regularly scheduled discussion...

It absolutely is, and if cost is your concern, they have deals periodically. The owner is a great friend of mine and frequents several forums periodically. Definately worth the cost just the same. To all-check it out. www.ems-safety.com

Especially for areas where you deal with flight services. Nice to have a few in a pinch. Suggest to your boss that they get company business cards printed. They are cheap for you (free) and have a few more practical applications to the service you work for. Or, go the vistaprint route. Plain white with minimal design will set you back about 5 bucks for 250.

There is nothing in EMS that is this certain. There are always circumstances where one specific tool or treatment while not ideal, might become more effective than the ideal. Your beginning to think inside the box only Dust, dig the sand out of your head.

This is the same call i think? WPTZ.com Woman Dies During Water Rescue Crews Try To Raise Boat SPRINGFIELD, Vt. -- Crews tried to raise a rescue boat that capsized Tuesday night, after a river rescue turned deadly. The boat is on its side so a salvage team will be called in to try again Thursday. Tuesday night a water rescue boat from the Cornish, N.H., Fire Department that had picked up an injured woman in the Connecticut River, ran into trouble and sank. The New Hampshire Marine Patrol said the woman, 60-year-old Virginia Yates from Rockingham Vt., ended up in the river and died. New Hampshire Fish and Game Department Sgt. Craig Morrocco said Yates was walking down some stairs when she fell and injured her head, causing her to fall into the river. Morrocco said the rescue boat picked her up and was heading back across the river when it started taking on water and sank. He said Yates was strapped to a backboard and drowned. None of the four rescue workers on board was hurt. The Marine Patrol is investigating what caused the boat to sink. http://www.wptz.com/news/9721653/detail.ht...01102%20-%2039k

Where are you getting this information? The reason EMS is failing in NJ is because of tainted views like yourself stopping people from being able to set up bundle billing agreements and get paid. Please clarify as well your statement about how its not worth billing patients upwards of 60k per month or more of billable transports because in NJ, they will give you free CEU's? Are you CEU courses in NJ expensive enough to warrant losing 60k in billable monthly calls? Get the volunteer wanker out of your head and get real. This is a business, and without billing, you fail.

Um, why? Fact: You can bill patients under and keep your non profit ststus. Fact: You can bill insurances and keep your non profit status. Fact: You can bill patients for refusals and no move calls, and maintain your non profit. EMS hit the nail on the head. Non-profits are measured by fiscal year on profit and loss, and cannot show a profit bigger than (insert varies by state figure here) Now that the silliness is out the way...next post.

Where you missed my point is this. There is no standard to logic. PRPG

I figured, and I do this too. Nice move telling us first to lessen the initial agitation of someone challenging this EMS gospel...

Each line has a number. Thus, we can only conclude a pressure at the lined marks. Lined marks are only marked with even numbers. If your cuff is different, throw it out, the manufacturing standard has even numbers at the black marks. Documenting a BP in between the even numbers would require you to "logically" put a number there. Since theres no standard to your logic, that means your making up an odd number. Because odd numbers dont appear on your BP cuff. Not that any of this truely makes a darn bit of difference in your treatment. 120/80 documented versus 122/80 documented isnt going to make anyone blink an eye. However, if your patient crashed and the sue happy family finds just the right slickhaired lawyer, the first thing he's going to pick you apart on is the little inconsistencies. Like at BP of 121/85 and no NIBP.