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.

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.

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.

This is not an actual call, but is something that happens here often.

You are a medic in a border town 100 miles to nearest hospital with no other ambulances closer than 60 miles away. You have no communications with medical control, you work strictly written protocol. Law enforcement and fire do not respond with you. It is just you and another medic.

You are dispatched "child with broken arm".

On arrival you find a 10 year old girl already in a cast.

Mother explains that the child had fallen and broken it earlier in the day in the USA. She had family members take child take the child to hospital in Mexico. She hands you a x-ray film that shows fracture at or about center of the radius. Everything is lined up and there are no fragments. Patients cast immobilizes arm above elbow and below wrist. All vitals in normal. Cap refill less than 2. Good motor function of fingers without pain on movement. Pain is dull pain at most a 1 out of 10 per child. Patient has pain pills prescribed in Mexico but hasn't taken one because it "does not really hurt" since was casted. You examine child for any signs of possible abuse none seen on back, legs, abd, etc.

You ask mother since child is already casted why she called ambulance, she says that Doctor in Mexico told the family (keep in mind mother did not go with child) that the girl might need surgery and since the child has medicaid they decided to bring her back to USA to see Doctor. 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.

So what do you do?

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.

LOL! Well, I didn't really mean them as levels in the certification sense. More of an educational level to strive for. And eventually, an MS requirement for teaching.

But no... for now I can still support full practice privileges with only two years of FOCUSED AND QUALITY education.

Nothing less belongs on an emergency ambulance.

CANIGETA AMEN?[/font:a99bc6bc4a]

MS Paramedic.

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.

At no point that I'm aware of was I made spokesman for the world council of Christians.

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.

Come on PRPG, what has that got to do with this question? Or, are you stating that Christians, as a group, are violent and dangerous so he is doing a public service with his non-stop childish attacks?

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.

Wow. Because there was religious injustice we now “owe” him his petty, childish grandstanding? Ridiculous.

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.

Not so long ago when my opinion was in oposition to another EMS site, you found it very offensive, and were very much opposed to my stating what you felt were inaccuracies on the subject. Yet somehow peoples feelings about their religion are less important than your feelings about that website? Many, I think, will find that logic faulty.

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.

Sorry, there is right and wrong. Too bad you get upset with some moral values and integrity. Yes, it is a shame that the Government would have to be involved. Unfortunately, the world has lost most of its common sense and now someone as to say.. sorry that is wrong! It goes against the laws of nature. Just because it is cool and the fad at the time, does not make it right.

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.

What concerns me the most is the attitude and lack of moral values that many younger adults have. It is okay (as long as one does not get hurt) and anti-establishment and poor work ethic type attitudes. It does remind me of the 60's and we know where that went.

I cant argue that.

James, I love ya (in a non-sexual way ) but let us remember many have died as well in the name of owning land, property and in the name of science too. Not all things that was being in the name of science is right or accurate either. Yes many have died in so called religious wars and still continue to do do. Unfortunately, most were enforcing their ways and ideologies not the teachings of the religion or faith they were supposed to be representing. Similar to what is done now per terrorism and the Karon.

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

I can point as many wrongs science has produced by poor and inaccurate treatments, and false findings as those in the religious nature. Just science attempts to hide it and it is brushed under the table as "inconclusive" What confuses many is religion and science can actually go hand in hand and not battle each other or one has to take one side or another.

Agreed

I am just as tired of being forced to watch or even have different views crammed down my throat as well. For example Tuesday night between 6 and 9 pm, three major networks (including cable) had television dramas regarding "gay" topics. Sure, I changed the channel to only see it again and again.

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.

Now even here on a medical forum, guess what we have? ... No agenda ?..hmm

Agreed. VS always has an agenda.

Sorry, you are not going to change my mind, like I am not going to change your mind set. However, do not accuse those that disagree with it as being a bigot, narrow minded, and unintelligent, when I could say the same defense. Those that recite how inaccurate and how mythical the Bible is, does not present to understand the history, the defines and scrutiny was followed, and the level of education of those that taught scriptures over centuries, not decades and a few years (<1000).

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.

The difference is now many (like myself) is no longer going to accept criticism without a fight. So many for years have turned the other cheek (pun intended) and was forced to change views, or be called a bigot, or emphasis to be ashamed and now are legally fighting back as well through legislation and laws.

Good. Never accept criticism, stand strong in your beliefs.

Just as those that claim discrimination, I can describe the same as well that I have to accept something that I do not believe in morally and my faith teaches that is wrong.

Like I described earlier, I have friends that are gay. They know my opinion, and like other those that practice immoral acts does not mean I ridicule, harass or treat them any indifferent than any other person. For you see, that is what my faith teaches me (Christianity). But, that does not mean I have to agree or accept that it is right. By my faith I am to point out the action is wrong (not judge you personally) and then you are to make that decision, so yes fee choice again.

Amen to that. However, acceptance of differences is what defines the human race.

VsEh, I respect you as a person and especially your knowledge in EMS. I do wish I knew the reasons for such antagonist views against Christians. I am sorry if you do not understand the concept of Grace, and that the body actually has a soul. If ever some self proclaimed Christian(s) ever hurt you.. unfortunately, we are human and like any other groups we definitely have poor representatives. If that was the case, we apologize.

I still pray for ya!

Word.

So I ask you hotshot, you've asked the motivations of Christians about 100 times on the City alone...what motives you to do this?

Why does attempting to damage peoples lives bring you such joy?

Dwayne

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:

i get paid at Warrington $5 for 3 hours of volunteer...given i havent been there in a while thats what it was the last i was there... warminster i refuse to run with for personal reasons i would like not to get into..

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.

The answer to this question is always "no." It cannot be done. Period. And anybody who thinks they can is an idiot. A dangerous idiot.

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

Let me warn you.

You can !!!!!NOT!!!!! start billing.

Let me explain why.

You are in NJ so your situation is unique. What the other posters don’t understand is that here in NJ there is something called the volunteer training fund. That is what enables you to get your free training/CEU's. You can only get this if your squad does not charge at all. Not even just insurance.

There is also allot of legal benefits and protections written into NJ law that protects a volunteer FAS, but you lose them as soon as you bill anything.

There was an article in Gold Cross about 2 issues ago listing what you stand to lose by switching. I will try to find it and post it.

So if you want you can start billing, but you lose allot, and the amount of money you gain usually wont be worth it. What your town could do is what allot of other town do (mine included): Have a two tiered system. During the day there is a paid squad. It has to be a separate squad (in our case, it belongs to the local PD) they can charge, and they aren’t eligible for all the protections. At night the vollys run, and they dont charge.

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.

You CAN bill and not lose your not for profit status. Just set your rates as high as Medicare standards will allow. Then, bill the patients' insurance. Once the insurance has paid what it will, write off the rest and don't agressively bill. That way you can still bill and not lose Non Profit Status.

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.

This is logic people...

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

PRPG

(Once again, I wouldn't teach anyone to record odd numbers..I'm just debating the way we teach things.)

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

I don't have a cuff in front of me right now, but aren't the black lines and the white spaces about the same width? HOW THEN WOULD AN ODD NUMBER BE A GUESS?

MOST OF THE BLACK MARKS/LINES DON'T HAVE NUMBERS EITHER, but you logically deduce that if the line before said 90 and the 5th line after it said 100, then the line you're at has a value of 92 (EVEN THOUGH there's no 92 written on the face).

In the same manner, you logically deduce that if needle lands on a white space and line after it says 92 and line before says 90, then your true measurement is 91. It would be falsification (where it not for the fact we were trained to read only evens) to say either 90 or 92.

Someone reread my previous post and reply to it, please.

(Once again, I wouldn't teach anyone to record odd numbers..I'm just debating the way we teach things.)

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.