mshow00

Yes, and because the pt feels they are not getting enough special attention does not qualify as a medically necessary transfer of care, hence the COBRA violation complete with fines and sanctions.

COBRA is in effect the same as EMTALA. Hospitals have to follow other wise very big fines and possible loss of Medicaid/Medicare http://www.medlaw.com/statute.htm

One of my night sups had a private call from a hospital floor to transport the pt to another hospital, while he was working the streets the other night. They went and the lady pt refused to stay, so after a lengthy talk with legal (both the hospital and ours @ about 0230) the Pt signed out AMA... walked across the street followed by my sup and then transported to the other hospital. All the above was done to avoid a COBRA violation for the original hospital.

Let me try to expand this a little... What/if any changes do you see for EMS if the U.S. were to go to an universal health care system? Would this be a chance to save EMS (give it a chance at a fresh start-see any of the hundreds of topics for example) or would it put the final nail in the coffin so to speak? Would the money "trickle down" or stay at the top amongst the big whigs? Would the private services prosper or coming crashing down? What about the municipality? I am interested in what others here think. I do not know enough about how Universal Health Care works, and my best examples of government run health care are Medicare and Medicaid- not very promising future IMHO.

I was wondering if anyone can tell me what effects universal health care has had on your EMS system. I am looking towards any changes in call volume, changes in the amount of "BS" or non-emergency emergency calls, changes in billing/amount received etc. I am curious to see what, if any, changes will come to pass in the American EMS system as a whole where we ever to go the universal health care.

I may be speaking out of turn here, but my service was bought out last year by AMR. It is common knowledge around our base that we are attempting to expand early next year. We have also been hiring like mad, we even have a sign on bonus of $3000 for full time medics, $2000 for part time medics, $275/year up to 7 years experience, $3000 for going from basic to medic and varying "head hunter fees" for recruitment. I am thinking that my company is thinking that we are going to be around for a while.

I am looking into expanding my skills in ECG interpetation, and therefore wondering if anyone has any ideas where I can practice on the web.

I agree spenac that when I get my NR paramedic I will do whatever I can to keep it.

I am employed and have both my Illinois and Missouri licensure (company required). Both states honor the NR but it is not required after the initial application process, as both states have there own license. I have everything I need to complete the process easily available, but my question stems from the point that I (hopefully) will be a practicing NR Paramedic by this time next year, so is it really worth it. If I did recert it would only be for a couple of months (again if everything goes well).

I need some advice on renewing my NR basic level, I am currently a paramedic student who at the end of my course (end of spring) will be taking the NR-paramedic level. My NR will expire before that time, so my question is: is it worth it at this point to renew it?

Eydawn- it pretty much boils down to what everyone has already said: EMS screwed itself when it fell under DOT and never left it; each state was allowed to set up its own system(the independent argument), the minimal education level required by DOT(that some try to lower). Which brings it all to a head, It is simply a lack of adequate training and knowledge across the board. I, being a current medic school student about half way through, truly understand that my basic education was extremely lacking, to the degree I am still discovering. I have come a long way from the "magic 15"(as in 15 LPM O2). I do see that my basic education was very lacking(I went to a community college for it where biology, english, medical terminology, and college algebra was required prior to the basic course) and I fail to see how any first responder course could be considered adequate for any who wish to work with the public. The first responder course should be a intro class not a licensing class. As I said in the other thread before it was locked(rightly so); it is my belief that current "first responders" be a semester long current "basic" class (with higher standards); the Basic class should be some sort of hybrid class that is heavily borrowed from a non-medic mill course. There should also be a national standard for all states (each state allowed minimal tweaking in SOGs to fit their needs) that raises the minimum requirements. Allowing for a true National Registry in which licensure is a gold standard that can be taken everywhere and equally recognized would be an asset to the profession. Bottom line the minimal requirements need to be raised, and we need to keep politics out, and people need to stop being so cheep. That is a start to a perfect world (IMHO).

A favorite "tool" of the paramedics I work with is the roll of the three inch tape. It has many uses and leaves a nice little sting when an EMT or another Paramedic starts driving like an "a$$hole" Plus it saves your voice, just in case you get stuck working with one in the future.

Talk about pucker factor!! :shock:

Ouch! Dust that really hurts (and a little offensive too). But I do understand your sentiment; now better than ever. I am a basic and have been working several years as such, however I have started to take the next step. I now am beginning to understand how much I don't know. I am about half way through my medic schooling, I study my a** off and constantly ask questions of the more experienced paramedics I work with. So much so that "they" having jokingly set a rule for me to follow of 20 minutes or 20 questions which ever comes first. I enjoy researching my question and then comparing my conclusion with that of highly educated paramedics, nurses and doctors I pull clinicals and work with. I think I have learned (am learning) as much from my questions and challenges given to me, as I do in class. Saying that I know that the only way I have even a semi-intelligent answer to offer is through the class work. I find myself gathering a deeper understanding through the critical thinking required of me. As far as the P vs I vs B (taking it a step further)vs FR goes: I think the public (first and foremost) and our profession (distant second) would be well served getting rid of the First Responder training making it the current NR Basic course. Setting a minimal requirement of a hybrid I-99* class (IV's, intubations, Pathophys, A & P etc{roughly 85-90% of the current NR Paramedic course}) if not full out "dual medic" trucks. * I do not know what is in the I-99 class course.

So let me see if I can paraphrase Dust here :twisted:; When it comes to ACLS- we, as well as our pts, are lab monkeys for someone in a suit?

I, unlike 4cmk6(all respect meant), belive in God; at least enough to know that I am not him/her. I do wish we could find the perfect algorithm, that would bring about a 99% success rate (lets face it logically not everyone can be saved). The only I am saying is I never want to be in the place where I have no issue "playing God". No MCI's don't count; I do know that I will have to make some "you live you die" decisions in my career (still very young and very green), but I don't want to start making those decisions arbitrarily in my every day to day actions. (saying stuff like very fine v-fib is asystole with artifact, just so I don't have to work the code)

Can the judge just drop all the cases that the officer had pending... and WTF happened to innocent till proven guilty? I guess that applies to everyone except for police? There seems to be a whole lot wrong with this and the following events.

In that manner I totally agree with you 4cm on that point. But what I was saying is it does not matter at this point if it is true. People are already talking as if it were (as in the news broadcast I heard). So again, if it is assumed to be true, it is.

Does it really matter if it is true, it is out there and people are talking about it. Thats all the fact that is needed.

http://www.gizmodo.com.au/2008/09/ambulanc...rillator-2.html ******************************************************************************** *************************** Random Stuff Ambulance Worker Tries to Cook a Prawn on a Dying Man's Chin Using a Defibrillator Posted by Sean Fallon at 2:40 AM on September 17, 2008 John Jones, a paramedic working in the UK, was recently dismissed from his job after he placed a prawn (a crustacean similar to shrimp) on the chin of a dying man awaiting a jolt from a defibrillator and joked: "Let's see if we can cook this prawn." After the shock was administered he was heard to remark "360 joules won't cook a prawn." If that wasn't enough, his colleague, Clive Greedy, looked on while eating a piece of celery in the patient's kitchen (Greedy is now serving a six-month suspension over the incident). To top it all off, the shock treatment failed and the patient never regained consciousness. God damn, that is cold. [Daily Mail] ******************************************************************************** *************************** Now this is sad. I heard about this on the news on my way home from a clinical today. Just wanted to share with you.

Obviously not well if they are trying to gut each other. :-k #-o

So what happens when they push the wrong drugs, or the wrong amount, or both? How life saving is that? As for "fair", they had a month to study and still failed. That is not "fair" to the people who they are responsible for. Instead of whining about their mistake, why don't they take a second to think about what they just told there community. People here at the City talk about whackers who make us all look bad, this is infinitely worse. This is a black eye to anyone who has anything to do with EMS.

You are just purposefully being ignorant now. No where has anyone said open the flood gates so any and everyone can attempt to do our job. A DUI (within a certain context and certain criteria met) should not be an automatic excluding point. Since you are so fond of hypothetical scenarios, try this one on for size: "ANY EMS personal who are involved in a motor vehicle accident while running with light and sirens, regardless of fault, should be immediately decertified and never allowed to work in this field again. Why you ask? simple they put the public in unnecessary risk." That is ignorant, like your comment, "They hired that guy with a DUI, why not me? I only hit my wife once." There is a huge difference, both in the "crime" and in public perception of said crime. Same point applies to your rapist/murderer comment. HUGE difference. Not even close to comparable.

I guess I am just spoiled. I have only had one job, and my company both pre and post AMR has had a lawyer. I agree with your assessment here Dust, I just have to much faith in peoples change; at least until they prove otherwise.

Is that not what your lawyer is for, to point that this one infraction does not make him the spawn of Satan? And we all must remember that jurys are at best unpredictable. Besides we are all getting a little a head of ourselves here. Mr. OP I ask you, does the record show DUI? Did you get it "knocked down"? My guess you will have no trouble finding a job, however it may not be the one you want and it may hinder your advancement. Follow the advice given talk to those who control these things and learn what you may. I personally wish you the best luck, and hope you have learned your lesson.