crotchitymedic1986

It depends on whether you are profit or non-profit. If money is no object just send ALS on everything, and do not run BLS units (rationale being, why have a limited resource, versus an ambulance that can respond to every call imaginable). If you are profit driven (which I doubt, since no one in your organization understands billing, that tells me that it isnt important), then you need to use the proper resource, as payment is determined by Medicare Policies (almost all private insurance and Medicaid base their payment schedule on Medicare's). Therefore you can send 3 medics on ever call, but if it is a BLS call, you will only get reimbursed at the BLS rate; conversely if you send a BLS crew on an ALS "rated" call, you will not get the higher reimbursement rate. The following document explains it fairly clearly, skip down to page 25 for explanations of categories (BLS/ALS1/ALS2/SCT). https://www.cms.gov/manuals/Downloads/bp102c10.pdf

No comment on the subject, but a rebuttal to Dwayne; You recently posted this topic: http://www.emtcity.com/index.php/topic/19068-freedom-of-speech-or-not/ but you deny racism still exists ?

Well I have beat this one to death, so I will bow out. But I leave you with this final comment. Those of you who are online right now reading this are probably at home. If in the next few minutes you hear a horrific crash and look out your window to find an overturned vehicle in your yard, that is on fire, I bet you will go investigate even though you have no protective gear or Fire Deparment on scene. And I imagine that if you heard crying children (of any race) trapped in that vehicle, you would do your best to get them out, even if it meant you got burned yourself. Or would you wait on Fire and listen/watch them burn to death ? Our job is risky, you have a greater chance of catching an infectious disease or being killed in a crash than you do of getting shot or stabbed. But if you want to hide behind that irrational fear when it comes to socio-economically depressed areas of town, and deny prompt/minimal care that every patient has a right to, then so be it. Peace Out Hommies, Catch you on the next topic.

And as my best white friend always says, "Crotchity, it really pisses me off when I see Al or Jessie on TV, playing the race card; but almost every single time, usually within 2 weeks, some dumb white person does something stupid, that hits the media and makes them relative again. I went to google news to test the theory, you said "beetle-juice", I didnt. Here is what pops up on google news for just a few of the issues in the past few hours: http://www.todaysthv.com/news/local/story.aspx?storyid=126655&catid=2 http://www.cbc.ca/canada/nova-scotia/story/2010/11/08/ns-rehberg-not-guilty.html (for Canadians) http://www.8newsnow.com/story/13460752/shadow-ridge-high-school-victim-of-hate-filled-graffitti http://imperialvalleynews.com/index.php?option=com_content&task=view&id=8471&Itemid=2 But of course, racism has been dead since the 60s right ?

Thank you Ugly for making my point, yes "one" wasted life it too many, question is why is the poor person in the hood's life not a waste. In all the classes that I took, where they talked about the "golden hour" or "time is muscle" or "time is tissue" they never put an *asterisk beside it and said, "unless you live in poor or high crime neighborhoods" ! Again, I am willing to bet for every story you can dig up on the internet about medics being injured/killed by patients/bystanders/random acts, I can find 10 stories of EMS injuring and killing patients in vehicle accidents. So if we are going to base decisions solely on statistical probability and/or perception, patients (rich or poor) should avoid an ambulance ride at all costs. But if you really fear for your safety, the easy answer is to take EMTs off the ambulance and replace them with cops acting as drivers. Then you will be safe on every call.

Oh, Lord, the coloreds are moving in next door, what will we do, what will we do ? As stated numerous times Uglyemt, I have no problem with you waiting for as long as necessary at a known violent crime scene. And as evidenced again, by your own statements, you can only come up with a handful of anecdotal accounts of medics being attacked, out of the millions of 911 calls that are handled every day. YOU GUYS LOVE STATISTICS, IT SHOULD NOT BE HARD TO BACK UP YOUR ARGUMENT AS TO WHY WE SHOULD DELAY CARE TO A CRITICAL PATIENT WHO LIVES IN A BAD NEIGHBORHOOD. IF THE PROBLEM IS AS BAD AS YOU CLAIM, YOU SHOULD BE JUST A FEW KEYSTROKES AWAY FROM CITING ALL KINDS OF STATISTICS THAT WILL JUSTIFY WITHHOLDING NEEDED CARE FOR YOUR PATIENTS. I will bet a paycheck righe now, that there is noone who can produce scientific evidence that justifies delaying care to patients based on the fact that they live in a poor neighborhood and that medics have actual risk (proven by statistics) if they go in without PD.

No, because your decision is based on "REAL" specific information about a particular residence, not an unfounded fear that is based on "public safety urban legend". But let me twist that on you. What if I were in Mississippi, and responded to an affluent white subdivision for chest pain. As I pull up to the driveway, I either see a confederate flag type symbol or "actual flag" on your pick-up, or one of those NRA (National Rifle Association) bumper stickers that state "You can have my gun when you pull it from my cold dead fingers". Can I refuse to go in ( I am African American if you havent heard yet) ? If I refuse to go in (or wait outside until PD gets there), based on my fear that there is a gun in the house, and that the occupants may or may not be racist, how long do you think I would have a job ?

P.S. I should not have said "you" do not want Obama-care, I have no idea what herbie's stance is, I should have said "white america or republican".

I can not argue that point Herbie, I would agree that the poor do use a greater share of resources. That is why the ER is full of Doctor's Office patients, and 911 is used as a cab. Obama is trying to fix that, but you dont seem to want that either. Is seems as though this "Chocolate City" may be doing something right: http://www.bizjournals.com/atlanta/stories/2008/06/30/daily65.html

I am not calling you or anyone else a racist, but I am stating that "race" is part of this issue. You are right, myself and a black partner on a back dirt road in Mississippi would probably feel uncomfortable due to the history that is there. I would also feel uncomfortable in a gay bar. I would also feel uncomfortable looking at the injured privates of a minor male or female patient. I feel uncomfortable when I have to roll or move a 700lb patient because I know the sights and smells that are about to come. But my "uncomfortableness" should not result in a patient suffering, or should it ? Someone correctly identifies that the 7 videos are all recent. Ok, most urban EMS agencies run 50k-150k EMS calls per year PER CITY. I do not know how many EMS calls were run in the entire US in the past 20 years, but I am guessing it is several million. According to this source: http://www.nena.org/911-statistics there are 240 million 911 calls made in the US each year, lets just say that only 10% (which you know is way low) were EMS calls, which is 24 million, multiplied times the last 10 years, puts us back at 240 million calls, and you have less than a fraction of 1% producing injuries and deaths. My guess is that your likelyhood of getting shot or stabbed on an EMS call is probably less than your chances of getting struck by lightning, while on an EMS call. Maybe we should stop running calls when it rains. According to this site: http://www.lightningsafety.noaa.gov/medical.htm , watch out now, the troll has sited references again: There are an average of 60 deaths from lightening strikes in the US EVERY YEAR. Can anyone on this site produce examples of 60 or more medic deaths from responding to calls this year or any other year (not vehicle accidents, but attacked while in the HOOD) ? If you respond to calls when its raining, then you need to start responding to the homes of the poor people in the same fashion. Come on, I know one of you sees the hypocricy here, and will stand up for the poor. Remember, I have not said you should respond to violent calls without PD, all I am saying is that you shouldnt delay care to the poor, because the neighborhood is scary (someone hold me, I'm scared).

I did not ignore ER docs 5 or 6 shootings nationwide that have occured since the 50s-60's. It actually makes my point. If you gave a drug that you knew worked without complication 99.9% of the time, over a 50 year period, but your partner argued that you should not give it because he read a post on an internet blog yesterday, would you still give it ? For all the fears of our unsafe scenes (code for minority neighborhoods), where are all the dead and wounded medics ? I am not denying that medics get assaulted or find themselves in dangersous situations on rare occassions. Why not wait for PD on every call ? How do you know that the nice home in the suburb you are about to enter isn't a methlab ? How do you know the rich white guy in the mansion doesn't beat his wife ? Actually, if you wanted to do something about deaths and injuries in our industry, you would do more driving training, as you are far more likely to die in a vehicle accident. To those who say it isnt about race: Like Mathew said in the clip, pretend he his white. You put a white victim in a white neighborhood, and then give it a 23 minute public safety response time, and see how it is treated differently ?

Thank you for calling me a troll, in this forum that is "code" for "I can't argue the facts, so lets just label the person who had the nerve to disagree". I thought you might want a few facts that support both sides of the issue: 1) The 2000 census puts the population of Jackson at 61.6% black or A/A. 29% white. I was unable to find actual response time records but if I had to bet which community had the worst public safety response times, Beverly Hills CA, or Jackson, MS. I am going to go with Jackson. Funny how the burbs always seem to have superior public safety to that of the inner-city, but of course race has nothing to do with it. 23% of the population in Jackson lives below the poverty line (that was before the downturn in this economy, I am sure they are all doing much better now). 2) Facts for the other side: In 2007 Jackson was rated as the 23rd most dangerous place to live, and violent crimes rose 238% between 07-08. I read an interesting quote from a medic about the incident that stirred all of this up: He asked why aren't you upset that it took your police 23 minutes to get to a shooting ? Good Question. I am not asking any medic/emt to go into a known violent situation without PD. I was raising the point that many departments do not respond as timely to bad neighborhoods when there is no violent crime involved. Maybe you respond non-emergent to give PD a little more time, maybe you stage around the block. The 80 year old grandma that lives in Compton has just as much right to an 8 minute response time when she has chest pain, as the 80 year old who lives in Beverly Hills. But if you have forgotten, I remember a movie based on a Mississippi crime that might explain my logic a little better (although totally different than this situation): http://www.youtube.com/watch?v=C7f-BgDgpmE

Good observation, I do not know why the people in our industry are the absolute most negative, gossiping, backstabbing set of folk in any industry, but we excel there. Whenever I hear it, I ask the simple question, "With the education you have right now, what other job could you do and make as much as you do ?" They use to answer construction, painting, landscaping, but that has all died in this economy, but when they answered that in the past, I would say great, quit and go do that, cause you are not doing anything here but bringing down morale. There is an old joke that still rings true: Do you know what the difference is between a puppy and a paramedic ? Puppies quit whining after 6 weeks.

Well said, you must be able to take off those rose colored glasses that reflect your beliefs as truth, and look for the truth you may not know. I know plenty of agencies that will not respond into a housing project for any call without PD. Funny, I have heard about all these ambulances that get shot at, but I have yet to see one in person. To DELAY Care to a patient based solely on the neighborhood they live in (WHEN A VIOLENT CRIME IS NOT INVOLVED), should be criminal. If I said I wouldn't give care to a white woman who had an abortion because of my religous principles, you would all raise hell. But if I say that minority who lives in the housing project will have to wait an extra 20 minutes on an ambulance, because the neighborhood looks spooky, then that is OK. As far as poor white people in trailor parks, I have yet to meet a rich white person living in a trailor park. Nor have I met a rich minority in a housing project. Its not racism, its acknowledgement that poor people live in poor neighborhoods.

Just use the Washington DC EMS method: Walk them all to the ambulance or get them to sign a refusal. Paralysis isn't always forever.

My problem with this is it just based on the call, or is it based on the neighborhood ? Obviously, we should not go in before PD if there is a report of violence (a shooting, assault, stabbing), but if it is a reported cardiac arrest and we are staging because the neighborhood is known to be rough, then that is just racism. And before everyone screams, I could prove it if I were there by simply asking, "Do you do the same practice everytime you respond to the local trailer park (where the poor white people live)?

I don't think this is the scenario that will get you in trouble. Instead, I think you are more likely to get in trouble when in a crowded restaurant, usually by two ways: 1. You are talking with your partner or family about the calls you ran last shift, and someone overhears your conversation. OR 2. Your dispatch gives out too much information during the dispatch of the call while you are inline at Burger King, and everyone hears it: M-2, respond to 1234 Main Street, the Smith Residence; on a 39 year old male with anal itching. Or "use precautions, patient is HIV positive". Don't forget all the nosey folks who have scanners at home too.

You know that within our industry we have those who cheat on their spouses. We have all known someone that got caught. Do you think we (men and women in EMS) have a higher infidelity rate than the typical 9-5 non-public safety industries ?

To me this is like blaming guns for gun-deaths. Ammonia Inhalants are innocent, it is medical personnel with the wrong attitude that are dangerous. As clearly stated by everyone, I believe it is important to know that the patient is a faker, but that does not mean that I embarass them, or get my jollies by punishing them in one way or another. I just do not want to waste valuable supplies and resources for someone who is having an emotional problem. I am not saying we shouldn't treat, but when you call in an "unresponsive" patient, the hospital is going to dedicate alot of unecessary resources (on-call Neuro, clear the CT scanner, tie up the "big trauma/code room". SO I am not a proponent for not trying to figure it out, but I do not thing you should do things that are obviously for your amusement, such as: Cupping the ammonia inhalants in several 4x4s so the ammonia is more concentrated and cant leak out. Putting alcohol preps in a syringe and squirting liquid alcohol in their nostrils. Starting multiple large bore IVs, or missing IVs on purpose. I am not even a fan of the "arm/hand drop" test, as you can cause an injury if the patient is not faking. Anyone who does the things listed above, or similar, should lose their certification.

You were too close to see it. Throughout your career you will be the one who instantly figures something out, that the patient's family never saw. "Hummmm you weigh 400lbs, are 30 years old, and have been incredibly thirsty", I am guessing you are diabetic ! Wife to you, my husband is too young to be diabetic, and has no history of it in his family ! Don't beat yourself up. Whatever goes on in your life becomes your "norm". It is very difficult to read other's minds. Cant blame yourself for not being psychic.

Dont take this the wrong way, but have you considered the fact that "you" may be the problem. Are you 100% sure that your resume, speech, and body language do not amplify your negative attitude towards your present career ? As someone who has done the hiring, I can promise you that it is fairly easy to spot the "negative" folks who will sap the life out of your organization, and I wouldn't hire them no matter how desperate I was to fill a schedule. There are professionals that you can see to help you improve your resume and interview skills. If you cant afford it, you can go to the library and get books/audio-video materials for free. Of course, it is easier to blame the employer, the county, the Fire Department, the State, the industry, the economy, and the vast secret political organization that is conspiring to ruin your life; but as long as you stay in this "internal rut", you will always be this miserable. 99% of attitude is about how you respond to adversity, not what adversity does to you. Maybe it is time for a total career change, or atleast a location change; the last time I checked, Florida interstates do not have any barriers that forbid you from driving out of the state (except the toll roads lol). Right now you are in "victim" mode, your life will not change until you change that.

Lighten up Francis ! Just read the "news" section on this forum, and you will find hundreds of examples of "professional EMSers" doing far worse for real,than what this commercial portrays as pretend. You want to get angry, watch an episode of any "wrestling show" and watch the "EMTs" treat the "injured" wrestler, and then get screamed at by the other wrestlers to "hurry". It's funny that many times, the shelves in the ambulance are completely empty.

Yes, my first EMT job paid less than 11k to work 24 on 24 off. My first Paramedic job paid about $14k year. I thought I had made it to the big-time when I was hired by the highest paying organization in the State for $19k (and yes that was a long time ago, 1986). Unless you are in a truly white collar job that would require many years of college (and no guarantee of a job), statistically, you will probably make between $25-50k, no matter which career you choose. Some commissioned sales people average above that, but they are the exception, not the rule. The problem is that a traditional job will most likely be an 8-hour shift, 5 days per week, with 2 off-days. EMS (like it or not) does give you a good opportunity to work 2 jobs and still have 1-2 days off per week. To all those who say, I shouldnt have to work 2 jobs; quit spending every dime that you earn, or quit working for what you feel is a substandard wage. The problem is we are killing ourselves because there are 1000s of EMTBs/Is and medics who will work for any wage offerred, so there is NO true shortage in our industry. Create the shortage by refusing to work that 2nd low-paying job, and your rates will increase. But as long as you are all willing to work 100 hours a week at $10.00/hour, the wage will never increase.

Its all up to you, the problem with the folks who whine about EMS pay is that they lack discipline in handling their finances. Yes, it is nice to have 2 new cars and a new house that is too big, and to eat out every day and night, but it is not necessary. Choose the job you love, live within the budget that job supports. Nothing worse than being trapped in a job you hate because you cant afford to quit.

Best advice is to go to Paramedic School. As pointed out, the market is saturated, the only places EMTBs are used is usually rural (volunteer), and you are too young for most insurors to cover you as a driver. Make sure you keep your driving record spotless. By the time you complete school, you will be of age, and will be more hirable as a medic. Its not only that schools have flooded the market with EMTBs, but you have to realize that all the fire monkeys who were forced to Be EMT-Is but never used it, immediately put it to use when the construction industry tanked (most of them had some side business related to construction or housing).