crotchitymedic1986

You guys are kidding right ? You would withold treatment that could help for a diagnostic test that is worthless in the field ? Let's try this thinking in other situations: You have an arterial bleeder; do you put pressure on the wound or do you wait until you have a blood pressure palpated ? You have a COPD patient with serious respiratory distress (tripod, cyanosis, accessory muscle use), do you put on the O2 and start an IV immediately, or wait until your pulse ox confirms distress ?

You guys are totally missing the point on this one. A small percentage of doctors have decided to go into private-private practice for those who can afford it. No one is forced to see these doctors, it is a choice among patients, who have to decide "do I want to pay more to get a higher level of personal care ? No one's doctor has been taken away, those who want to use traditional insurance for medical care, can still choose many physicians to see. These doctors have just chosen a different business model that allows them to provide more personal care.

Its like this, I use an oil change place that charges about $45.00 to do an oil change, but with that oil change, my car gets fully detailed (cleaning) inside and out. Now there are plenty of places that I can get an oil change for $29.95 or less, but I just get an oil change. For me, it is worth another $15.00 to get my vehicle washed, waxed, vacummed, and have all of the glass cleaned. If you can not afford $45, then you can change your oil yourself, go to a cheaper oil change place, or go to a standard oil change place, but wash your vehicle yourself. The fact that I paid an extra $15.00 does not mean that your oil change is not as good as mine, or that you have been wronged. I have the means to pay more to get more, and I spent my dollars to attain that. When you supersize your value meal, you get more than the standard guy who just orders the value meal. Under you guys thinking, this guy just starved because the other guy paid more for his meal. They both ate !

I know we agree on little, and that I know that I have made many of you curse in 2009, but I still want to wish each and everyone of you a Happy Thanksgiving. I hope all of you have the chance to celebrate Thanksgiving in a way that brings you and your family closer together. Eat too much, laugh too much, care too much, make every moment count, and I hope that we all have a better 2010.

There is nothing elitist about this, it is just the free market working, and it has been around for years. Following you guy's logic, there would be no need for any vehicle with more standards than a Ford Focus. If you can and are willing to pay for a BMW, Lexus, or Mercedes does that make you elitist because some people can't ? If you do not eat Ramen noodles at least twice per week, are you elitist ? If you can afford a good steak restaurant instead of Krystals are you elitist ? How many times have you been really sick, and called your Doctor to find out that they were booked solid ? How many of your Doctors will call you in a script without seeing you, or doing a bunch of expensive labs you dont need ? And this is great for the Doctors because they dont have to see 40 patients a day just to keep the lights on (because insurance reimbursement sucks).

I have noticed that the concern over lawsuits frequently creeps into many categories of questions; whether or not you will do a certain procedure, the problem with protocols or lack of protocols, when to use medical control, or how you document to protect yourself. Then I asked myself, "Crotchity, is this lawsuit fear a founded fear ?" I got to thinking about it, and I could not recall one person that I worked with who had ever been sued over patient care issues. I know some that were sued, but all of those were over vehicle accidents, not patient care issues. So how real is this boogey-man ? Do you know someone personally that has been sued ? If so, how many ?

Are you actually saying you would want your child to be taken care of by a sex-offender if she ever needed an ambulance ? Just because you forgive someone, does not mean that you have to employ them. Would you send your dog to a neighbor for the week, who has been charged with animal cruelty ? Would you let a sex-offender teach or babysit your child ? Would you give your identity information to someone who has been convicted of identity theft ? But since you asked, I believe it is God's job to forgive them, not mine.

I seriously doubt your instructor has actually shocked 300 infants in his career, but his point is correct. Shockable rhythms are rarely seen in children under 1 (unless you count tachycardias, but you shouldnt be shocking those, or if they had a preexisting cardiac conditions). The question you have to ask is one that has been asked before on here, in any situation, where are you most likely to get into trouble ? Not everything in EMS is black and white ? In this scenario if you had a child in V-Fib, do you think you would get in more trouble for using the equipment you have on hand to try to save the child, or letting the child die because you had issues with AHA guidelines (or protocols), or lackthereof ? This is what Medical Control is for.

It varies by the type of insurance the company has. Smaller private companies tend to purchase the cheapest insurance, which will also have a higher standard (may not allow anyone under 21 or 23 to be employed even with good record). Many municipalites may choose to be self-insured, which could have much more lenient standards; then there is everyone who is in between. Most insurance companies will pull your full 7 year record, and my guess is you are somewhere in the middle of bad and OK because of 3 violations in 6 years, but luckily you havent had any recently. The following study (didnt have time to find the original, but you can google from what you read and find it) shows that EMS folks who have had an accident or moving violation in the last 3 years are far more likely to be in a fatal ambulance wreck:

http://www.emsresponder.com/print/EMS-Magazine/Ambulance-Crashes--Fatality-Factors-for-EMS-Workers/1$1796

Quote:

"Nearly half of the ambulance drivers in all of the fatal crashes (both overall and among those involving EMS worker fatalities) had some kind of collision or moving violation in the three years before the fatal event. Several drivers had more than one offense listed in FARS; one in particular had been cited for speeding five times, had had his license suspended or revoked five times, and had been convicted of one other moving violation--all within three years prior to his fatal ambulance crash. The authors of a study examining 11 years of fatal ambulance crashes were similarly taken aback at the high numbers of previous citations among drivers of ambulances involved in fatal crashes."

I did the same, if it effected the time intervals of the call, I just documented in the notes that daylight savings had occured; Dispatched at 01:59 and arrived at O1:08

How do they pass the national registry or state exam if they do not speak english ? Please tell me that your state does not offer the test in foreign languages.

No, I do not believe that people with preexisting conditions (not their fault) should pay more. But people who CHOOSE to engage in dangerous activities should. Want to ride a motorcycle without a helmet, want to parachute out of planes, want to smoke tobacco or drugs, want to drink your liver to death, want to shoot up heroin, want to weigh 300+lbs ? Fine, just dont ask the taxpayers to subsidize your poor decisions.

I like scoobys answer, I would add that they more you see, the less shocking it becomes. You can google "trauma pics" or similar statements on the internet and get an eyefull of various gorey patients. The worst ones that you will see in the field will not be as shocking to you if you have seen some pics of those who have their insides on their outsides. For most people, it is the smells, not the sights that get to you. Of course, at the point you are totally callous to these scenes is probably when you should retire.

Here is the only problem with your pro-marijuana stance: Currently, the testing for this drug only proves that you have smoked it in the past 30 days, it is difficult to pinpoint exactly when you did it; two hours before your shift, or two weeks ago. So, do you want an EMT who is just barely buzzing to drive your rig ? How about your brain surgeon, is it Ok if fired one up 12 hours ago ?

I agree, the war on drugs is as stupid as "prohibition" was in the last century. Legalize it, tax it, make those who indulge pay more for their health insurance premiums, and alot of our crime will go away.

Have not looked at it from that perspective doc, but I have to agree with you about making the employee stay home, but the problem is that you can be an asymptomatic carrier for two weeks. The good news is that I think most of us will be just that, the asymptomatic carrier; the bad news is that we will most likely be the carrier that takes it home to our families.

I think this is a symptom of the disease "greed". Throughout the 80's until now, this younger generation has watched corporations down-size, merge,be taken over hostily, and rape their employees just so the stockholders can make money, and the CEO can make 40 times what the average worker makes. I think they saw their dads get screwed over several times, and they said they heck with being loyal to a company, or taking pride in a company. The second thing is that to have pride, you have to have something to be proud of. Most management in EMS today is lacking the ability to produce companies that you can take pride in. You would hope that people would do the things you suggested out of "self-pride" but I believe that died somewhere around 1990.

LET THE RECORD BE CLEAR THAT IT WAS NOT I WHO INTRODUCED RACE INTO THIS TOPIC, but that was an interesting article tniugs. As far as "when" does the patient become a hospital patient, it was changed by EMTALA / JCAHO to include up to 75 feet off of the edge of the hospital's property, after someone who tried to ambulate to the hospital collapsed and died at the edge of the property, and the ER staff refused to go get him (thats the urban legend anyway). Once the patient enters that perimeter, regardless of how they got there, they have "came to that hospital seeking help", have become the responsibility of the hospital, and must be provided their medical screening exam (in the US).

As to who is to blame for what happens if the patient arrests on your stretcher while awaiting an ER bed; you and the hospital should be in trouble -- just because you have entered the hospital's property does not mean that you should stop monitoring your patient, and the ER has a responsibility to provide atleast a timely and adequate triage for all patients, regardless of how busy they are.

Just a few facts to consider: 1. The experts fear a pandemic, this is not the "normal" flu. 2. We will probably double the number of flu deaths this year (if we are lucky) as the regular flu will kill it's regular numbers, and then H1N1 will wipe out some portion of the population (probably more pediatric). 3. The flu vaccine has been safely produced for over 60 years, with a change in the flu-shot almost every single year, as the strains change. 4. In 1976 there was an aberrance where alot of people died after receiving the flu shot, because something happened that triggered guilam-beret in those patients (experts argue if it was the flu or the flu shot, but if you want to blame the shot, then there was one year out of 60 when the flu shot was bad, but has not reoccurred in the 33 years that followed). 5. Had many of us taken the same opinion on smallpox or polio vaccines, it would never had been irradicated, and we would still be dealing with it.

A coworker of mine caught the swine-flu from one of his children, as did everyone in his family. How would you feel if you learned it was you who was the carrier that brought home swine flu, which resulted in the death of one of your children ? I don't like the word MANDATORY any more than anyone else, but in some ways we are starting to sound like the dumb redneck that is always on the news before the Category 5 Hurricane is about to hit, who says "hell no i ain't evacuuuuaaatttin, i gots to protect my stuff".

I didnt mention anything concerning race, I was just pointing out that sickle cell/migraine/drug seekers are complaining of "PAIN". If we are all about relieving pain, shouldn't we relieve their pain too ?

Dixie was as sexy as 70's television would allow.

The answer is you treat them no matter how far you are from hospital, but you use the appropriate med. Fentanyl is very short acting, but works great, it is the perfect drug for your scenario. It knocks down the pain, but they are fairly alert 15-20 minutes later, when the Doc sees them. The Nurse was wrong, as LOC doesnt matter for an isolated extremity fracture. LOC is important in the multi-trauma patient where a head injury is possible (but they will get a CT either way, so maybe not).

My point is that if you are giving Morphine for every patient that has pain, then that is a disservice to those patients. They should be treated with the appropriate drug. I say the same thing for Paragods that use Versed for RSI, it is the wrong drug for the scenario -- you should not overdose someone so that you can put in an ETT. If you are going to do RSI, use paralytics.

Now the spinoff question, who are you, and who are you not managing pain for ? Are you medicating all sickle cell patients who claim to be in crisis ? Are you medicating your drug-seekers who are screaming in pain, but have absolutely normal vital signs ? How about severe abdominal pain ? Migraines ? Fractured finger/toe ?

I am sure someone has already stated this somewhere, but if not, we also have to realize that many EMS agencies are very limited in pain medicine that they carry. I am all for pain management, but that should include using the right drug. Morphine, Demerol, and Valium are usually all that is available; most services do not include Toradol, Versed, Fentanyl, or other alternatives. So you might want to see if your agency can use a drug that is more short-acting. If you continue to be the Paramedic who doles out the most narcs, you will be the Paramedic who gets the first pee test -- not sayin it is fair, just reality.

Not to be sacreligous, and I admit I am not a Trauma fan, but is it really that far off the mark than what "Emergency" was in it's day ?

1. Obviously Emergency used Gage and Dixie for their sex appeal.

2. I imagine the high-tech Emergency was ridiculed by emergency workers who were still riding in hearses without cardiac monitors and two way radios.

3. I imagine there were some mistakes in treatment on Emergency. But then again, maybe not, the treatment was the same no matter what was wrong with you -- some intracardiac epi and some D5W tko.

4. Bad acting ? you have to admit, the best actor on Emergency was Chet, everyone else was a horrible actor.

You really didnt expect a tv show to realistically portray us ? After "The Shield" and "Rescue Me", you had to see this one coming.

Will be happy to answer any questions that you have. My two cents worth: Its not a bad thing if it is voluntary, and it is closed to everyone except those who were involved in the call (should offer invitation to dispatchers, they are often forgotten). I have found that sometimes you have people show up that want to be spectators, who had no involvment with the event. But I think it should just be used to "vent", if someone is really troubled by an event they should see a true mental health professional. I have found it to be more useful in rural areas where you may have volunteers who are part-time providers, and due to the low call volume, they are not used to dealing with these calls, and/or the patient may have been a friend/relative.

The schools financial aid office is the best source for what is available. In many areas, hospitals will pay your loans in exchange for signing a contract to work there "x" number of years.

I disagree with blaming the schools for this phenomenon. The schools are there to produce an entry-level employee, not a five-year veteran. As most of you know there is a big transition from book-learning to patient care. The problem is not with the school, it is with our substandard training and orientation programs for new hires and new medics. I think new employees should have to ride third or with a preceptor until they have been checked off (actually ran) every type of arrest (adult and pediatric) and other critical calls. Until the prove their worth on the most critical of calls, they should not be the lead provider on an ambulance. In a busy service, this means they would probably have a 6 month orientation, in a slow service, maybe a year. Do you honestly believe someone who just passed the Bar exam and became a lawyer gets assigned as lead counsel on the highest profile cases 2 months after they get out of school ? There is only so much that can be taught in the classroom with manequins.