crotchitymedic1986

Cut open his chest with your swiss army knife and do cardiac massage, he will be dead if you dont. But seriously, the epi dose IV (stick a vein dont do IM) couldnt hurt.

Wonder why all those Canadians come to the US when they need real medical care ? Are you suggesting socialized medicine Ms. Obama

Where is the farting and masturbation competition

I know it sounds crazy but the OR does have an influence on the whole hospital. The OR is the cash cow for the hospital, no matter where it is. Although the ER often gets overwhelmed by the volume of patients who present to the ER, the other end of the problem is when the ER can not move admitted patients to the floors because rooms are not available or ready. In hospitals that have drastically improved diversion, they have done so by expediting elective surgeries and room turn around times on the floor. You have to improve flow throughout the whole facility to solve the diversion issue p.S. Another mind blower, consutants in the industry are now promoting that ERs do away with the triage process and see everyone as they appear, to avoid logjams. Sounds crazy but it is true.

I will be the one to vote the other route. There is an old joke: A guy is interviewing applicants for an accounting position, as the applicants come in, he asks one easy question, "What is 2 + 2 ?" Everyone quickly answers 4, and is then shown the door. Finally an applicant comes in and answers, "what would you like it to equal", and he is given the job. In this economy, I advise that you sort of lie; answer no about being terminated, and then don't list that employer on your application. There is no way for them to check it if you do not admit to working there.

And per the OP, this person transmitted the information electronically via facebook.

You guys are in serious need of a HIPAA class.

You started a good list, but you missed the most important reason for ER backlog, but thats ok cause its an inside industry secret that will not get published. Those hospitals that have improved ER flow have done so by attacking the problem on the floors and in the ER. In most hospitals, doctors come and make rounds once; they see all their patients, sit in a cubicle for an hour or two, and then dump 12 charts at the nurse's station at one time. When doctors are forced to round at certain times, turn in charts as they complete them, and are forced to take care of potential discharges first, the flow of patients moves much better throughout the facility. The second sacred cow is the OR. Doctors are assigned blocks of time in the ER, and those times are never altered. If Doctor A has OR room one reserved from 9a-12p, no other surgeries occur in that room, even if he has no procedures that day. By forcing the surgeons to use time and rooms efficiently, again flow improves, but no one will touch the sacred surgeons. There should be a new law passed nationally, if your hospital is on diversion, you should not be allowed to perform elective surgeries until such time that you are off diversion. The Diversion Problem would be solved overnight.

Because I worked in a pediatric ER, and 62% of menengitis patients were originally seen by EMS and sent to hospital or doctor by car. Close to 40% were seen in a regular ER and either discharged or transferred to us without a spinal tap being done. Petechia rash is a late sign of menengitis, and it is hard for a 2 year old to tell you his neck is stiff. Just read through the EMS news section and read the countless stories of medics leaving people at home to die. There is too much we can not diagnose in the field with the limited resources that we have, and there are many disease processes you simply do not have the experience to understand. For instance, WITHOUT GOOGLING, tell me the proper treatment for an adult sarchiodosis patient in respiratory distress ? Most new medics can not tell the difference between early CHF versus COPD ? Tell me all that you know about the prehospital treatment of pulmonary hypertension. Tell me about how you treat a child with hypoplastic left heart and an O2 sat of 68%. I imagine you will have some of the answers by morning when you research the web for the next few hours, or you could be honest and say I do not have a clue. These are just a few examples of why we should not leave patients at home. Then do me this one last favor; take the number of patients your service sees, and then multiply that number by 1-2%, what number did you come up with ? That is the number you kill every year from refusals. Sounds good when you say hey we are right 98-99% of the time, not so good when you say, damn we killed "x" number of patients. Even if the number is "2" that is "2" too many. And for the record, an unexpected death due to EMS refusing to transport a patient to the hospital does not equal clinical excellance; it constitutes negligence.

Not at all, tell me what clinical competence you use to decide to let a 2 year old with fever stay at home and go see the doctor the next day ? How do you determine it is simple teething, versus ear infection, versus viral infection, versus menengitis ? Please tell me that you do not use the lack of petechia rash to determine the child is safe to go by car, I hope you are not that dumb ? Or do you subscribe to what we stupid people do and aire on the side of caution and transport all children with fever ? Show me a Doctor who wont look in an ear, do a CBC, or a strep test prior to discharging this child to stay at home ! So please educate me to your clinical expertise. P.S. Not trying to insult you, but before you decide to lecture the rest of us, you might want to run at least 100 calls.

answer my scenario please. According to you guys, since this information was not transmitted electronically, and the cops are not health care providers, there is no violation. Right ?

Yes I read it, any "protected information" is forbidden to be given out whether you are a firefighter, cop, or whatever. Here is a scenario for you: Two cops talking at a donut shop loudly: "Could you believe how bad Mr. Smith over there on Elm Street looked ? I didnt even know he had AIDS ? Neighbor in booth next to them and hears it. HIPAA violation yes or no ?

We are not talking aboout Patient Refusals, we are talking about Lazy EMS people refusing patient transport. Big difference. No one is going to argue that patients refuse AMA, although I will contend there was rarely a patient I could not talk into going if I tried for more than 2 minutes.

OH, I see you dont want to talk about this universe, you want to talk about an alternate universe that is somewhere in the future. Your argument is similar to we drive cars, but in the future we will all have personal hover-crafts, so we should stop using cars now. Having an attitude of "patients should suffer because I do not agree with the way the world operates" is very scary.

First of all this is not a frequent call, I doubt it happens more than 2 times per month in any county, the fact that you are just now bringing it up, shows how often in happens in your neck of the woods. Would you consider this an EMTALA problem if the patient called a cab ? A patient calling from the ER (or any other part of the hospital) for an ambulance transfer to a hospital they prefer for whatever reason does not constitute an EMTALA violation for EMS (unless the ambulance service is hospital owned).

Here you go, look under "what information is protected": http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

It is only predictable because you refused to transport to definitive care. The EMS standard of care does not contain the ability for lazy medics to not transport those they deem non-emergent. Please correct me by citing where you find that in the DOT curriculum, CAAS standards, or any other national standard. You do not have the proper tools in the field to be even 60% accurate in determining who needs to see a doctor and who does not, if you could get close to 99%, I might agree with you as there is always a 1% outlier in everything that is done in the world (including ems). But just scroll through the EMS News section of this one forum, and you will see countless examples of what happens when EMS does not transport. Start doing labs and xrays in the field, and we will talk.

I am sorry then, I missed the part where you described that this patient was not being seen due to inability to pay.

You are sadly mistaken if you think a drop in call volume would be good for us. Just look at your brothers/sisters in the Fire Departmet, if it were not for EMS calls, most departments could not justifiy half thier equipment and people based solely on the number of fires they respond to. Thank God people call you for BS every day, cause once they go away, your job goes with them. And beiber, anytime you start a conversation with "this will undoubtedly cause patient deaths, but that is ok", you just gave lawyers everywhere a hard-on. Any policy or procedure that results in predictable patient death should result in the license being pulled from that service or individuals who spout it. If it were your grandmother, you would have a different opinion. I knew of a service who refused to transport hospice patients per policy (makes sense in theory, if you are in hospice you do not need an emergency ambulance), it was the worst political nightmare that service ever came out with when they implemented that policy. Again, you rarely have a chance to save a life, but you have the chance to touch a life everyday, if you choose. But for some providers, having nap/tv/feeding/masturbating time interrupted by patients who dare call them is a sin.

To some extent he is right. If your automechanic saw huge increases in customers between the hours of 3p-5p, he would probably add some mechanics or expand hours. But in the ER, this never happens. Whereelse do you wait 5-6 hours for service ? In any other business this is unacceptable, but hospital CEOs do not care.

Riblett, this has nothing to do with EMTALA. EMTALA is a law that guarantees any patient "a proper screening exam" regardless of ability to pay. This patient had been screened, there was no issue regarding paymnet per the OP. This was about a mom who felt that her child was not being cared for fast enough or well enough. It does not matter where the patient is, if the patient were in a Pediatrician's Office, would you refuse to transport ? No, because while the Doctor's office is care, it is not the definitive care the patient needs. Although this was an ER by name, it sounds like one of those rural facilities (probably a nursing home, with an ER attached) where very little real care can be provided. A pediatric patient with a respiratory condition of any kind probably needed to be somewhere else.

Sorry AK, you are wrong regarding this law only applying to those who bill. Anyone who divulges confidential information is subject to the law, but you are correct, this was not a violation of the law, as no specific person was identified. But this does show the need for a law to rein in this whole facebook/internet mess. The poster is right, there was probably only one cardiac arrest in a town that small that day, so it would not be hard to figure out who the poster was talking about. I am tired of constant posts from firefighters, emts, and medics bitching about how their shift is going. If you got time to post about it on the internet, while on shift, I would say your boss needs to find something for you to do.

Everyone probably did as they should. Dispatch SHOULD have sent the ambulance, as they have no way of knowing what is going on, and it is always better to send someone to investigate versus denying a request from a room miles away. I am sure the hospital made them or asked them to sign out AMA before they left. And the crew did the right thing as the child probably would get transferred out later (my experience is that these facilities do not admit peds under any circumstance). The parent was tired of waiting for definitive care, cant blame a mom for that.

i would just remind you that if the only people who called an ambulance were only those who truly needed an ambulance, 75% of you would be unemployed.

Hate to break the bad news to you zippy, but if you are a cop, you sometimes have to direct traffic in the rain, if you are a plumber you sometimes have to smell other peoples feces, and if you are a vet you sometimes get bit by animals. If you are a medic, sometimes you are a taxi driver. Let me ask you this zippyRN, I will assume you are a nurse since you have RN in your name; so how many patients do you routinely refuse to treat once you have done simple V/S in triage ? NONE !