crotchitymedic1986

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 !

Beiber, I am a little shocked by your statements, maybe you are playing devil's advocate ? But thank you for reiterrating what I said about your generation, you are more concerned with what YOU CAN DO TO A PATIENT, instead of for the patient.

Bieber, since when is leaving patients home to die a sign of clinical excellance ? Thats the problem with this generation, you are too concerned about the procedures and treatments you can do to a patient, versus good old fashion assessment. As long as you can do RSI or use a drill to IO someone, you think you have accomplished something. Be a patient advocate first, a paramedic practicum advocate second.

kiwi may i ask how many deaths due to your service's laziness is too many ?

that was directed at dwayne, not you Ruff

Skin is skin, its not about a surgical procedure or IV starts, its about what is most aseptic. Just because we have always done it that way, doesnt make it right. Doctors were allowed to smoke in the OR back in the 50's, but we dont do that anymore. You can call me an idiot all you want, but I promise you that at some point in your career you will see a change in alcohol prep use for IVs. If alcohol were the bomb, then there would be no need to use Betadine for surgical incisions, spinal taps, or central line placement.

First of all this has nothing to do with race. Second the employees were not asked to give up their job, they were asked to take a 12 hour shift versus a 24, yes that means a pay cut. They were offered a rotating schedule where they work 4 12 hour shifts one week, 3 the next, so they would get 48 hours one week, 36 the next. Those on 24's do not work a true 24, they have a "kelly day" the week of they have 3 24 hour shifts, so they work 48 hours per week, every week. Those who have another full-time job were asked to leave the 24s for those who did not have another full-time job (the work 48 on 24 off).

So, it appears very few here (like the employees there) would give up their shift. Would you think that an across the board paycut for everyone would be more fair ?

The problem is that once you take care of that wound with dermabond, you are going to be liable for any infections that occur, because the patient will claim you did not clean it properly. You also have to realize that dermabond is basically glorified glue; it will bring the skin back together, but will leave a "scar", whereas with sutures the scars will be minimal. Probably doesnt matter for a cut on the hand or foot, but the face is a different story.

The CDC disagrees.

Perhaps when when you make such comments you can show us the respect of citing them so that it doesn't appear that you are simply passing on rumor as fact.

http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

"Alcohol can prevent the transfer of health-care–associated

pathogens (25,63,64). In one study, gram-negative bacilli were

transferred from a colonized patient’s skin to a piece of catheter

material via the hands of nurses in only 17% of experiments

after antiseptic hand rub with an alcohol-based hand

rinse (25). In contrast, transfer of the organisms occurred in

92% of experiments after handwashing with plain soap and

water. This experimental model indicates that when the hands

of HCWs are heavily contaminated, an antiseptic hand rub

using an alcohol-based rinse can prevent pathogen transmission

more effectively than can handwashing with plain soap

and water."

Does this tell the entire story? Of course not. But relying on reputable sources for such information over believing whatever crap your partner happens to mumble in his/her sleep is certainly a beginning.

Actually, the cited document is pretty interesting if you have a few minutes to spend reading it.

Dwayne

Dwayne, so quick to judge me. If alcohol is so good why don't we sterilize surgical instruments with it. Why don't we soak our laryngoscope blades or other soiled EMS equipment in it ? Put your money where your mouth is, the next time you work an arrest, I want you to clean that laryngoscope blade with an alcohol prep, let it dry, and then put it in your mouth --- betting that is not going to happen. Makes me wonder why surgeons use all that betadine in the OR, why not just hit that site with some alcohol preps ?

Now if YOU had done more research rather than just accept the first article that popped up when you googled it, you will find that alcohol has a hard time killing lipophilic viruses (HIV, RSV, and Hepatitis- because of the virus'lipid shell, and alcohol also has a tough time with hydrophylic viruses (Poliovirus, Rhinovirus, and Hepatits A)because of it's protein shell. If you want to knock the dust bunnies and boogers off someone's hand, use alcohol. If you want to use an aseptic technique, use something else.

Well I was thinking about IFT services more than 911. I recently read a post on an internet site where someone who had just started a new service was frustrated that she spent tons of money to make sure her service was more professional and had better equipment than any of the competitors, but the local hospital still calls the grungy service that is unprofessional instead of hers. Was trying to give her some suggestions.

Good Luck, and nights are better, less supervisors.